| RESTAURANT QUOTE |
| Your Name: |
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| Business Name: |
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| Address: |
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| City: |
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| State: |
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| Zip Code: |
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| PROPERTY INFORMATION |
| Property County: |
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| Total Square Footage of the Building Your Business
Is In: |
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| Square Footage Of Your Business Only: |
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| Square Footage Of The Customer Area: |
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| Construction Type: |
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| Are There Smoke Detectors At This Location? |
yes
no
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| Smoke Alarm: |
yes
no
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| Theft Alarm: |
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| Fire Alarm: |
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| Fire Extinguisher: |
yes
no
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| Deadbolts On All Doors? |
yes
no
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| Interior Automatic Fire Sprinklers: |
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| UNDERWRITING INFORMATION |
| Please Describe the Nature of Your Business and Any
Unusual Exposures: |
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| Total Annual Gross Receipts: |
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| Total Annual LIQUOR Receipts: |
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| Total Annual FOOD Gross Receipts: |
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| Years of Experience: |
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| How Many Years Have You Operated This Business: |
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| Is This Business Open 24 Hours A Day? |
yes
no
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| ENTERTAINMENT INFORMATION |
| Is There Entertainment? |
yes
no
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| If Yes, Describe: |
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| Is There LIVE Music? |
yes
no
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| If Yes, Indicate Size of the Dance Floor and Nights
Per Week: |
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| Any Coin Operated Amusement Devices? |
yes
no
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| If Yes, Describe: |
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| Any Pool Tables? |
yes
no
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| If Yes, How Many And Are They Coin Operated: |
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| Any Bouncers, Doormen, ID Checkers, Armed Guard, Security
Guards? |
yes
no
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| If Yes, How Many Of Each, List Their Job Duties & Are
They Your Employees: |
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| Any Contests or Exhibitions? |
yes
no
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| If Yes, Describe Events: |
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| Any Audience Participation Events? |
yes
no
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| If Yes, Describe Events: |
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| Do You Sponsor Any Sporting Events? |
yes
no
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| If Yes, Describe Events: |
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| Did We Miss Any Other Type Of Entertainment, If Yes,
Describe: |
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| COOKING INFORMATION |
| Describe The Cooking Devices At Your Business: |
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| Tableside Cooking? |
yes
no
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| Automatic Suppression System? |
yes
no
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| If Yes, Do They Protect All Hoods, Ducts & Griddles? |
yes
no
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| Any Deep Frying (Food)? |
yes
no
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| If Yes, Is There A High Limit Shutoff? |
yes
no
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| Do You Have An Outside Cleaning Service For The Hoods & Duct
System? |
yes
no
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| How Often Are Hood & Duct Cleaned: |
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| Any Delivery Service? |
yes
no
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| Any Catering Service? |
yes
no
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| MISC. INFORMATION |
| Losses-Claims in the last 5 years: |
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| If yes, date, amount paid and description of each loss-claim |
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| Current Insurance Company: |
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| Current Renewal Date: |
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| Has Insurance Ever Been Cancelled? |
yes
no
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| If Yes, Describe: |
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| COVERAGE INFORMATION |
| Building Coverage: |
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| Other Structures Coverage: |
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| Business Contents Coverage: |
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| Loss of Use Coverage: |
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| Liability Limits Requested: |
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| Policy Deductible: |
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Questions or Comments
to help the Agent: |
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| How should we contact
you? Please select |
| Phone Number: |
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| Fax Number: |
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| E-Mail Address: |
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