Nickie Heath Insurance Agency

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Restaurant Quote

Restaurant Insurance Quote

Name of Business:
Contact Name:
Address:
City:	State: Zip:
Business Phone:	Fax Number:
Contact Email Address:

Current Insurance Information

Current Insurance Carrier:

Premium: $ Expiration Date:

Your Business Information

Number of years In business under current ownership?

At this location?

Has the owner ever been involved in a bankruptcy or business failure?

YES NO

lf needed, will financial statements be provided prior to binding?

YES NO

What are the gross sales for past 3 years:

Year	Food $	Liquor $
Year	Food $	Liquor $
Year	Food $	Liquor $

What are the hours of operation?

Is the business seasonal?

YES NO
Months of operation:
to

Is there a bar or lounge?

YES NO

If yes, describe

Happy Hour?

YES NO

If liquor is served, describe the training protocol for liquor servers

Is there live entertainment?

YES NO

If yes, describe In Comments section (type, nights per week, hours, etc.).

Is there a dance floor(s)?

YES NO

If yes, what is its size?

Are there any operations away from the premises, such as catering?

YES NO

If yes, explain.

Any tableside cooking or food preparation?

YES NO

Was the building originally built as a restaurant?

YES NO

If no, has wiring, etc., been updated for restaurant occupancy?

YES NO

If Yes, When?

Which floor is the restaurant located on?

Maximum seating capacity of restaurant:

Of lounge

Number of exits:

Are all exits free of obstruction, lighted and marked with exit signs?

YES NO

Is there emergency lighting?

YES NO

Has insured ever been cited by Board of Health?

YES NO

If yes, explain

Housekeeping:

Excellent

Good

Fair

Poor

Valet Parking?

YES NO

Is there a coat check room?

YES NO

Are all areas over ranges grills, fryers, and all other cooking surfaces, and hoods and ducts protected by a ULB00-compliant automatic fire extinguishing system?

YES NO

Is there a maintenance agreement to regularly inspect and service the system?

YES NO
No Times per year

Are the employees trained in the use of the automatic extinguishing system and portable fire extinguishers?

YES NO

Is there a maintenance agreement with an outside firm to clean the hood and duct system?

YES NO
Times per year

If no, explain

How often are the grease filters cleaned by the employees?

Additional Comments

Please give any additional comments or questions

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Licensed in: CA #0F04182, AZ #899875, NE #377668, NV #556861 & TX #1552990