Restaurant Insurance Quote

First Name (required) : Last Name (required) :

Street Address (required) : City (required) : State (required) : Zip Code (required) :

Phone (required) : Your Email (required) : Best Time To Reach You:

UNDERWRITING INFORMATION

Restaurant Name: Restaurant Type: Entity Owner Payroll:

# Of Employees: Employees Payroll: Annual Gross: Open 24 Hours: Deep Frying:

Please describe the nature of your business and ANY unusual exposures:

COVERAGE INFORMATION

Liability limit?: Building limit?: Business Personal Property (contents)?: Deductible?:

BUILDING PROPERTY INFORMATION

Total SqFt Bldg.: Total SqFt Business: Construction Type: Roof Type: Year Updated:

Was electrical updated?: Year Updated: Was plumbing updated?: Year Updated:

Does the building have interior automatic fire sprinklers?: Is there a theft alarm?: Is there a fire alarm?:

Are there any other restaurants in your building?: Are there any other restaurants in the building next to your business?:

CLAIMS INFORMATION

Any losses or claims in the last 5 years?: If yes, what is date, amount, and description of losses / claims?:

Are there any questions, comments, additional coverage, or Service You Require?:

Please contact us by phone if you'd prefer to speak to an agent or need help with this form. We can be reached at (916) 984-9320