For your protection and security, the information you provide is sent to us via a secured server. Please fill out this form as completely as possible to ensure an accurate request.
- Complete the following information if you would like to obtain a Restaurant Insurance quote. Please understand this is not an application. An application will be sent to you if coverage is desired.
All information provided on this information sheet is confidential and will be used solely for the purpose of developing a quote for you.
Please Note: We only write insurance for these states.
What is your address?
What is your name?
What is your business name?
What is your business telepone number?
What is your home telepone number?
What is your email address?
What is your fax number?
What is the Property Address?
What is the total square footage of the building your business is in?
What is the total square footage of your business only?
What is the square footage of the customer area only?
How many stories is it?
If two or more stories, what is the ground floor square footage?
Year Roof Updated
Is the business in a brush area?
Do you have a storage area more than 1500 Sq. Ft.?
Are there smoke detectors at this location?
Are there smoke alarms at this location?
Are there fire extinguishers?
Does the building have interior automatic fire sprinklers?
Is there a fire alarm?
Is there a theft alarm?
Are there deadbolts on all doors?
Are there circuit breakers?
Is the heading/ air conditioning thermostatically controlled?
Is the heating/ air conditioning central?
Has the plumbing been updated?
Year Plumbing Updated
Is the parking lot under your protection?
What is the nature of your business?
How many owners?
How many Employees
What is the payroll amount of the owners?
What is the payroll amount of the employees?
What is the total annual gross?
What are the total annual hard liquor receipts?
What are the total annual beer and wine receipts?
What are the total annual food gross receipts?
What is the business license number?
What is the license type?
Years of experience in this business?
How many years have you operated this business?
Is this business open 24 hours a day?
Is there filling of propane tanks?
Please describe the nature of your business and ANY unusual exposures.
Is there tableside cooking?
Is there an automatic suppression system?
Is there any deep frying?
Do you have an outside cleaning service for the hoods and duct system?
How often are hood and duct cleaned?
Is there any manufacturing, mixing, re-labeling or repackaging of products?
Is there any delivery service?
Is there any catering service?
Claims and Miscellaneous Information
Were there any losses or claims in the last 5 years?
How much are you paying now?
What is the renewal date?
MM slash DD slash YYYY
Has insurance ever been cancelled?
Have you ever had regulatory violations or citations?
Are employees trained on how to handle minors or intoxicated customers?
What building coverage is requested?
What other structures is requested?
What business contents is requested?
What is the loss of use coverage requested?
What is the liability limits requested?
What policy deductible is requested?
Are there any questions, comments or additional coverage required?