Restaurant Insurance

Restaurant Insurance Quote Request

Your Information

Last Name*

First Name*

Email Address*

Street Address*

City*

State*

Zip Code*

Phone Number*

Alternate Phone

Business Information

Company Name

Company Street Address

City

State

Zip Code

Is the business a corporation, partnership, or sole proprietorship? Corporation
Partnership
Sole Proprietorship

Number of owners

Number of Employees

Payroll of Owners

Payroll of Employees

Total annual gross receipts

Total annual Hard Liquor receipts

Total annual Beer & Wine receipts

Total annual Food gross receipts

Business License Number

License Type

Years of experience

Years operated under current name

Other business names

Is this business open 24 hours a day? Yes No

Is there any manufacturing, mixing, re-labeling or repackaging of products? Yes No

Is there filling of propane tanks? Yes No

Please describe the nature of your business and ANY unusual exposures: (500 chars left)

Building & Property Information

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 two stories, what is the ground floor square footage?

What is the construction type?

What type of roof covering?

Was the roof updated? Yes No

If yes, what year?

What is the distance to fire protection?

Is the business in a brush area? Yes No

Do you have a storage area more than 1500 sq. ft? Yes No

Are there smoke detectors at this location? Yes No

Is there a fire extinguisher? Yes No

Does the building have interior automatic fire sprinklers? Yes No

Are there deadbolts on all doors? Yes No

Is the electrical updated? Yes No

Are there circuit breakers? Yes No

Is the heating / air conditioning thermostatically controlled? Yes No

Is the heating/ air conditioning central?

Has the plumbing been updated? Yes No

If yes, what year was the plumbing updated?

Does the building have interior automatic fire sprinklers? Yes No

Is there a theft alarm? Yes No

Is there a fire alarm? Yes No

Are there any restaurants in your building Yes No

Are there any restaurants in the building next to your business? Yes No

Entertainment Information

Is there entertainment? Yes No

If yes, please describe

Is there live music? Yes No

If yes, what size is the dance floor and how many nights per week is there dancing?

Are there any coin operated amusement devices? Yes No

If yes, please describe

Are there any pool tables? Yes No

If yes, how many and are they coin operated?

Are there any bouncers, doormen, ID checkers, armed or security guards? Yes No

If yes, how many of each? (list their job duties and employer)

Are there any contests or exhibition? Yes No

If yes, describe events.

Are there any audience participation events? Yes No

If yes, please describe

Do you sponsor any sporting events? Yes No

If yes, please describe

Do you have any other type of entertainment? Yes No

If yes, describe events.

Describe the cooking devices at your business.

Is there tableside cooking? Yes No

Is there an automatic suppression system? Yes No

If yes, do they protect all hoods, ducts and griddles? Yes No

Is there any deep frying? Yes No

If yes, is there a high limit shutoff? Yes No

Do you have an outside cleaning service for the hoods and duct system? Yes No

How often are hood and duct cleaned?

Is there any manufacturing, mixing, re-labeling or repackaging of products? Yes No

Is there any delivery service? Yes No

Is there any catering service? Yes No

Claim & Coverage Information

Claim Information

Were there any losses or claims in the last 5 years? Yes
No

If yes, what is the date, amount paid and description of each loss or claim? (500 chars left)

Coverage Information

Current Insurance Company

How much are you paying now?

What is the liability limit requested?

What is the building limit requested?

What is the building deductible requested?

What is the business personal property (contents) limit requested?

What is the contents deductible requested?

What is the loss of income requested?

Has insurance ever been cancelled? Yes No

If yes, describe.

Have you ever had regulatory violations or citations? Yes No

If yes, describe.

Are employees trained on how to handle minors or intoxicated customers? Yes No

If yes, describe.

Please let us know the best time to call and discuss your quote. Morning
Afternoon
Evening
Anytime

Questions or Comments (1000 chars left)

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