Restaurant Insurance Questionnaire
General Liability
Applicant name
*
First Name
Last Name
Phone number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Legal entity name
*
Legal entity
*
Please Select
Sole Proprietorship
Partnership
LLC
Corporation
Nonprofit
Other
Company website
Business established date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Number of employees
*
Detailed description of business location(s) and operations
Detailed description of products sold or services offered
Gross annual sales
*
Estimate is ok
Annual payroll
*
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Restaurant Information
Restaurant name
*
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Hours of operation
Most recent health inspection results
Are there operations other than dining? Explain
Examples: Entertainment, holding events, ect.
Type of food served
*
Percent liquor sales
*
Business personal property total value
*
Equipment, appliances, ect.
Building square footage
*
Building security
Rows
Local
Central
None
Fire Alarm
Burglar Alarm
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Building Information
Do you require building coverage?
Yes
No
Address (If different from above)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Construction type
Please Select
fire-resistive
non-combustible
ordinary
heavy timber
wood-framed
other
Year built
Square footage
*If different from above
Do other businesses occupy the building?
Explain
Year Renovated
Rows
Year of Renovation
Roof
Electrical
Plumbing
Heating
Estimated Building Value
Submit
Should be Empty: