Elementor #3973 - Urban Advantage

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Restaurant Quote

Restaurant quote submission form

Agency Name

Agency Email

Agency Phone Number

During the last five years, has any applicant been indicted for or convicted of any degree of the crime of fraud, bribery, arson or any other arson-related crime in connection with this or any other property?

Yes

No

Has the prospect had a foreclosure, repossession, bankruptcy, judgment or tax lien, business failure or any litigation during the past five (5) years?

Yes

No

Have there been any past losses or claims relating to sexual abuse or molestation allegations, discrimination or negligent hiring?

Yes

No

Has the prospect had any losses in the past 4 years (current policy and prior 3 years)? If "Yes", please provide details of loss on "Additional Comments" field below.

Yes

No

Has any policy or coverage been cancelled or non-renewed during the prior three (3) years for other than non-payment of premium?

Yes

No

Business Type

Corporation

Partnership

Individual

Other

LLC

Joint Venture

Insured's Name

Doing Business As (DBA)

Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Restaurant Type

Fast food

Casual

Family Dining

Fine Dining

Other

Years in Business

Effective Date

Does the prospect own or operate any other business?

Yes

No

Limits of Liability

$300,000

$500,000

$1,000,000 / $2,000,000

$2,000,000

Medical Expenses - Each Person

$5,000

$10,000

Excluded

Deductible

$500

$1,000

$2,500

Liability Property Damage Deductible

$500

$1,000

$2,500

None

Liability Bodily Injury

$500

$1,000

$1,500

$2,500

None

Important! Total Annual Sales

Total Number of Employees

Will you be selecting Hired and/or Non-owned Auto coverage for this prospect?

Yes

No

Data Compromise Coverage

$50,000

$100,000

$250,000

None

Liquor Liability Coverage

$300,000

$500,000

$1,000,000 (Aggregate)

None

Amended Liquor Liability Excluding Scheduled Activities (Special Events)

Yes

No

Gross Annual Liquor Receipts

Restaurants Loss or Damage to Customers' Auto

Yes

No

Is the risk within 1000 feet of a fire hydrant?

Yes

No

How Many road miles is the risk from a responding fire station?

Less than 5 road miles

Greater than 5 miles but less than 7 road miles

Greater than 7 road miles

I don't know

Consecutive years in business?

Does the prospect currently have property and liability insurance on this location?

Yes

No

Occupancy

Owner occupied

Tenant

Building Type

Located in Enclosed Mall

Located in Strip Mall

Stand Alone Building

Sole Occupant

Yes

No

Franchise

Yes

No

Is the prospect solely a banquet hall, reception hall, or function hall that hosts parties, banquets, weddings, or other receptions or social events?

Yes

No

Describe the food preparation operations:

Ltd cooking-domestic range, warming/pizza oven, microwave or cold prep

Also includes deep fat frying, grilling. Enclosed broiling, roasting or BBQ

Also includes open broiling or solid fuel(charcoal/Hardwood) cooking

Is alcohol consumed on the prospects premises?

Yes

No

What percentage of the annual receipts is from the sale of alcohol?

Do they continue to serve alcohol for more than 2 hours after the kitchen closes?

Yes

No

Is the restaurant seasonal?

Yes

No

Restaurant Class

Cafes-Ltd, cooking- No deep Fat Frying

Concession Stands/Snack Bars- Ltd. Cooking- No deep Fat Frying

Delicatessens and Sandwich Shops

Donut Shops

Ice Cream and Yogurt Shops

Pizza Shops

Take out Only

Construction Type

Frame

Joisted Masonry

Non-Combustible

Modified Fire Resistive

Fire Resistive

Building Year Built

Year Roof was last completely replaces or resurface:

Year of Plumbing update

Year of Heating update

Number of stories

Roof Type

Concrete

Flat Roof - Asphalt

Flat Roof – PVC/TPO

Metal

Shingle-Asphalt/Fiberglass

Slate/Tile

Wood

Unknown/Other

Total Building Square Footage

Total Square Footage occupied by the insured:

Is the business open 24 hours/day?

Yes

No

Automatic Sprinkler System (100% of Building):

Yes

No

Automatic Fire Alarm:

Central or Police Station

Outside Siren Only

None

Automatic Burglar Alarm:

Central or Police Station

Outside Siren Only

None

Automatic Commercial Cooking Extinguishing System (aka Ansul system):

Yes

No

N/A

Seating Capacity

Is this building currently closed due to COVID-19?

Yes

No

Is Building coverage needed for this property?

Yes

No

Is the prospect involved in manufacturing, mixing, relabeling or repackaging of products?

Yes

No

What is the percentage of off-site catering services including set-up, service and clean-up?

Is the prospect a dance club or night club or do they have any door security, hookah, exotic dancers, bottle service (other than wine) or an entry fee?

Yes

No

Does the prospect have live entertainment, karaoke or Disc Jockeys (DJs)?

Yes

No

Are all fire extinguishers tagged, mounted and tested annually?

Yes

No

Does the prospect have a written semi-annual (quarterly for Asian style cuisine) service contract to clean the cooking hood and exhaust duct system?

Yes

No

Are the deep fat fryers located at least 16 inches from open flame or separated by a vertical stainless steel barrier?

Yes

No

Does the prospect have a pest control service contract?

Yes

No

What percentage of total receipts are from employee deliveries?

What percentage of total receipts are from outside delivery services such as Uber Eats, DoorDash, Grubhub, etc?

Is any table side cooking performed?

Yes

No

Does the prospect sell, design, manufacture, distribute, serve or furnish any products containing cannabis, synthetic cannabinoids or equivalents, such as, but not limited to K2, Spice, or other similar products in any form for bodily ingestion, inhalation, absorption or consumption either on-site or off site(excluding any CBD products)?

Yes

No

What percentage of total receipts come from products containing CBD?

Business Personal Property Limit

Building Coverage Limit

Restaurant Deluxe Coverage

Yes

No

I understand that Urban Advantage Insurance will be contacting the insured for additional information. Please let us know if you would like to be notified, before reaching out to the insured, in the additional comments below.

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