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RESTAURANT INSURANCE QUOTE

We would like to provide you with a free, no-obligation restaurant insurance quote. Please provide as much information possible for the most accurate quote. This information will be kept confidential and will be used for quote purposes only.

    
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General Information
Name of Business:
Contact Name:
Mailing Address:
City:   State:   Zip:
Business Phone:   Fax:
Best Time To Call:   AM   PM
Contact Email Address:

About Your Business
Location Address (if different):
City:   State:   Zip:
Tax ID#:
Type of Risk: Restaurant   Tavern   Fast Food   Bar
Other:
Applicant is: Individual   Corporation   Partnership   Joint Venture
Other:
Mortgagee:    Mortgagee Interest:
Addt'l Insured:   Addt'l Insured Interest:
Effective Date Requested:    Expiration Date:

Coverages
Property
Building (90%) AC   Broad Form   $
Contents (90%) Replacement Value   Special Form   $
Business Income   %   $
Per Claim Deductible    
Liability
General Aggregate   $
Products/Completed Operations Aggregate   $
Per Occurrence   $
Medical Payments   $
Fire Damage   $
Liquor Liability   $
Optional Coverages
Sign   $   Limits In/Out
Glass   $   Square Footage
Money/Secs   $   Limits In/Out
Food Spoilage   $   Limits In/Out
Other     

Rating Information
Construction Type:   Seating Capacity:
Fire/Protection: Sprinkler       Smoke Detector       Fire Extinguisher
Square Footage: Total       Customer
Food Receipts: $         Liquor Receipts $
Employees: # Full Time:   # Part Time:   Annual Payroll: $
Website:
Has the Applicant filed for bankruptcy in the past 5 years? Yes   No
Is the Restaurant(s) part of a franchise? Yes   No
Is food or alcohol delivered by vehicle? By foot or bicycle? Yes   No
Is more than 5% of food served raw fish or meats? Yes   No
Do designated employees receive annual training on safe food handling practices? Yes   No
Does business participate in any off premises operations, such as parades,
contests, festivals or fairs?
Yes   No
Is there a written procedure to document slips and falls, objects in food, food poisoning and other complaints? Yes   No
Are all commercial cooking surfaces and deep fryers protected by a WET
automatic chemical extinguishing system?
Yes   No
Are the outside wall, roof and bell housing free of grease accumulation? Yes   No
Is any tableside cooking performed? Yes   No
Are there any open pits/hearths or open flame grills? Yes   No
Are there Class K fire extinguishers and are they serviced annually? Yes   No
Does the business have a formal alcohol awareness training program? Yes   No
If yes, what is the name of the program (TIPS, TOPS, etc.)
Has applicant ever had their liquor license suspended or revoked? Yes   No
Auto used in business? Yes   No

Underwriting Information
PROPERTY
Building Information
Age
When Rewired
Electrical in Conduit
Circuit Breakers
Fuse Box
Plumbing up to Code
N
N
N
N
Building Condition
Housekeeping
# of Stories
Building Code Violations
N
What is Right Exposure
What is Left Exposure
What is Rear Exposure
Free Standing
Other Occupancies
Distance to Nearest Fire Hydrant
N
If adjacent business is a restaurant, does it have automatic extinguishing devices?
Is any portion of the building vacant, unoccupied, or seasonal? (If yes, explain)
N
N    
Kitchen Information
Grease Cooking
Are ducts, hoods, grease filters and surface cooking areas (including deep fat fryers) protected by a U.S. listed automatic fire extinguishing system?
Is such a system professionally inspected and serviced every 6 months?
N
N
N
Exhaust filters are cleaned
Is there a professional flue cleaning service used on quarterly contract?
N   By:   Phone Number:
Deep Fat Fryers
Automatic Shut Off
High Limit Switch
Non-Slip Floors
Other Kitchen Safety Precautions
N
N
N

Underwriting Information
LIABILITY
Entertainment
Live Entertainment
# of Players
Kind of Music
How Many Nights
N
Dancing
Disco
# of Pool Tables
# of Game Machines
N
N

Underwriting Information
CRIME
Safe Class
Type of Locks
Maximum Cash in Register
Check Cashing
N
Alarm
# of Alarms
Motion Detectors
N     How often checked:
Name of Alarm Company
Any weapons on premises
  Ph#:
N     If yes, explain:

Underwriting Information
GENERAL
How long at this location
How long in this type business
Operated by Owner
Table Service
Self Service
Any Delivery
N
N
N
N
Hours Open
Days Closed
# of Employees
Estimated Annual Payroll
Neighborhood
From  to
Ever suffered earthquake damage
Type of food served on premises
Flaming Drinks
Happy Hours
Written policy for
serving minors/
intoxicated patrons
N
N
N
N
Exits properly marked
Alternate Access
Security Guards
Parking areas adequately lit/maintained
Separate cigarette butt containers
Designated Smoking Areas
N
N
N
N
N
N
Dart Boards
Mechanical Devices
Prior problems requiring police
Any Liquor Violations
N
N
N
If yes:
N
If yes:

Loss History
Current / Previous Insurance Company:
Policy Number:   Expires:
Has any carrier cancelled or refused insurance to this applicant: N     If yes:
Please describe any losses during the past three (3) years
Date of Loss:
Amount:
Description of Loss:
$
$
$
$
$

Additional Comments
Please give any additional comments you feel appropriate for this quotation. If you have
additional information where there was not enough space, please enter them here.

Please click on the "Submit Quote" button to send your quote request.
One of our representatives will respond to your submission as soon as possible.

   


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