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Restaurants

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Business Name*
Contact Name*
Email Address*
Phone Number*
Fax Number
Street Address
City
State
Zip
Description of your restaurant
Please provide a detailed description of your restaurant business.
Premises Information
Value of Building
Value of Contents
Total Square Feet
Square Footage of Dining Room Area (if you don't have a dining area - enter 0)
Year Built
Construction Type
Value of food in storage/refrigerator
Do you own or rent the building you're in?
If you selected 'Own', do you rent to others?		Yes No
If so, how many square feet?
Is there a basement?		Yes No
Do you have a burgler alarm?		Yes No
If 'Yes', is it a Central Station Alarm?		Yes No
Name of Alarm Company
Do you have a fire alarm?		Yes No
Who maintains it?
Have you made any improvements to the building?		Yes No
If "Yes", please tell us what and when:
Distance from the nearest building:
Right
Left
Rear
Annual Gross Receipts
Annual Payroll
Years in business
Gross Sales from Food
Alcohol Service
Desired deductible
Current carrier
Current Policy Number
Policy Expiration Date

*Required Field