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Taverns & Restaurants

Hospitality insurance is an agency specialty.

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Let’s start with the basics.

Tell us a little about your needs so our Peoria team can follow up.

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Comments

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DBA

Individual

Partnership

Corporation

Other

If other, please describe

Full Name of Business including DBA as per your liquor license*

Name of Owner of Property*

Address of Owner of Property*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Mailing Address

Street Address Address Line 2 City State ZIP Code

Location of Business Address

Is address the same as mailing address?

Street Address Address Line 2 City State ZIP Code

Phone (Day)

Phone (Evening)

Website

Business Description

Length of Time in Business/Experience

In Years

New Venture?

Yes

No

Prior Carrier

Expiring Premium

Lapse in Coverage?

Yes

No

Please describe

Any Claims in Last Three (3) Years?

Yes

No

Please describe

Has Any Company Cancelled or Refused Coverage to the Applicant?

Yes

No

Please describe

Property Section

Desired Limits and Coverages

Building Replacement Cost or Actual Cash Value

Replacement Cost

Actual Cash Value

Amount of Coverage

Business Personal Property — Replacement Cost or Actual Cash Value

Replacement Cost

Actual Cash Value

Amount of Coverage

Loss of Income*

Yes

No

Sign

PLEASE PROVIDE AMOUNT OF COVERAGE FOR EA SIGN

Do You Have a Central Fire Alarm?

Yes

No

Do You Have a Central Theft Station Alarm?

Yes

No

Year Built

Number of Stories

Apartments Above?

Yes

No

Construction

Frame

Masonry

If other, please describe

Square Feet of Entire Building

Square Feet of Percentage Occupied

Year of Property Updates

Roof

Wiring

Heating

Plumbing

Looking at your business from the front please describe what is located next to your business below

Use plus sign (+) to add more to any column

Right

Left

Front

Rear

Within City Limits?

Yes

No

Distance to Fire Department

Distance to Hydrant

Type of Area of Your Location

Check all that apply

Urban

Suburban

Rural

Industrial

Commercial

Residential

Cooking on Premises?

Yes

No

If Yes, Do You Use a Deep Fryer?

Yes

No

If Yes, Temperature Limit Protection?

Yes

No

Automatic Extinguisher?

Yes

No

Semi-Annual Maintenance Contract?

Yes

No

If you do cook, do you have a Fire Suppression System?

Yes

No

Month and Year last professionally cleaned

ex. June 2015 or 6/2015

Liability Limits

$300,000

$500,000

$1,000,000

$2,000,000

Estimated Annual Receipts

Food

Catering

Other

Beer/Wine/Liquor

Type of Alcoholic Beverages Sold:

Beer

Wine

Hard Liquor

Is there a Parking Lot On-Premises for Customers?

Yes

No

Square Feet or Length and Width of Parking Lot

What is your seating capacity?

Average Age of Clientele

Dance Floor

Yes

No

Square Feet of Dance Floor

Live Entertainment?

Yes

No

How Often?

Describe

Have you had any claims in the last five years?

Yes

No

If yes, explain

Who is your current insurance company?*

When does it expire/renew?*

Do you want workers compensation?*

Yes

No

What is your annual payroll?

Contact Information

Contact Full Name*

Email*

Position*

Best Method of Contact*

Phone

Email

Text

Fax

Phone Number*

Best Time to Contact*

:

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Taverns & Restaurants

Let’s start with the basics.

Property Section

Contact Information

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