«
»

Restaurant Insurance Quote

Please take a few minutes and compete the following information if you would like to obtain a quote.   Please understand, this is not an application.   An application will be provided to you if coverage is desired.

All information given on this form is confidential and will be used solely for the purpose of developing a quote for you.

Name
Business Name
Street Address
City and Zip
Phone Number
Alternate Telephone
Fax Number
Email Address
What is the business entity
Property Information
Property Street Address
City and Zip
Total square footage of the building your business is in
Total square footage of your business only
Total square footage of the customer area only
How many stories is it?
If it's two stories, what is the ground floor square footage?
What is the construction type?
What type of roof covering?
Was the roof updated?
If yes, what year?
What is the distance to fire protection?
Do you have a storage area more than 1500 Sq. Ft.?
Are there smoke detectors at this location?
Are there fire extinguishers?
Does the building have interior automatic fire sprinklers?
Is there a fire alarm?
Is there a theft alarm?
Are there deadbolts on all doors?
Are there circuit breakers?
Is the electrical updated?
Is the heating / air conditioning thermostatically controlled?
Is the heating/ air conditioning central?
Has the plumbing been updated?
If yes, what year?
Is the parking lot under your protection?
Underwriting Information
What is the nature of your business?
Number of owners
Number of Employees
Payroll of Owners
Payroll of Employees
Total annual gross receipts
Total annual hard liquor receipts
Total annual beer and wine receipts
Total annual food gross receipts
Business License Number
License Type
Years of experience
Years operated under current name
Is this business open 24 hours a day?
Is there filling of propane tanks?
Please describe the nature of your business and ANY unusual exposures:
Entertainment Information
Is there entertainment?
If yes, please describe
Is there live music?
If yes, what size is the dance floor and how many nights per week is there dancing?
Are there any coin operated amusement devices?
If yes, please describe
Are there any pool tables?
If yes, how many and are they coin operated?
Are there any bouncers, doormen, ID checkers, armed or security guards?
If yes, how many of each? (list their job duties and employer)
Are there any contests or exhibition?
If yes, describe events.
Are there any audience participation events?
If yes, describe events.
Do you sponsor any sporting events?
If yes, describe events.
Do you have any other type of entertainment?
If yes, describe events.
Cooking Information
Describe the cooking devices at your business.
Is there tableside cooking?
Is there an automatic suppression system?
If yes, do they protect all hoods, ducts and griddles?
Is there any deep frying?
If yes, is there a high limit shutoff?
Do you have an outside cleaning service for the hoods and duct system?
How often are hood and duct cleaned?
Is there any manufacturing, mixing, re-labeling or repackaging of products?
Is there any delivery service?
Is there any catering service?
Miscellaneous and Claims Information
Were there any losses or claims in the last 5 years?
If yes, what is the date, amount paid and description of each loss or claim?
Current Insurance Company
How much are you paying now?
What is the renewal date?
Has insurance ever been cancelled?
If yes, describe.
Have you ever had regulatory violations or citations?
Are employees trained on how to handle minors or intoxicated customers?
If yes, describe.
Coverage Information
What building coverage is requested?
What other structures is requested?
What business contents is requested?
What is the loss of use coverage requested?
What is the liability limit requested?
What policy deductible is requested?
Questions or Comments
Best Time To Contact You
Please let us know the best time to call and discuss your quote.
Or Specify Other:

Tags: , , ,

This entry was posted on Thursday, May 20th, 2010 at 10:40 pm and is filed under Business. You can follow any responses to this entry through the RSS 2.0 feed. Both comments and pings are currently closed.