Restaurant Insurance Quote

RESTAURANT QUESTIONNAIRE

PLEASE COMPLETE THE FOLLOWING TO ASSIST US IN PROVIDING OUR MOST COMPETITIVE INSURANCE QUOTATION:

Business Information

Legal Name of Business:

DBA if different:

Entity type:

Names of all owners and % of ownership:

Address:

Phone:

Email:

Name of best contact person:

Any claims in the last 5 years?

Date GL policy expires:

Restaurant Information

Name of Restaurant:

Is it Franchised?

If Yes, please explain:

Years in operation under your ownership?

If less than three years, please describe previous Restaurant type experience:

The Following exposures are generally unacceptable. Please discuss with your underwriter.

Please check any that apply:
Check Cashing ServicesAre Bouncers Employed Live Entertainment or DancingValet Parking Happy HoursAny Tableside CookingFirearms kept for SecurityChildren’s PlaygroundsGas Pumps on PremisesAny Docks, Piers or WharfsLiquor License Revoked in last 5 YearsSporting/Game ActivitiesABC Violations in last 5 YearsIs Business Seasonal /Closed at any Time During YearInsurance Canceled or NonRenewed last 3 yearsPool Tables or Dart BoardsIs a Cover Charge madeSecurity Guards Used

Please check if any exposures listed below exist:
Bar or Tavern includedAny Delivery ServicesAny Catering ActivitiesAlcoholic Beverage SalesVideo GamesBanquet Facilities

Please explain any "checked" answers above:

Annual Gross Food Sales: $

Catering Receipts: $

Annual Gross Liquor Sales: $

Beer %:

Full Bar %:

Wine %:

Avg Price/Bottle: $

PUBLIC AREA in sq. ft (hallway, restroom, etc):

Separate Banquet Room area, if any:

Hours of Operation - Weekdays (e.g. 9-4PM):

Hours of Operation - Weekends (e.g. 9-4PM):

Table Service?

Self Service?

 
 
Is there valet parking services provided?

 
If provided by an outside service, is proof
of insurance obtained?

Is there a U.L. approved Automatic Fire
Suppression System in the Vent Hood and
Ducts covering ALL cooking areas?

 
Any deep fat frying?

 
If yes, is there an automatic shut-off?

Is there a Hood and Duct Cleaning
Service under contract?

 
How often is Hood and Duct system cleaned?

Please describe the type of Burglar Alarm?
(Central Station, Local Gong, etc.):

 
Is the building fully, partially, or not sprinkled?

 
Building details:

Is building currently undergoing any
remodeling/renovation work?

 
If Yes, please explain: