Restaurant Liability
Owner Info
First Name
Last Name
Address
City
Zip
State
Select State
AL
AZ
AR
FL
GA
ID
IA
IL
IN
KS
KY
LA
MD
MI
MN
MS
MO
NC
NE
NJ
NM
OH
OK
OR
PA
SC
TN
TX
UT
VA
WA
WI
WY
Phone Number
Email
Property Info
Address
City
Zip
State
Select State
AL
AZ
AR
FL
GA
ID
IA
IL
IN
KS
KY
LA
MD
MI
MN
MS
MO
NC
NE
NJ
NM
OH
OK
OR
PA
SC
TN
TX
UT
VA
WA
WI
WY
Liability Info
Occupancy Class
Select
Restuarant with cooking
Restuarant without cooking
Requested Effective Date
Entity Type
Please Select
Individual
LLC
Corporation
Policy Term
Select
3 Months
6 Months
12 Months
Liablity Limits
Select
10,000
20,000
30,000
40,000
50,000
Total Annual Liquor Sale
Total Annual Gross Sale
Building Value
BPP Value
BI Value
Sign Value
Bullding Constructions
Year Built
Building Condition
Select
Average
Old
New
Building Area in SQFT
Roof Construction
Select
Average
Old
New
Roof Year Built/Replaced
Select
Average
Old
New
BI Option
Select
Yes
No
BI Extra Expense
Central Station Alarm
Select
Yes
No
Sprinklered
Select
Yes
No
IS the risk a, new purchase
Select
Yes
No
Years since All major system (heating,plumbing,air condition,electrical) have been updated)
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