Distillery Insurance Questionnaire

Distillery Insurance Questionnaire
Applicant's Name:*
Address:*
Mailing Address
Address (cont):*
Mailing Address - continued
Contact:*
Email*
Telephone:*
Website
Fax:
Applicant is:

IndividualPartnershipCorporationOther (specify)Other
Current Carrier:
Expiration Date:
Limits: ($)
Premium: ($)
Deductible: ($)
GENERAL INFORMATION
1. Year business started:
2. Years under current manageent:
3. Are you the sole owner/sole tenant of the building?

YesNo
3a. If no, please describe other tenants in the building:
PROPERTY COMMON HAZARDS - ELECTRICAL SYSTEM
1. Is there a Backup Generator for emergency power?

YesNo
1a. If yes, how many KV and what does it power, describe:
2. Is there a documented Electrical System Preventative Maintenance Program?

YesNo
3. Date of last Thermography Scan:
4. Are alcohol dispensing/processing systems electrically grounded and bonded?

YesNo
5. Are alcohol dispensing/processing systems electrically grounded and bonded?

YesNo
6. Explosion proof electrical connections?

YesNo

COMPUTER/DATA
1. Any custom/proprietary computer software/systems that would be difficult to replace and extend business interruption?

YesNo
1a. If yes, describe:
2. Any Back Up Power UPS (Uninterrupted Power Supply – battery backup to computer system) Systems?

YesNo
2a. If yes, describe duration of power supply:
PROCESSING/EQUIPMENT
1. Estimated Value of Processing Equipment:
2. What is the barrel capacity of the equipment?
3. How often is equipment examined for leaks?
4. What type of still is used?

Open SystemClosed System
5. What is the heating source of the still?

ElectricGasSteamOther
5a. If other, describe:
6. How many boilers are used to provide process steam (per location):
7. Is there a documented Preventative Maintenance (PM) Program for processing equipment?

YesNo
8. Date of last Pressure Vessel Inspection:
9. Pressure relief?

YesNo
10. Pressure monitoring alarms?

YesNo
11. High temperature limit alarm?

YesNo
12. Is there onsite grain milling?

YesNo
12a. If yes, describe dust controls:

	Feet
Still equipment, condenser, containers, etc.
Any open transfer area
Any bottling area

	Total Revenue($)
Liquor/Spirits
Cannabidol (CBD) infused liquor
"To Go/Carry Out" Liquor

	Total Revenie($)
Liquor/Spirits
Cannabidol (CBD) infused liquor
Tours & Tastings
Food/Non-Alcoholic Beverages
Merchandise/Gift Shop

	Yes	No
Smoke Detectors
Heat Detectors