RESTAURANT INSURANCE QUOTE   We would like to provide you with a free, no-obligation Restaurant insurance quote. Please provide as much information possible for the most accurate quote. This information will be kept confidential and will be used for quote purposes only.   General Information Name of Business:  Contact Name:  Mailing Address:  City:    State:   Zip:  Business Phone:    Fax:  Best Time To Call:   AM PM Contact Email Address:  About Your Business Location Address (if different):  City:    State:   Zip:  Type of Risk: Restaurant Tavern Fast Food Bar Other:  Applicant is:  Individual Corporation Partnership Joint Venture Other:  Mortgagee:     Mortgagee Interest:  Additional Insured:     Additional Insured Interest: $   Per Claim Deductible    $1,000 Liability General Aggregate  $   Products/Completed Operations Aggregate  $   Per Occurrence  $   Medical Payments  $   Fire Damage  $   Liquor Liability  $ Optional Coverages Sign  $  Limits In/Out   Glass  $  Square Footage   Money/Secs  $  Limits In/Out   Food Spoilage  $  Limits In/Out   Other    Rating Information  Construction Type:  Fire/Protection:  Sprinkler Smoke Detector Fire Extinguisher Square Footage:  Total       Customer  Food Receipts:  $         Liquor Receipts $ Underwriting Information  PROPERTY Building Information Age When Rewired Electrical in Conduit Circuit Breakers Fuse Box Plumbing up to Code Y N Y N Y N Y N Building Condition Housekeeping # of Stories Building Code Violations ExcellentGoodPoor Y N What is Right Exposure What is Left Exposure What is Rear Exposure Free Standing Other Occupancies Distance to Nearest Fire Hydrant Y N If adjacent business is a restaurant, does it have automatic extinguishing devices? Is any portion of the building vacant, unoccupied, or seasonal? (If yes, explain) Y N Y N  Kitchen Information Grease Cooking Are ducts, hoods, grease filters and surface cooking areas (including deep fat fryers) protected by a U.S. listed automatic fire extinguishing system? Is such a system professionally inspected and serviced every 6 months? Y N Y N Y N Exhaust filters are cleaned Is there a professional flue cleaning service used on quarterly contract? DailyWeeklyMonthlyOther Y N     By:     Phone Number:  Deep Fat Fryers Automatic Shut Off High Limit Switch Non-Slip Floors Other Kitchen Safety Precautions NoneGasElectricBoth Y N Y N Y N Underwriting Information  LIABILITY Entertainment Live Entertainment # of Players Kind of Music How Many Nights Y N Dancing Disco # of Pool Tables # of Game Machines Y N Y N Underwriting Information  CRIME Safe Class Type of Locks Maximum Cash in Register Check Cashing Y N Alarm # of Alarms Motion Detectors NoneLocalCentral Y N     How often checked:  Name of Alarm Company Any weapons on premises   Ph#:  Y N     If yes, explain:  Underwriting Information  GENERAL How long at this location How long in this type business Operated by Owner Table Service Self Service Any Delivery Y N Y N Y N Y N Hours Open Days Closed # of Employees Estimated Annual Payroll Neighborhood From  to  StableDeclining Ever suffered earthquake damage Type of food served on premises Flaming Drinks Happy Hours Written policy for serving minors/ intoxicated patrons Y N Y N Y N Y N Exits properly marked Alternate Access Security Guards Parking areas adequately lit/maintained Separate cigarette butt containers Designated Smoking Areas Y N Y N Y N Y N Y N Y N Dart Boards Mechanical Devices Prior problems requiring police Any Liquor Violations Y N Y N Y N If yes:  Y N If yes:  Loss History  Current / Previous Insurance Company:  Policy Number:    Expires:  Has any carrier cancelled or refused insurance to this applicant:  Y N     If yes:  Please describe any losses during the past three (3) years Date of Loss:  Amount:  Description of Loss:  $ $