General Information
Address *
Address
Main Contact *
Main Contact
Contact Number *
Contact Number
http://
Insurance Renewal Date
Insurance Renewal Date
Please provide a detailed description of your operations. The more we know, the more equipped we'll be to negotiate with our underwriters for competitive rates!
How many years have you been in business?
Check all Coverages Needed
What is the seating capacity within your restaurant?
Some of our insurance carriers will rate your premiums on area (square footage), while others will rate you off of sales or even payroll. We would like to know each of these items, so we can determine the most competitive way to rate YOUR restaurant.
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Please tell us about the number of claims you've experienced in the last 5 years. Please be as detailed as possible including when the claim happened, approximately how much was paid out, and any other details that come to mind.
How much is your gross annual payroll? We will break this number down more specifically if you'd like Work Comp coverage below, but for now the Gross Annual Payroll will suffice.
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Restaurant Questionnaire
How late does the restaurant stay open?
How late does the restaurant stay open?
disregard the seconds...we're not THAT nosy
Is the restaurant seasonal?
Is the restaurant part of a franchise?
Any food or alcohol delivered?
Any raw fish or meats served?
Do designated employees receive annual training on safe food handling practices?
Any critical or high food service or health board violations?
Is there a written procedure to document slips and falls, objects in food, food poisoning, and other complaints?
Does the restaurant participate in any off premises operations (parades, contests, festivals, etc)?
Is there a written contract to service refrigeration systems?
Are all floors in good repair and nonslip precautions in place?
Are slicer safety features in place?
Is cleanliness of the food preparation area good?
Are exit doors easily accessible and lit?
Are the sidewalks, entry areas and parking lot in good condition?
Kitchen Fire Protection
Are all cooking surfaces and deep fryers covered by a metal exhaust hood with ductwork?
Is there a written contract for commercial cleaning of the exhaust hood, including ductwork and filters?
Are all commercial cooking surfaces and deep fryers protected by a WET automatic chemical extinguishing system?
Is the automatic extinguishing system(s) serviced under a written maintenance contract at least every 6 months?
If yes, what was the last date of service inspection?
If yes, what was the last date of service inspection?
Are the filters, hood, rear wall and appliances free of grease accumulation?
Is the outside wall, roof, and bell housing free of grease accumulation?
Does the restaurant(s) have banquet hall facilities seating more than 50 people?
Is any tableside cooking performed?
Are there any open pits/hearths or open flame grills?
Are there "Class K" fire extinguishers and are they serviced annually?
Is there a fire alarm?
Entertainment
Entertainment (check all that apply)
Liquor
Please give a detailed description, including the name of the program (ie: TIPS, TOPS, etc.), indicate if all servers/bartenders are required to attend the program within 60 days of hiring, and if written materials are made available to employees to reinforce skills learned in training.
If yes, please describe...
Has your liquor license ever been suspended or revoked?
If yes, please describe details...
Is there a separate bar or lounge area?
If yes, please describe in detail including the number of each...
Does the business supply the bartender/servers for catered events?
Are receipts from catering operations more than 10% of your Total Receipts?
Please check all that apply
Property
IF PROPERTY COVERAGE IS NOT DESIRED, FEEL FREE TO SKIP DOWN TO THE NEXT ELIGIBLE SECTION.
Whether you own the entire building, or if you're a condo unit owner, or even if you're a tenant, we're looking for the total square footage of the entire building.
In this section, we're only looking the the approximate square footage of the area you inhabit within the building.
If there are other tenants within your building, we'll need to know their business names as well as what they do.
If you own your building or condo, how much coverage would you like on it?
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How much coverage would you like for your business personal property (contents)?
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Please list any additional buildings, signs, fences, playgrounds, etc.
Approximately what year was your building built?
A "central" reporting burglar alarm reports to a police station, and a "local" burglar alarm reports to a local alarm company.
If your sump-pump fails, or sewage backs up through your sewers and drains, you'll need to add this coverage by endorsement if you would like coverage. This is standard throughout the industry.
While many insurance agents are not aware of this, coverage for computer hardware and software are excluded underneath the business personal property form and must be added separately underneath the Electronic Data Processing (EDP) form. This is standard across the industry.
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This insurance protects the employer from financial loss due to the fraudulent activities of an employee or group of employees. The loss can be the result of the employee's theft of money, securities or other property of the employer.
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Premises Exposures
Please indicate how much average money you keep on premises, how often the bank deposits occur, and whether or not money is kept in a safe.
Asphalt Shingles (most common) Metal Slate/Tile Flat
None Sagging Missing Shingles Worn Shingles
General Liability
If you have any additional insured's, please list them below. The reason we ask here, is because if you have a landlord or a food vendor asking to be listed as an additional insured on your General Liability policy, we will want to factor this into the quote that we work up.
This coverage is liability insurance for employers that covers them from from wrongful termination, discrimination, sexual harassment, and other violations of employees' legal rights.
Data Breach Insurance, also known as Cyber Liability Insurance, provides coverage after the theft or loss of both first-party and third-party data. This means that, whether the data breach happens directly to your company or to a company whose data you are working with, you’re covered. If you would like a quote for this coverage, please indicate the amount.
When a data breach is experienced, there is often a large expense incurred by simply responding to the crisis through conducting proper Public Relations. If you would like coverage for this exposure, please indicate the amount.
Workers' Compensation
An experience modification, commonly called an “e-mod,” is an important factor used to adjust your work comp premium. Experience modifiers are calculated by organizations known as "rating bureaus" and rely on information reported by insurance companies. The rating bureau used by most states is the NCCI, the National Council on Compensation Insurance.
An owner of a business has the option to exclude themselves from their Work Comp coverage and thus save some money on their premiums. If you would like to take this option, please list each owner, their annual payroll, and the type of work they are specifically engaged in (ie: office work, sales, in the field, etc.)
Please list each classification along with its corresponding payroll. For example, you may have a "server/waiter/waitress" classification for your servers with a corresponding payroll of $100,000, or a "chef/cook" classification for your kitchen staff with a payroll of $50,000.
This coverage provided by part 2 of the workers compensation policy provides coverage to the insured (employer) for liability to employees for work-related bodily injury or disease, other than liability imposed on the insured by a workers compensation law.
Commercial Auto
Please list the year, make, model, and VIN for each vehicle that you would like coverage for. Please also indicate which vehicles should have full coverage (collision & comp deductibles) and which should have liability only. Or, call the office at 219-213-2306 to send a PDF file over.
If your car is damaged or destroyed in an accident, collision insurance coverage will typically pay to fix or replace it. Types of covered accidents include hitting another car or hitting a stationary object, like a bridge or a tree.
With Comprehensive coverage, your insurance company pays for damage to your auto caused by an event other than a collision, such as fire, theft or vandalism. If you hit an animal, or if your auto is flooded or stolen, Comprehensive coverage will apply.
Non-owned and hired automobile liability insurance covers bodily injury and property damage caused by a vehicle you hire (including rented or borrowed vehicles) or caused by non-owned vehicles (vehicles owned by others, including vehicles owned by your employees).
Commercial Umbrella
A business umbrella policy picks up where your business auto liability, general liability or other liability coverage stops. Umbrella insurance is an inexpensive way to provide extra coverage against bodily injury and/or property damage.
Is there anything else that you would like us to know?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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