Restaurant Insurance Quote Form

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Copyright 2000 [Thompson-Gusic Insurance Group, Inc.].  
ALL RIGHTS RESERVED

Restaurant / Tavern / Club
Quote Form

-  If you are located outside of PA or OH, please email robb@thompsongusic.com or call 412-271-8888 to check availability.

-  The "ENTER" or "RETURN" Key will submit the application.   Use the "TAB" Key and Mouse to navigate.  If application is submitted by mistake, use the "BACK" Button on your browser to return to the application. 

-  Allow up to 2 weeks to receive a quotation

GENERAL INFORMATION

Legal Business Name:

 Phone:

Mailing Address:

 Contact:

City:

State:  Zip:  Fax:

Type of Entity:

C Corp S Corp LLC Partnership Individual Non-Profit  Email:

Year Business Established:

     Years Experience in Field:  Quote Need by Date:

Federal ID # (FEIN):

 
 Brief Description of the Restaurant / Tavern / Club (Example American/Latin Fusion Restaurant):

POLICY INFORMATION

 Current Carrier:     Expiration Date:     Current Premium:
 (Not Agency)  State "NONE" if no current coverage.

PREMISES INFORMATION
NOTE: Building Owners & Tenants must complete the below information if any Property is to be covered.  

 Location:  Address, City, State, Zip:
 List Other Tenants in Bldg. (Ex: Offices, Retail, Manufacturing, Storage):
 Bldg. Construction:   # Stories:   Approx. Square Feet You Occupy:   % Bldg You Occupy:
 What % of the area you occupy is NOT open to the public (such as kitchen, office, employee room)?
 Year Built:    Is Building Stand Alone or Connected to Buildings: Stand Alone...Connected    # of Apartments?
 NOTE:  Are Heating, Air Conditioning, Electrical, Plumbing and Roof in good condition and up to code:   Y...N

PROPERTY PROTECTION

 Burglar Alarm:Y..N      Fire Alarm:Y..N      Are Alarms connected to Police/Fire or Monitored?Y..N
 What company services the alarm?
 Fire Department within 5 miles?Y..N      Fire Hydrant within 1,000 Feet?Y..N      Building Sprinklered?Y..N  
COOKING / OTHER PROTECTION
 UL Approved Extinguishing System over Cooking Equipment?Y..N   Automatic Gas / Electric Shut Off?Y..N
 How often is the Automatic Extinguishing System serviced by an outside firm?Monthly  Semi-Annually  Quarterly  Annually
 
What company services the system?
 How often are Hoods, Ducts, Fans cleaned by an outside firm? Weekly Monthly Semi-Annually Quarterly Annually
 
What company cleans the hoods, ducts, fans?
 Contract with Pest Control?Y..N     Service Frequency? Weekly Monthly Semi-Annually Quarterly Annually

LIMITS OF INSURANCE

 DEDUCTIBLE?
 IF YOU OWN THE BUILDING:   Building Limit?   Contents Limit?
 IF YOU ARE A TENANT:
  "Build Out" Limit (Permanently Installed Items such as flooring, lighting, bar, kitchen equipment?
  "Contents Limit" (any other items you could carry out such as inventory, tables, chairs, computers, etc?
  OTHER NOTABLE SPECIFIC COVERAGES & LIMITS:

LIABILITY INFORMATION & LIMITS

 LIABILITY OCCURRENCE LIMIT:
 LIQUOR LIABILITY OCCURRENCE LIMIT:
 UMBRELLA LIMIT:

 LIABILITY RATING

 Annual:  Food Sales:  Alcohol Sales:   Other Sales:
 DELIVERY: Approx. % of Sales from Delivery:

SUPPLEMENTAL INFORMATION

 Days of Operation:  Monday  Tuesday  Wednesday  Thursday  Friday  Saturday  Sunday
 Earliest Time You Open:
  Latest Time You Close:    OR  Open 24 Hours
 Seating Dining Room:    --   Seating Bar:   or No Bar  or  Service Bar Only
 Do you have Liquor License?Y..N   If Yes, type of License?    License #?
 Are alcohol Servers given formal alcohol training such as TIPS, ServSafe, etc?Y..N
 Do you offer Table Side cooking?Y..N
 Describe Any Entertainment or Amusement Devices? (Bands/DJ-type & how often, Pool Tables-# of, Video Games-# of, Jukebox, etc.) 
 Is there a Dance Floor?Y..N     If Yes, how large (square feet):     Any Bouncers Used?Y..N
 Is there a Happy Hours or Drink Specials?Y..N    If Yes, is reduced priced food offered during?Y..N
 What is the average Entree Meal Price? or Not Applicable (meals are not served)
 Do you offer Valet Parking?Y..N   If Yes, Valet Parking is provided by?  You   An Outside Firm
 # of Employees:  Full Time    Part Time

CLAIMS INFORMATION or LIQUOR VIOLATIONS -  Past 5 Years

Check here if NONE.  If incidents please complete below

Date of Loss

Description of Loss  -  Enter "NONE" in Description Line below if no losses.

Amount Paid

ADDITIONAL COMMENTS / INFORMATION


 
The above information is correct to the best of my knowledge.  Check:   Initials:
  

WOULD ALSO LIKE A QUOTE FOR:
   AUTO  -  Please complete COMMERCIAL AUTO Quote Form on the Quote Forms page.
   WORKERS COMPENSATION - We will contact you for information needed to quote.     

QUESTIONS / HELP

Phone: 412-271-8888
Fax: 877-271-8898
Email: insurance@thompsongusic.com

 

 

T.R.G.
Copyright 2000 [Thompson-Gusic Insurance Group, Inc.].  ALL RIGHTS RESERVED
Revised: April 06, 2016 .