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RETAIL SUPPLEMENTAL APPLICATION: FIREARMS / AMMO / OTHER RETAILComplete in addition to OSAR Supplemental Application & Acord Applications AGENCY INFORMATION Agency Name: FORMTEXT ?????Contact Name: FORMTEXT ????? Email: FORMTEXT ?????INSURED INFORMATION Named Insured: FORMTEXT ?????DBA: FORMTEXT ?????Does Applicant sell ammunition with Applicant’s label or brand manufactured by another entity? FORMCHECKBOX YES FORMCHECKBOX NO If yes, does the manufacturer provide a “Vendors Endorsement” liability insurance with Applicant as an Additional Insured? FORMCHECKBOX YES FORMCHECKBOX NO Does Applicant sell at gun shows? FORMCHECKBOX YES FORMCHECKBOX NO If yes, what percentage of sales are at gun shows? Products: Ammo/Firearms/Other FORMTEXT ?????%If yes, does Applicant complete a Form 4473 and NICS Background Check for each buyer? FORMCHECKBOX YES FORMCHECKBOX NO Does Applicant sell any products through the internet? FORMCHECKBOX YES FORMCHECKBOX NO If yes, what is the percentage of total sales? FORMTEXT ????? If yes, does Applicant have procedures in place to address state specific laws/regulations related to all sales? FORMCHECKBOX YES FORMCHECKBOX NO List all states, jurisdictions that you will NOT ship to: FORMTEXT ?????Does Applicant ship any products to licensed FFL Dealers? FORMCHECKBOX YES FORMCHECKBOX NO If yes, does Applicant obtain and keep a copy of that FFL Dealer’s License? FORMCHECKBOX YES FORMCHECKBOX NO Are all your firearm/ammunition products purchased from U.S. manufacturers or distributors? YES FORMTEXT ?????if no, FORMTEXT ????? % are directly imported by you from foreign companiesIf no, FORMTEXT ?????% are purchased from foreign wholesalers/distributorsDoes Applicant provide a written owner’s manual, warning and safety instructions with each firearm that is sold? FORMCHECKBOX YES FORMCHECKBOX NO Please share how firearms are secured during business hours to prevent theft? FORMTEXT ????? FORMTEXT ?????After business hours: FORMTEXT ?????If not secured, describe additional safeguards taken against ‘Smash & Grab’: FORMTEXT ?????What system does Applicant use for Inventory Management? FORMTEXT ?????Does Applicant sell or provide hand loaded ammunition? FORMCHECKBOX YES FORMCHECKBOX NO Does Applicant sell Automatic (NFA) firearms and accessories? FORMCHECKBOX YES FORMCHECKBOX NO Does Applicant participate in ammunition manufacturing, importing or reloading operations? FORMCHECKBOX YES FORMCHECKBOX NO If yes, what is the % of sales? FORMTEXT ?????If Applicant is a wholesaler or distributor, is Applicant named on manufacturer’s or importer’s insurance policy of vendor’s liability coverage? FORMCHECKBOX YES FORMCHECKBOX NO Does Applicant present or display any products/services at gun shows? FORMCHECKBOX YES FORMCHECKBOX NO *If yes, please provide a copy of the endorsement*Does Applicant provide any gunsmith operations? FORMCHECKBOX YES FORMCHECKBOX NO If yes, please complete SECTION 6 on Gunsmith OperationsWhat is the total value of (non-firearms) retail inventory at this building? $ FORMTEXT ?????What is the total value of firearms inventory at this building? $ FORMTEXT ?????Finished Goods: Total Value held for sale--NOT Retail Value: $ FORMTEXT ?????BLACK / SMOKELESS POWDERDoes Applicant sell or distribute black powder? FORMCHECKBOX YES FORMCHECKBOX NO If yes, what amount, estimated in pounds, of black powder is in display? FORMTEXT ????? lbsDescribe how storage/handling is in compliance with applicable Federal, state, and local regulations? Please explain: FORMTEXT ?????Describe how you store your stock of black powder that is not displaced (Including types of magazines and/or containers): Note: Safes are not acceptable FORMTEXT ?????How much smokeless powder does Applicant display? FORMTEXT ????? lbsHow Does Applicant store the remainder of the smokeless powder not on display? FORMTEXT ?????Has your local fire department approved your storage of Black and/or smokeless powder? FORMCHECKBOX YES FORMCHECKBOX NO (Attach written approval or certificate)AUTOMATIC (NFA) FIREARMSNumber of fully automatic firearms sold: FORMTEXT ?????Number of fully automatic firearms on premises: FORMTEXT ?????For sale FORMTEXT ????? For rent FORMTEXT ?????If rentals, what is the age requirement to rent fully automatic weapons? FORMTEXT ?????What is the minimum age you/your entity allows in operating (firing) NFAs? FORMTEXT ?????Who is the customer base to whom you sell/market your fully automatic firearms? FORMTEXT ?????Where and how are the fully automatic firearms stored during business hours? FORMTEXT ?????After business hours? FORMTEXT ?????Estimated revenue from sales of fully automatic firearms? FORMTEXT ?????Estimated revenue of rental of fully automatic firearms? FORMTEXT ?????ADDITIONAL INFORMATION FOR THIS SECTION: FORMTEXT ????? ................
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