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Restaurant Businessowner's Quote

Location Information                                 Location Number                                 

1)    Type of Restaurant:            o Fast Food      o Casual Dinning         o Fine Dining               o Restaurants – No Cooking/No Frying and Limited Seating            o Restaurants – WITH Cooking and Limited Seating       o Other than shown


2)    Is the restaurant a franchise?  o Yes   o No

3)    What is the primary type of cuisine? 


4)    Does the restaurant regularly provide meal/food delivery?  o Yes   o No


5)    What is the year the business was established or acquired at this location?       


6)    How many years management/ownership experience does applicant have in this industry?      


7)    Total annual gross receipts at this location $      

8)    Catering receipts at this location:  $      


9)    What are the total annual receipts generated from serving alcohol at this location?  $      


10)  Indicate the location type:  o  Stand-alone building  o Located in a strip shopping center  o Attached or within buildings with residential apartments or condos   o  Attached to or within office buildings   o  Attached to or within a mixed occupancy bldg without residential exposures  o  Attached to or within a hotel/motel  Located in an enclosed mall  o  Other than described above


11)  Hours of operation at this location:       Open:         



12)  Total square footage occupied by the applicant:       


13)  Total square footage of the public area:          NOTE:  Public Area is defined as the total square footage
of all areas where the public is permitted to go, such as dining areas & lounges, hallways, stairs, rest rooms, waiting areas & dance floors.  Public area does not include kitchens, storage, behind the counter or bar & outside driveways for drive thru service. Please contact your underwriter if you have questions regarding public area.


14)  Seating Capacity:             Note:  Seating capacity is the number of seats available for restaurant patrons.


15)  Indicate the type of entertainment provided at this location: o NONE    o Live Band or DJ         o Mechanical Rides   

  • Dartboards          Number of video games Number of Televisions       Number of Pool or Gaming Tables 
  •   Other than listed  _____________


16)  Is there a video surveillance system at this location?  o Yes   o No


17)  Is the restaurant responsible for the parking lot?  o Yes   o No


18)  Is there a drive-through at this location?  o Yes   o No


19)  Are there any playgrounds at this location?  o Yes   o No


20)  What percentage of the building does the restaurant occupy?       


21)  If less than 100%, what percentage is occupied by the following types of operations:        %  Habitation/Apartment

      % Auto Service/Repair       Bars/Pubs/Taverns       %  Grocery Store          % Offices 

      % Other Restaurants          Retail stores        Other than above


22)  What percentage of the building is vacant or unoccupied?        %


Cooking Operations   Complete if applicable

23)  Indicate the type of fully operational automatic fire extinguishing system covering all hoods, ducts and cooking equipment:   (circle one)

Dry Chemical

UL 300 Wet Chemical

Water Spray



24)  How often is the automatic fire extinguishing system inspected and serviced by a contracted outside firm? (Circle one)






25)  How often are flues and ducts inspected and cleaned by a contracted outside firm? (Circle one)






26)  How often is cooking equipment exhaust filters cleaned? (Circle one)








27)  Is any table-side service provided which involved open flames?

  • Yes   o No

28)  Are they any deep fat fryers on the premises?   o Yes   o No 

a.  If yes, do the fryers have thermostats, fuel cut-offs and proper ventilation?  o Yes   o No 

Liquor Liability          Complete if applicable                                                       

29)  Liquor License?  o Yes   o No

If yes, license number:

30)  Is there a separate bar area?  o Yes   o No

a)    Does the bar area close later than the dining area?  o Yes   o No

31)  Are drink promotions, such as happy hours, 2-For-1 specials or ladies night offered?  o Yes   o No

32)  Does the restaurant allow patrons to bring their own (BYO)?  o Yes   o No

33)  Have there been any prior liquor citations?  o Yes   o No

34)  Has there been prior liquor liability coverage?  o Yes   o No

35)  Are all employees that serve alcohol given formal alcohol service training, such as TIPS?  o Yes   o No

36)  Does the restaurant have a written policy covering alcohol service guidelines?  o Yes   o No

37)  Are alcohol related incidents documented?   o Yes   o No

Automobile Related Operations/Valet Parking  Complete if applicable                                                                  

38)  Does the restaurant provide valet parking at this location?  o Yes   o No

39)  Do all valet parking attendants have a valid U.S. driver’s license and are they all over the age of 21?  o Yes   o No

40)  Do any of the valet parking attendants have any major driving violations?  o Yes   o No

41)  Have there been any valet parking losses?  o Yes   o No

42)  Are keys regularly left in the vehicles after they are parked?  o Yes   o No

43)  Are car wash, oil changes or other related services other than valet parking provided?  o Yes   o No

Company Information
Company Name
ZIP / Postal Code
Primary Phone Number
Alternate Phone Number
E-Mail Address
Company Owner
First Name
Last Name
Nature of Business
Number of Owners
Gross Annual Sales
Number of Employees
Annual Employee Payroll
Subcontractors Used
Annual Cost of Subcontractors
Square Footage of Location
Additional Information
Prior Insurance
Length of Coverage (Months and Years)
Number of Additional Insureds Needed
How did you hear about us?
Underwriting Questions
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