Restaurant Insurance Quote Form

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: # isCell Biz Home
Mailing Address:		Contact Name:
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):		Website:
List all Owners / Officers Names:

Brief Description of the Restaurant / Tavern / Club (Examples: Family Style, Fine Dining, Bar, Night Club)

POLICY INFORMATION

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

If you have had prior insurance, have you ever had a policy cancel or non-renew for any reason?Y..N

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