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  Restaurant Insurance Quote
Full Name:
Street Address:  
City, State & Zip:  
E-Mail Address:  
Website Address:
Day Telephone:  
Eve Telephone:  
Fax:  
*Please email or fax copies of current policies, declarations, 3 year loss runs, and any other available information.
 
 Current Insurance Information
Current Insurance Carrier:
Premium: $                          Expiration Date:   
 
 Your Business Information

Number of years In business under current ownership?

At this location?
Has the owner ever been involved in a bankruptcy or business failure?   No
lf needed, will financial statements be provided prior to binding?   No
What are the gross sales for the past 3 years:
Year Food  $ Liquor  $
Year Food  $ Liquor  $
Year Food  $ Liquor  $
What are the hours of operation?
Is the business seasonal?   No
Months of Operation: to
Is there a bar or lounge?   No
If yes, describe:
Happy Hour? Yes   No
If liquor is served, describe the training protocol for liquor servers:
Is there live entertainment?   No
If yes, describe In Comments section (type, nights per week, hours, etc.):
Is there a dance floor(s)? Yes    No
If yes, what is its size?

Are there any operations away from the premises, such as catering?

Yes No

If yes, explain.
Any tableside cooking or food preparation? Yes    No
Was the building originally built as a restaurant? Yes     No
If no, has wiring, etc., been updated for restaurant occupancy? Yes    No
If Yes, When?
Which floor is the restaurant located on?
Maximum seating capacity of restaurant: Of lounge
Number of exits:

Are all exits free of obstruction, lighted and marked with exit signs?

Yes No

Is there emergency lighting? Yes    No
Has insured ever been cited by Board of Health? Yes    No
If yes, explain
Housekeeping: Excellent   Good    Fair    Poor
Valet Parking? Yes    No
Is there a coat check room? Yes   No

Are all areas over ranges grills, fryers, and all other cooking surfaces, and hoods and ducts protected by a ULB00-compliant automatic fire extinguishing system?

Yes     No                     Number of Times per year

Is there a maintenance agreement to regularly inspect and service the system?

Yes    No

Are the employees trained in the use of the automatic extinguishing system and portable fire extinguishers? Yes    No
Is there a maintenance agreement with an outside firm to clean the hood and duct system? Yes    No                   Times per year
If no, explain
How often are the grease filters cleaned by the employees?
 
 Any additional comments or information that might be helpful in your quote:

No coverage of any kind is bound or implied by submitting information via this online form

Information from you and other sources, such as your driving, claims and insurance histories, may be used to calculate an accurate price for your insurance.

We will not distribute information to other parties other than for insurance underwriting purposes.

By checking the box below you agree to release us from any liability should this information be accidentally viewed by others.

 

YES! I Agree - By checking this box, you agree to release us from any liability should this information be accidentally viewed by others and you specifically agree that you are permitting any records to be run and reviewed in order to provide you with the best quotation including but not limited to accident loss history, motor vehicle record and credit.

 

 

(p) (828) 258-8030 ∙ (f) (828) 258-8030
(e) tony_johnson_agency@nationwide.com