Restaurant and Bars Quote Request
Company Name
Location Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Contact Name
First Name
Last Name
Phone Number
Format: (000) 000-0000.
E-mail
Back
Next
Type of Business:
Restaurant (Family Style)
Restaurant (Fast Food)
Sports Bar
Bar
Nightclub
Other
Business Description
Describe operations, hours, entertainment, etc.
Years in Business
Years Experience
Prior / Currently Insured
Yes
No
Expiration Date
-
Month
-
Day
Year
Date Picker Icon
Check all that apply
Prior Claims
Open after 2 AM
Delivery
Live Entertainment
Dance Floor
Bouncers / ID Checkers
Catering
Banquet Hall
Food Sales
Liquor Sales
Other Sales
Seating Capacity
Full Time Employees
Part Time Employees
Total Payroll
General Liability Limit
Please Select
$100,000
$300,000
$500,000
$1,000,000
$1,000,000/$2,000,000
Liquor Liability Limit
Please Select
None
$100,000
$300,000
$500,000
$1,000,000
$1,000,000/$2,000,000
Property Coverage
Yes
No
Back
Next
Year Built
Number of Floors
Area (SQFT)
Type of Construction
Please Select
Frame (Wood)
Jointed Masonry
Masonry Non Combustible
Fire Resistive
Check all that apply
Central Station Burglar Alarm
Central Station Fire Alarm
Surveillance Cameras
Building Limit
If building owned
Improvements
Contents
Bus. Income
Sign
Other Coverage Requested
Submit
Print Form
Should be Empty: