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Business Insurance - Restaurant Program
Named Insured:
Contact Name:
Contact Email:
Location of Risk:
Postal Code:
Phone Number:
Building Information
Is the building sprinklered?
Yes     No
Age of building:
Number of Storeys:
Construction of building:
Construction of roof:
How much area do you occupy? (sqFt)
Seating Capacity:
How many other tenants are there?
Is there a Burglar Alarm?
Monitored     Yes     No
Is there a Safe on Premises?
Yes     No
Class of Safe:
Do you use Deep Fat Fryers?
Yes     No
Is there a UL-300 Wet Chemical System in place?
Yes     No
Is the Wet Chemical system on semi-annual contract?
Yes     No
Number of Full-time Employees:
Number of Part-time Employees:
Operation Description
Do you offer Take-out?
Yes     No
Do you offer Dine-in?
Yes     No
Do you offer Delivery?
Yes     No
Food Receipts:
Liquor Receipts:
Delivery Receipts:
Other Receipts:
Limit of Insurance
Building Limit:
Inventory/Stock Limit:
Equipment Limit:
Liability Limit:
Additional Information
Present Insurance Company:
Present Insurance Broker:
Renewal Date (mm/yy/yyyy):
Expiring Premium:
Have there been any insurance
claims in the last 3 years?