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:         

Close:  

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

Other

  None

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

Monthly

Quarterly

Semi-Annual

Annual

  Never

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

Monthly

Quarterly

Semi-Annual

Annual

  Never

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

Daily

Weekly

Monthly

Quarterly

Semi-Annual

Annual

  Never

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 

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

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