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What type of insurance do you need? * (check all that apply)

Business Owners Policy (Package)

Disability Insurance

Employment Practices Liability Insurance

General Liability Insurance

Property Insurance

Worker's Compensation Insurance

Contact Name

Contact Phone Number

Contact E-mail

info When should this coverage begin? *

If you have existing insurance policies, please enter your approximate renewal date.

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info Are you under construction?

If you are currently under construction or are planning a build out, please tell us how long you will be under renovation.

What is the business' legal (LLC) name? *

What is the business' trade name? *

What is your Federal ID number?

info Address of the location?

Please provide multiple addresses if you have multiple locations.

Days and Hours of Operation?

Please list all company owners and their ownership

info Please describe management experience of each owner

Business owners with significant industry experience are eligible for thousands of dollars in annual discounts, called "experience modifiers".

Additional Insureds (landlords etc.)?

Projected Annual Revenue?

Any Previous/Current Insurance Policies?

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What types of cooking will be done on site? (check all that apply)

Grilling

Roasting

Frying

BBQ

Hood and duct information (check all that apply)

Hoods and ducts over all cooking equipment?

Sprinklers / automatic extinguishing system covering all cooking services?

Hood and filters cleaned weekly by staff?

Hood and filters cleaned by contracted third party?

Will There Be Catering / Banquet Operations?

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Will there be employed delivery drivers?

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info Value of business personal property on site?

Business Personal Property includes all supplies, equipment and any fixtures used in the operation of a business. Also referred to as "contents".

Liquor License # (if applicable)

Do you have a happy hour?

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What is your % of alcohol sales to total sales?

info Do you have live entertainment?

Venues that host live music events, cabaret shows, DJs, or similar events may be subject to higher liability insurance rates.

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What year was your building built?

info Construction Class

If you are unsure, your landlord should know this information.

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What is the approximate square footage of your space?

Is there a basement or cellar on site?

When was the roof last updated?

When was the heating last updated?

Primary Heat

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When was the plumbing last updated?

Do you have fire sprinklers installed?

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Do you have a burglar alarm installed?

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Do you have security cameras installed?

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What is your projected annual payroll?

How many full time employees do you have?

How many part time employees do you have?

How many of your employees are male?

How many of your employees are female?

% of employee turnover in last 12 months?

Will any owners/officers be excluded from Worker's Comp coverage? If yes please list excluded members

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Do you offer employee benefits or health insurance? If yes, what % is contributed by employer

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Is there safety training/a safety manual in place? If yes please describe

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