Restaurant Information Minimize


 
Contact Information
Corporation Name:*
D.B.A./ restaurant name:
Primary Contact:*
Primary Contact - Phone Number*
E-mail Address
Address of Restaurant:
City
State
Zip


Restaurant Information
Briefly Describe the Restaurant:
Approximate annual receipts for food sales:
Approximate annual receipts for alcohol sales:
Do you have a deep fryer?
Do you have entertainment?
If yes, what kind and how frequent?
Do you have a dance floor?
Do you have security?
How many locations do you have?



Insurance Coverage Information
What limits of General Liability would you like?
What limit of liquor liability would you like?
Do you currently have insurance coverage?
If Yes, what is the expiration date of your current policy?
If yes, what is the name of your current company?
If yes what is the current annual amount that you are paying?
Have you had any claims in the last three years?


Property information
If you would like coverage on the building please list amount needed:
What amount of business personal property (contents) would you like?
Sq ft of building:
Type of construction:
Type of roof:
Do you have a central station alarm?


Workers Compensation
Would you like a quote for workers compensation?
If yes, what is the payroll for the cooking staff?
If yes, what is the payroll for the wait staff?


Other Coverages
Would you like a quote for any of the following insurance?


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