Restaurant Insurance Quote Step 1 of 5 - Applicant 20% Phone*Email* The fields above are the minimum required. You can skip to the end and submit the application and we will contact you to go over the rest of the application. Otherwise, you may continue to fill out this form. Named InsuredDBAMailing address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Website Business TypeCorporationLLCPartnershipSoleNumber of years in businessTax IDEffective Date Hours of Operations Building InformationOwner or TenantTriple Net LeasePhysical Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Year BuiltSquare FootagePatio Square Footage# of StoriesType of ConstructionFrameJoisted MasonryBlockNoncombustibleSafety Fire Alarm Burglar Alarm Sprinklered Video Cameras Amount of Building CoverageTenant Improvements/Build-Out LimitBusiness Personal PropertyAmoung of Business Income CoverageIs the building over 20 years old?YesNoList the year of the last updateRoofPlumbingElectricalHVACOtherDoes your restaurant have a UL 300 Automatic Extinguishing System (AES) over cooking areas and fryer?YesNoAES System TypeWetDryIs the AES serviced by an outside firm?YesNoHow Often is the AES serviced?Are the hoods, ducts, and filters serviced by an outside firm?YesNoHow often are they serviced?Are the filters cleaned weekly?YesNoAre the hoods and ducts cleaned semi annually?YesNo Money & SecuritiesDoes the insured maintain a cash register and records of daily receipts?YesNoAre deposit records kept on premises?YesNoAre daily bank deposits made?YesNoHow often are bank deposits made?Is money stored in a class B safe or better?YesNo General Liability# of years and experience of owners and managementEstimated Annual Food SalesEstimated Annual Liquor SalesOther SalesNumber of Full Time EmployeesNumber of part time employeesAverage Age of EmployeesNumber of ServersNumber of BartendersNumber of ManagersDo you deliver?YesNoDo you cater or do banquets?YesNoEstimated Annual Banquet or Catering SalesDo you have a valid liquor license?YesNoLicense #Have you ever had your license revoked or suspended?YesNoHave you ever been denied coverage for liquor or nonrenewed?YesNoHave you had any claims in the last five years?YesNoDo you have a written policy that is distributed to new and current employees?YesNoAre all servers certified in a formal alcohol training course?YesNoCourses TIPS TAM RAMP ServSafe Other CourseIs a food menu available during all hours of liquor service?YesNoIs service delayed or discontinued for customers who show signs of intoxication?YesNoAre transportation arrangements made for customers who appear to be intoxicated?YesNoHow do you prevent underage drinking and over serving?Are incident logs maintained?YesNoDo you offer happy hour or other drink specials?YesNoDo you offer entertainment?YesNo Live Bands DJ Karaoke OtherDo you have an Umbrella Policy?YesNoWhat is the policy limit?Notes Important Notice I DECLARE THAT THE STATEMENTS IN THIS APPLICATION ARE COMPLETE AND TRUE TO THE BEST OF MY KNOWLEDGE AFTER REASONABLE INQUIRY. Any person who knowingly and with intent to defraud any insurance company or another person submits an application for insurance or statement of claim containing any materially false information, or conceals for the purpose of misleading, information containing any material fact thereto, commits a fraudulent act that is subject to criminal and substantial civil penalties. I agree that any intentional concealment or misrepresentation of a material fact concerning this insurance or the subject thereof may void any policy issued. (As part of our underwriting procedures, a routine inquiry may be made to obtain applicable information concerning character, general reputation, and credit history. Upon your written request, additional information as to the nature and scope of the report, if one is made, will be providedEmailThis field is for validation purposes and should be left unchanged.