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- Paul Johnson, CA.

Restaurant Insurance Quote

  

General Information

First Name: *
Business Name:
Gender:
Male  Female
Date of Birth:
Occupation:
Business Address:
Zip Code:
The Best Time to Call?:
Best Phone Number to Reach You:
Fax:
Email Address: *

Business Information

Business License Number:
License Type:
Years in Business:

Policy Information

Current Policy Expiry:
Current Insurance Company:
Annual Premium:
Losses and Claims for the Last 5 years:
If yes, what is the date, amount paid and description of each loss or claim?:
What is the Building Coverage Requested?:
Contents Property Coverage Requested?:
Premise Liability:
Policy Deductible:

Building Information

Total Square Footage of Business Building :
Total Square Footage of Business Only:
Square Footage of Customer Area:
How many stories?:
Construction Type:
What Type Roof Covering?:
Has the Roof Been Updated?:
Yes  No
If Yes, what year?:
Fire & Burglary Alarm:
Yes  No
Distance of the Property to the Closest Fire Department:
Is the Business in the Brush Area?:
Yes  No
Do you Have a Storage Area More than 1500 Sq. Ft.?:
Yes  No 
Is there a Smoke Alarm?:
Yes  No 
Is there a Fire Extinguisher?:
Yes  No 
Are there Deadbolts?:
Yes  No 
Is the Electrical Updated?:
Yes  No 
Are there Circuit Breakers?:
Yes  No 
Is the Heating / Air Conditioning Thermostatically Controlled?:
Yes  No 
Has the Plumbing Been Updated?:
Yes  No 
Is the Plumbing Copper?:
Yes  No 
Is there a Theft Alarm?:
Yes  No 
Are There any Restaurants in the Building Next to Your Business?:
Yes  No 

Underwriting Information

Number of Stories:
Number of Employees:
Payroll of Owners:
Payroll of Employees:
Annual Gross Receipts:
Hard Liquor Receipts:
Beer and Wine Receipts:
Food Receipts:
Open 24 Hours:
Yes  No
Propane Tank Filling:
Yes  No
Describe the Nature of Your Business and Any Unusual Exposures.:

Entertainment Information

Is 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, how many and are they coin operated:
Are there any Pool Tables?:
Yes  No 
If yes, Please Describe:
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 Contests or Exhibition?:
Yes  No 
If yes, Describe Events:
Are there any Audience Participation Events?:
Yes  No 
If yes, Describe Events:
Do you have any other type of entertainment?:
Yes  No 
If yes, Describe Events:

Cooking Information

Describe the Cooking Devices at Your Business:
Is there Tableside Cooking?:
Yes  No
Is there an Automatic Suppression System?:
Yes  No 
If yes, do they Protect all Hoods, Ducts and Griddles?:
Yes  No 
Is there any Deep Frying?:
Yes  No
If yes, is there a High Limit Shutoff?:
Yes  No
Do you have an Outside Cleaning Service for the Hoods and Duct System?:
Yes  No
How Often are Hood and Duct Cleaned?:
Is there any Manufacturing, Mixing, Re-Labeling or Repackaging of Products?:
Yes  No 
Is there any Delivery Service?:
Yes  No 
Is there any Catering Service?:
Yes  No 
Additional Information: