Restaurant Insurance Quote Request Restaurant Insurance Quote Request 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.Personal InformationSelect Your StatePlease Note: We only write insurance for these states.SelectNew HampshireVermontAddressWhat is your address? Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Name*What is your name? First Last Business NameWhat is your business name? Telephone Number (Business)*What is your business telepone number?Telephone Number (Home)What is your home telepone number?Email Address*What is your email address? FaxWhat is your fax number? Property InformationProperty AddressWhat is the Property Address? Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Total Square Footage of Business BuildingWhat is the total square footage of the building your business is in?Please enter a number greater than or equal to 0.Total Square Footage of Business OnlyWhat is the total square footage of your business only?Please enter a number greater than or equal to 0.Square Footage of Customer AreaWhat is the square footage of the customer area only?Please enter a number greater than or equal to 0.StoriesHow many stories is it?Please enter a number from 0 to 99.Ground Floor Square FootageIf two or more stories, what is the ground floor square footage?Please enter a number greater than or equal to 0.What is the construction type?SelectBrickStoneFrameMasonrySuperiorLog CabinFrame-StuccoMasonry VeneerWhat type of roof covering?SelectArchitectural shinglesAsphalt/Fiberglass shinglesBuilt-up/Tar and gravelClay tileConcrete tileCorrugated steelMineral fiber shakesMission TileRock roofRoll roofingRubber roofSlateTinWood fiber shinglesWood shakeWas the roof updated? Yes No If yes, what year?Year Roof UpdatedPlease enter a number from 1700 to 3000.What is the distance of fire protection?Select1000 ft or less to hydrant & 5 mi or less to fire stationOver 1000 ft to hydrant & 5 MI or less to fire stationOver 5 & up to 10 MI to fire stationOver 10 MI to fire stationBrushIs the business in a brush area? Yes No Storage AreaDo you have a storage area more than 1500 Sq. Ft.? Yes No Smoke DetectorsAre there smoke detectors at this location? Yes No Smoke AlarmAre there smoke alarms at this location? Yes No Fire ExtinguishersAre there fire extinguishers? Yes No Automatic Fire SprinklersDoes the building have interior automatic fire sprinklers? Yes No Fire AlarmIs there a fire alarm? Yes No Theft AlarmIs there a theft alarm? Yes No DeadboltsAre there deadbolts on all doors? Yes No Circuit BreakersAre there circuit breakers? Yes No Is the electrical updated?Electrical UpdateSelectYes, Recently UpdatedNoThermostatically ControlledIs the heading/ air conditioning thermostatically controlled? Yes No CentralIs the heating/ air conditioning central? Yes No Plumbing UpdatedHas the plumbing been updated? Yes No If yes, what year was the plumbing updated?Year Plumbing UpdatedPlease enter a number from 1700 to 3000.Parking ProtectionIs the parking lot under your protection? Yes No Underwriting InformationNature of BusinessWhat is the nature of your business?Number of OwnersHow many owners?Please enter a number greater than or equal to 0.Number of EmployeesHow many EmployeesPlease enter a number greater than or equal to 0.Payroll of ownersWhat is the payroll amount of the owners? Payroll of employeesWhat is the payroll amount of the employees? Total Annual Gross ReceiptsWhat is the total annual gross? Hard Liquor ReceiptsWhat are the total annual hard liquor receipts? Beer and Wine ReceiptsWhat are the total annual beer and wine receipts? Food ReceiptsWhat are the total annual food gross receipts? Business License NumberWhat is the business license number? License TypeWhat is the license type? Years of ExperienceYears of experience in this business?Please enter a number greater than or equal to 0.Years OperatedHow many years have you operated this business?Please enter a number greater than or equal to 0.Open 24 hoursIs this business open 24 hours a day? Yes No Propane Tank FillingIs there filling of propane tanks? Yes No Unusual ExposuresPlease describe the nature of your business and ANY unusual exposures.Entertainment InformationIs there entertainment? Yes No If yes, please describe.Is there live music? Yes No If yes, what size is the dance floor and how many nights per week is there dancing?Are there any coin operated amusement devices? Yes No If yes, please describe.Are there any pool tables? Yes No If yes, how many and are they coin operated?Are there any bouncers, doormen, ID checkers, armed or security guards? Yes No If yes, how many of each? (list their job duties and employer)Are there any audience participation events? Yes No If yes, describe events.Do you sponsor any sporting events? Yes No If yes, describe events.Do you have any other type of entertainment? Yes No If yes, describe events.Cooking InformationDescribe the cooking devices at your business.Tableside CookingIs there tableside cooking? Yes No Automatic Suppression SystemIs there an automatic suppression system? Yes No If yes, do they protect all hoods, ducts and griddles? Yes No Deep FryingIs there any deep frying? Yes No If yes, is there a high limit shutoff? Yes No Outside Cleaning ServiceDo you have an outside cleaning service for the hoods and duct system? Yes No How Often CleanedHow often are hood and duct cleaned? ManufacturingIs there any manufacturing, mixing, re-labeling or repackaging of products? Yes No Delivery ServiceIs there any delivery service? Yes No Catering ServiceIs there any catering service? Yes No Claims and Miscellaneous InformationLosses - ClaimsWere there any losses or claims in the last 5 years? Yes No If yes, what is the date, amount paid and description of each loss or claim?What is the current insurance company? Amount Current CoverageHow much are you paying now? Renewal DateWhat is the renewal date? MM slash DD slash YYYY Insurance CancelledHas insurance ever been cancelled? Yes No If yes, describe.Regulatory Violations or CitationsHave you ever had regulatory violations or citations? Yes No If yes, describe.Employees TrainedAre employees trained on how to handle minors or intoxicated customers? Yes No If yes, describe.Coverage InformationBuilding CoverageWhat building coverage is requested? Other Structures CoverageWhat other structures is requested? Business Contents CoverageWhat business contents is requested? Loss of Use CoverageWhat is the loss of use coverage requested? Liability LimitsWhat is the liability limits requested?Select$1,000,000$100,000$300,000$500,000Policy DeductibleWhat policy deductible is requested?Select100250500750100025005000Questions, Comments or Additional CoverageAre there any questions, comments or additional coverage required?CaptchaPrint Form