Hospitality Risk Consultants

The Hospitality Insurance Experts

Online Quote for Restaurant/Bar/Lounge/Nightclub
Please fill in as much information as possible.
You may contact our office with any questions.
"*" denotes required field

Corporate Name:*
S-Corp C-Corp LLC Partnership* Individual Other
Business Name:* (DBA)
Federal ID Number:* (FEIN)
Describe your business:*
Location address:*
City:*
State:*
Zip code :*
Located within city limits?*	Yes No
Phone:*
Fax:
Cell Phone:
Email address:
Web Site:
# of years ownership under this name:*
Currently open for business?*	Yes No
If not open, estimated opening date:
Effective or renewal date of policy:*
If new, please describe ownership/management experience:
Do you sell food?	Yes No
Food Sales (annual $):* If none, please enter "0" If new, please estimate
Do you sell alcohol?	Beer/Wine only Full Liquor No
Alcohol Sales (annual $):* If none, please enter "0" If new, please estimate
Do you have a cover charge?	Yes No
Cover Sales (annual $):* If none, please enter "0" If new, please estimate
Do you deliver?	Yes No
Delivery Sales (annual $):* If none, please enter "0" If new, please estimate
Do you cater off premise?	Yes No
Off Premise Catering Sales (annual $):* If none, please enter "0" If new, please estimate
Do you have any other sales?	Yes No Describe
Other Sales (annual $):* If none, please enter "0" If new, please estimate
Building Information
Total square feet:
Public access area square feet:
Seating capacity inside:
Seating capacity outside:
Number of stories:
Basement?	Yes No
Free standing building?	Yes No
Adjacent tenants?	Yes No
Left exposure:		Looking at your front door, what is to your left? (i.e. parking, driveway, store, etc.)
Right exposure:		Looking at your front door, what is to your right? (i.e. parking, driveway, store, etc.)
Rear exposure:		Looking at your front door, what is to your rear? (i.e. parking, driveway, store, etc.)
Year building built:
Building construction type:		Concrete, CBS block, wood frame or metal?
Roof construction type:		Wood, concrete or metal?
Building Updates (what year)
Roof:
Wiring:
Plumbing:
Heating:
Other:
Windstorm Information
Distance to shoreline: (miles to ocean or gulf)
Do you have hurricane shutters?	Yes No
If yes, what type?
Risk eligible for:	FWUA ICAT Not sure
Safety Information
Central Station Alarm?	Yes No
If yes, name of monitoring company:
Cooking?	Yes No
Fuel shut off valve?	Yes No
Any open flame grilling?	Yes No
Fire supression system?	Yes No
If yes, type of system:
Service contract for supression system?	Yes No Not Applicable
Date of last service:
Frequency of service:
Cleaning contract for hood & duct system?	Yes No Not Applicable
Date of last service:
Frequency of service:
# of fire extinguishers in Kitchen: Dining Area: Bar Area:
Distance from fire hydrant:
Distance from fire station:
How many lighted exit signs?
Date of last inspection by Board of Health?
Number of Violations?
Are deep fat fryes equipped with thermostat control and automatic shutoff?
Yes No Not Applicable (no fryers)
Do you have a system for dating food deliveries?
Yes No
Do you serve raw seafood?
Yes No If yes, what are annual sales?
Do you keep food covered at all times while refrigerated?
Yes No
Do you have written procedures to inspect premises for spills, etc to control potential slipping/tripping?
Yes No
Do you have written inspection logs for bathrooms and public access areas?
Yes No
Are employees trained in the proper method of assisting a choking patron?
Yes No
Do you properly dispose trash and store dirty linens?
Yes No
Do you provide table side cooking?
Yes No
Do you have TV monitors?	Yes No
If yes, how many?
Is parking lot under your control?	Yes No
If yes, how many square feet?
Do you maintain the parking lot free of debris and is the parking lot properly lit?
Yes No Not Applicable
Is there a safe on the premises?	Yes No
How frequently are bank deposits made?
Liquor Information
Is liquor served beyond 2:00 AM?	Yes No If yes, until what time?
Is there a last call for Alcohol?	Yes No
Do you provide Happy Hour?	Yes No
If yes, please describe: (i.e. Mon-Thurs 4-6)
What is you liquor license #?
Alcohol Awareness training program in force?	Yes No Type:
Entertainment Information
Is there any live entertainment?	Yes No
If yes, please describe: (i.e. piano, 2-3 piece bands, days per week, etc)
Is there a contract signed for the entertainment?	Yes No
Do you have a dance floor?	Yes No If yes, square footage:
# of Bouncers/Guards: # of ID Checkers:
# of Pool Tables: # of Dart Boards: # of Video Games: Other:
Insured Values
Building		Dollar value of replacement cost of building. This will apply if you own the building or are required to insure the building as part of your lease.
Improvements & Betterments		Dollar value of replacement cost for all interior improvements including all built-in items, bars, attached equipment such as hoods, ansuls, etc.
Contents/Personal Property		Dollar value of replacement cost for all other contents and personal property and non-built-in items. (i.e. tables, chairs, computers, POS system, equipment, etc.)
Business Interruption		Monthly amount needed to pay for all on-going operating expenses such as rent or mortgage, insurance payments, key employees, loss or profits, etc. in the event of business interruption due to a covered loss.
Attached signs		Dollar value of replacement cost of all signs that are attached to the building. If none, please enter "0".
Free standing signs		Dollar value of replacement cost for all free-standing signs. If none, please enter "0".

Additional information/comments: