Restaurant Bar Quote Form

INSTANTLY REQUEST A QUOTE

THIS FORM WILL ON AVERAGE TAKE 12 MINUTES TO COMPLETE
Business Name*
DBA*
Phone*
Email*
example@example.com
Physical Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Is Mailing Address Same As Physical Address?*

YesNo
Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Business Structure*

Individual Sole Proprietor (No Incorporation)LLCCorporationOther
Contact Phone Number*
Contact Name*
Email Address*
example@example.com
Website Address*
When Would You Like Coverage to Start if You Chose Us to Serve You?*
Date Business Started*

MonthDayYear
Date
Provide # years of experience in this trade/business*
Does applicant own or operate any other business or premises under the same legal entity name/ownership?*

YesNo
Does Insured sell, serve, or allow bring your own alcohol?*

YesNo
Description of Operations*
Any losses more than $5,000 paid or reserved in the past 3 years or more than 2 losses in the past 3 years?*

YesNo
Loss History: Total number of claims in the past 3 years*
If More Than One Location List Name/Address For Each Below:
General Underwriting Information

Complete all questions, for each location. Attach separate sheet as needed.
Automatic Fire Alarm*

LocalCentral:
Burglar Alarm*

LocalCentral:
Smoke Detectors*

YesNo
Is there a hold harmless contract in place naming landlord, event, or client harmless (Copy of contract required) :*

YesNoI Don't Know. Please Advise Me.
Is this a seasonal operation (Closed more than 30 consecutive days):*

YesNo
Is there any entertainment ever held on site (music, comedy, etc):*

YesNo
Are there the following on the premises – check all that apply:
Swimming Pool:*

YesNo
Playground:*

YesNo
Fire Pit:*

YesNo
Working Wood Fireplace:*

YesNo
Are athletic teams sponsored:*

YesNo
Are sub-contractors allowed to work without providing a certificate of insurance?*

YesNo
If no, who checks certificates:
During the last five years has any applicant been indicted or convicted of any degree of the crime of fraud, bribery, arson, or any other arson-related crime in connection with this or any other property:*

YesNo
Do you own or operate any other business:*

YesNo
If yes, describe:
Are you involved in manufacturing, mixing, relabeling, or repackaging of products:*

YesNo
Do you rent or loan equipment to others:*

YesNo
Any cast iron sectional boilers used for the production or processing of products: (If yes, underwriting referral required)*

YesNo
Any past losses or claims relating to sexual abuse or molestation allegations, discrimination, or negligent hiring:*

YesNo
Any fire code violations in the past 5 years:*

YesNo;
Does insured lease any part of the building to others*

YesNo
Business Owners Package Coverage – Property & Liability
Distance to nearest Fire Hydrant (feet):*
Nearest Fire Station (miles):*
Insured is:*

OwnerTenant
Hours of Operation: *
Year Built*
Number of Stories*
Total Sq Feet of Building*
Sq Feet Occupied by Insured*
Portion of building unoccupied or vacant %*
Building Construction:*

FrameJoisted MasonryFire ResistiveNon-CombustibleNon-Combustible Masonry
Year of last update: Electric*
Year of last update: Heating/AC*
Year of last update: Plumbing*
Year of last update: Roof*
Is building 100% sprinklered?*

YesNo
List other businesses adjacent to yours in the same building?
Building Replacement Cost at 100% to value*
Business Personal Property Replacement Cost at 100% to value*
Tenant’s Improvements and Betterments Replacement Cost at 100% to value*
Any surrounding exposures?*

YesNo
if yes, describe*
Location Options and Coverages
Equipment Breakdown Perishable Goods Limit: $25,000 (limit included): Additional limits available, select Limit:*

$50,000$75,000$100,000
Projected sales over next 12 month at this location: FOOD*
Projected sales over next 12 month at this location: LIQUOR*
Policy Level - Options and Coverages
Liability Limits – Select one*

$1,000,000 per occurrence/$2,000,000 aggregate$2,000,000 per occurrence/$4,000,000 aggregateNot Sure. Please Advise Me.
Damage for Premises Rented to You*

YesNo
Active Shooter Coverage?*

YesNo
Would you like Employment Practices Liability: (Coverage if you are sued by employee for issues of race, religion, gender, etc)*

YesNo
# of Full Time Employees (35hrs+ per week)*
# of Part Time Employees (under 35hrs per week)*
Location Level - Options and Coverages continued
Would you like Cyber Liability Coverage?

YesNo
Hired and Non-Owned Auto Liability (If personal autos are driven for work related activity by any employee or owner)*

YesNo
Does insured offer delivery or valet parking?*

YesNo
Building Level - Options and Coverages
Additional Interests: (Mortgage, Loss Payee, Additional Insured) – if more than two, provide on separate sheet:
Name*
Interest*
Address*
Name
Interest
Address
RESTAURANT SUPPLEMENT

Attach restaurant supplement for each location
Is the restaurant operated by insured?*

YesNo
If no, please explain below:*
How long has insured been at this location?
Is restaurant on ground floor?*

YesNo
If no, indicate floor #
Does restaurant maintain parking areas?

YesNo
Has restaurant ever been cited by the board of health?*

YesNo
Outside Patio area*

YesNo
Deck*

YesNo
If yes, Height of Deck*
Seating Capacity*
Dance Floor:*

YesNo
Background Music:*

Piano Player, incidental soft music
Is there a catering exposure:*

YesNo
If yes*

On premisesOff Premises
Are delivery services offered?*

YesNo
If yes, please indicate the method of delivery below:

Company autoEmployee autoDelivery service (Uber Eats, Grub Hub etc.)
Does insured serve alcohol?*

YesNo
Are delivery services offered?*

Company autoEmployee autoDelivery service Uber Eats, Grub Hub etc
Are you requesting Liquor Liability Coverage*

YesNo
Does applicant conduct “happy hours” or other promotional events?*

YesNo
Select all the cooking methods used*

Wood burning stoveTandoorHot PotHot StoneTableside Hibachi or cookingOpen Pit BarbequeBBQ TableNone of the aboveOther
Does insured have Banquet/Function Hall Facilities:*

YesNo
Are all commercial cooking appliances covered by a wet chemical UL 300 Automatic Extinguishing System (AES) that is serviced every 6 months?*

YesNo
Have the life safety requirements (NFPA 101) for emergency lighting and number of exists been met?*

YesNo
Are all cooking appliances that produce smoke or grease laden vapors placed under a hood and duct system?*

YesNoNA
Is the hood, filter and duct system(s) inspected daily and professionally cleaned every 6 months?*

YesNoNA
Are the deep fat fryer(s) equipped with an automatic fuel shutoff for temperatures above 475 degrees?*

YesNoNA
Do the deep fat fryer(s) have a steel or glass baffle of at least 10 inches between the fryer and adjacent cooking surfaces?*

YesNoNA
Is a K-Rated fire extinguisher present in the kitchen?*

YesNoNA
Has applicant ever been fined by any federal, state, or local governmental agency or entity related to any past or current business operations?*

YesNo
BOP Liquor Liability Supplement
Bottle Service Available?

YesNo
Member of Association:*

YesNo
Name of Association:*
Policy Limits Requested:*

250,000 per person / $500,000 per occurrence / $500,000 aggregate$500,000 per person / $1,000,000 per occurrence / $1,000,000 aggregate$1,000,000 per person / $1,000,000 per occurrence / $2,000,000 aggregateNA
Assault & Battery Endorsement – select A&B Sublimit:*

$250,000 / $500,000 / $500,000$500,000 / $1,000,000 / $1,000,000$1,000,000 / $1,000,000 / $2,000,000I decline to purchase Assault & Battery Coverage
Business Sales
Entertainment – Are any of the following provided at this premises? (Check all that apply)*

NANo EntertainmentDJ with DancingKaraokeDancingPool TablesLive BandsMechanical BullsDance FloorPub CrawlsHappy HourExotic DancingDrinking Games/TournamentsDartOther
Number of Days with live entertainment per week
Name*
Are any bouncers, doorpersons or security used?*

YesNoIs there a written alcohol serving policy in place?
If yes, are they:*

Company EmployeesContracted
Is there a written alcohol serving policy in place?*

YesNo
Name of Alcohol Training Program (if applicable):
Have 100% of management and 100% non-management servers been certified?*

YesNoNA
Have 100% of management and 100% non-management servers been certified?*

YesNoNA
Are employees permitted to consume alcohol on the applicant’s premises prior to, during or after their shift ends?*

YesNoNA
Citations And / Or Hearings
Has the applicant had any citations or hearings with their local liquor licensing board in past 3 years?*

YesNo
Has the applicant been fined or cited for ABC violations of law or ordinances related to illegal activities or the sale of alcohol in past 3 years?*

YesNo
Schedule a call with your restaurant & bar insurance advisor below.
Should be Empty:

INSTANTLY REQUEST A QUOTE

General Underwriting Information

Business Owners Package Coverage – Property & Liability

Location Options and Coverages

Policy Level - Options and Coverages

Location Level - Options and Coverages continued

Building Level - Options and Coverages

RESTAURANT SUPPLEMENT

BOP Liquor Liability Supplement

Business Sales

Citations And / Or Hearings