• AGENT: Joanie Klein
  • ID: 92b835a4-4e1c-4a25-a2d4-ca2748838585

Bar / Tavern / Pub / Restaurant



Applicant Information  
Effective Date:
Is this a new opener?
DBA Name:
Name of the individual, partnership, LLC or corporation applying for insurance:
Business hours:
Applicant telephone number:
Applicant web site address:
Years of management experience:
Number of full time employees:
Number of part time employees:
Does the risk currently have an EPLI policy?
Are there past Employee Practice claims or any known situations that could give rise to a claim?
Location address:
City:
State:
Zip Code:
County:
Are the Location Address and Mailing Address the same?
Mail address:
City:
State:
Zip Code:
Years applicant has been at this location:
Inspection contact name:
Officer/Owner/Manager name:

 
Current year carrier:
Do you currently control the account?
Current year premium including taxes and fees: If unknown, enter 0.
Are there any claims in the past 3 years?

 
Property  
Questions:  
Building address:
Year built:
Is the building fully sprinklered?
Has the sprinkler system been tested in the last 12 months?
Is there an active fire central station alarm with a valid certificate present?
Is there an active burglar central station alarm with a valid certificate present?
Describe other building occupants besides applicants:
Describe neighboring exposures:

 
Is this a seasonal risk?

 
Does the risk have cooking on premises?
How frequently is the hood & duct system cleaned?

 
Are there adequate Fire Doors, Panic Bars, Lighted Exit Signs, Emergency Lighting or Emergency Exit devices?
Have the fire extinquishers been serviced in the last 12 months?
Video Surveillance:

 
Is property and liability insurance coverage currently in effect?
Has risk been previously cancelled or had a lapse in coverage?

 
Is any property currently vacant, partially vacant, unoccupied or closed for business?
Is the risk in the course of construction or major renovation?

 
Have there been any bankruptcies, financial reorganizations, or liens in the past 3 years?
Are there any firearms or guard dogs on premises during or after business hours?

 
Protection class:
Does the risk have an Inland Marine exposure?

 
Coverages:  
Building limit:
Building cause of loss:
Building coinsurance:
Building valuation:

 
Does the risk own or lease the building?
Improvements & betterments (IB) limit:
IB cause of loss:
IB coinsurance:
IB valuation:

 
Business personal property (BPP) limit:
BPP cause of loss:
BPP coinsurance:
BPP valuation:

 
Business income limit:
Business income type:
BI coinsurance:

 
Exclude ordinary payroll?

 
Building Ordinance A?
Building Ordinance B Limit:
Building Ordinance C Limit:

 
Please enter the year of the last HVAC system update:
Please enter the year of the last roof update:
Please enter the year of the last electrical updates:
Please enter the year of the last plumbing updates:

 
Total building square footage:
Insured public square footage:

 
Number of stories:
Number of stories occupied by the insured:
Construction type:
Roof type:
Property extension endorsement:

 
Property deductible:
Theft deductible:
Outdoor signs limit:
Outdoor signs deductible:

 
General Liabilty  

 
Questions:  
Does the insured sponsor any teen nights or events targeted for patrons under the age of 21?

Are pyrotechnics allowed on the premises?
Are there any bikini, wet T-shirt and/or lingerie contests or events conducted on premises?
Are there metal detectors on the premises?
Does Risk Collect Cover Charges?
How many nights per week are cover charges collected?

 
Does the risk have dancing?

 
Does the risk have music?

 
Does the risk offer adult entertainment?

 
Does the risk have live entertainers (other than live bands such as comedians or dancers)?

 
Does the risk have security personnel or ID checkers?

 
Does the risk have amusement devices?

 
Does the risk have gaming or gambling exposures?
Number of card tables:

 
Does the risk serve alcohol?
Please describe the warning/citation/violation including their dates:

 

 
Does the risk have on-site beer brewing?

 
Coverages:  
For increased limits up to 3 million please contact your underwriter!
 
General aggregate limit:
Each occurence:
Personal and advertising injury:
Products / Completed operations aggregate limit:
Liquor Liability Limit:
Assault & Battery Sublimit:
Fire damage limit:
Does the risk want employee benefit liability coverage?
Bodily injury deductible:
Property damage deductible:
Does the risk have primary auto coverage in place?
If no, does the risk want hired, non-owned auto coverage?

 
Sales and Exposures:  
Food and Non Alcoholic Beverages Receipts:
Liquor, Beer and Wine Receipts:
Gambling net Receipts:
Catering Receipts:
Cover Charge Receipts:
Miscellaneous receipts:
Describe any other miscellaneous receipts:
Parking Lot Square footage:
Lessor's Risk Only exposure type:
Lessor's Risk Only exposure square footage:
Vacant land (acres):
Number of apartments:
Does the risk want stop gap coverage?
Does the risk have Special Events?
Describe any special events in which the risk participates during the year:

 
Assault & Battery  
Does your current policy exclude assault or battery coverage?
What is the current assault or battery limit?
Number of assault or battery claims in the past 3 years:
Please describe the claims:
Desired Assault & Battery Limit:

 
Crime  
Is crime coverage required?

 
Fidelity  
Does the risk want fidelity coverage?

 
Additional Interest:  
 


Name: 
Address: 
City: 
State: 
Zip: 
Relation: 

 
Loss Payees:  
 


Name: 
Address: 
City: 
State: 
Zip: 
Relation: 

 
Additional Storage or Office Space:  
 


Description: 
Address: 
City: 
State: 
Zip: 
Square Feet: 
Property Limit: 
BPP Limit: 

 
Agent Notes:  
Has the producer visited the risk in the last 90 days?
Submission notes:
255 maximum characters which is approximately 5 lines. If you need to say more then please email your underwriter.