Food Truck Insurance Questionnaire

Food Truck Insurance Questionnaire
Applicant's Name: *
Address: *
Mailing Address
Address (cont): *
Mailing Address - continued
Contact: *
Email *
Telephone: *
Website
Fax:
Applicant is:

Individual Partnership Corporation Other (specify) Other
Current Carrier:
Expiration Date:
Limits: ($)
Premium: ($)
Deductible: ($)
OPERATIONS - Please provide pictures of inside and outside of each food truck, food trailer, and/or food stand.
1. Do you have a mobile food service license or permit? (Please provide copies of all permits/licenses)

Yes No
2. How long have you been in operation?
2a. If less than 3 years, how many years of experience do you have in the food industry?
2b. Describe experience:
3. Please list type of cuisine served and other items you sell. (Please provide a menu if available.)
4. In what states do you operate?
5. Radius of operations
6. Do you park at a specific location/site for extended periods of time?

Yes No
6a. If yes, how many locations/sites per day?
6b. Describe the locations/sites:

7. Gross Receipts

7a. Describe "Other" Receipts:
8. Describe the cleaning and sanitation schedule for the food truck/cart.
9. Has the local Department of Health inspected your operation? ( If yes, provdie a copy of the most recent inspection.)

Yes No
10. Have you ever been cited for any city, county or state health code violations?

Yes No
10a. If yes, please explain.
11. List the type of hand held fire extinguishers kept in the food truck/cart.
12. Does your cooking emit grease-laden vapors?

Yes No
12a. If yes, is the cooking area protected by an extinguishing system meeting UL 300 standards?

Yes No
12b. If yes, do you have a semi-annual servicing/cleaning contract for the extinguishing system?

Yes No
13. Is your business operational year round?

Yes No
13a. If no, what months are you operational?
14. Hours of operation.

15. Number of Employees

	Full-time	Part-time
Number of Employees

16. Commissary / Central Kitchen
Name, Street Address, City, State, Zip, Phone Number
17. Limit requested for spoilage ($):

	Building Age	Building Construction	Building Limit ($)	Content Limit ($)
Building 1
Building 2

	Vehicle 1	Vehicle 2	Vehicle 3
Year
Vehicle Make
Vehicle Model
Body Type
Length
GVW
VIN
Radius
Owner/Operated - Yes/No
Lessor Operated - Yes/No
Employee Operated - Yes/No
Purchase Date
Purchase Price
Stated Amount
Did price include conversion cost (permanently installed equipment) - Yes/No/NA
If No, Date kitchen conversion
Cost to customize kitchen (Describe below)
Cost of mobile personal property (non-permanent equipment)
Anti-Lock Brakes (2-wheel, 4-wheel, none)
Antitheft Devices (Describe below)
Trailers - Hitch-lock installed - Yes/No