Utilize our One-Step Online Quote Request Forms to get a pricing indication for your insurance need.



RESTAURANT INSURANCE QUOTE
Please fully complete the following data form, and simply click the "Submit" button and we will contact you with an insurance quotation.

Please note we cannot accept binders or policy changes by email, only by phone during normal working hours.



RESTAURANT OWNER INSURANCE

First Name:
Last Name:
Email Address:
Business Name:
Mailing Address:
Mailing City:
Mailing State:
Mailing Zip Code:
Phone Number:
Fax Number:
PROPERTY INFORMATION

Property Address:

Property City:
Property State:
Property Zip Code:
Property County:
Total Square Footage of the Building Your Business Is In:
Square Footage Of Your Business Only:
Square Footage Of The Customer Area:
How Many Stories:
Construction Type:
  
Roof Type:
  
Roof Updated:
 yes no  
If Yes, Year Roof was Updated:
Protection Distance:
Is The Business In A Brush Area?
 yes no  
Is There Storage More Than 1500 Sq Ft?
 yes no  
Are There Smoke Detectors At This Location?
 yes no
Smoke Alarm:
 yes no
Theft Alarm:
Fire Alarm:
Fire Extinguisher:
 yes no
Deadbolts On All Doors?
 yes no
Circuit Breakers:
 yes no
Electrical Updated:
Heating - Air Conditioning, Thermostatically Controlled?:
 yes no 
Heating - Air Conditioning, Central?
 yes no
Plumbing Updated:
 yes no
If Yes, Year Plumbing was Updated:
Interior Automatic Fire Sprinklers: 
Is The Parking Lot Under Your Protection?

yes no

UNDERWRITING INFORMATION

Please Describe the Nature of Your Business and Any Unusual Exposures:

Number of Owners:
Number of Employees:
Payroll of Owners:
Payroll of Employees:
Total Annual Gross Receipts:
Total Annual HARD LIQUOR Receipts:
Total Annual BEER & WINE Receipts:
Total Annual FOOD Gross Receipts:
Business License Number:
License Type:
Years of Experience:
How Many Years Have You Operated This Business:
Is This Business Open 24 Hours A Day?
 yes no
Is there Filing Of Propane Tanks? 

yes no  

ENTERTAINMENT INFORMATION

Is There Entertainment?

yes no

If Yes, Describe:
Is There LIVE Music?
 yes no
If Yes, Indicate Size of the Dance Floor and Nights Per Week:
Any Coin Operated Amusement Devices?
 yes no
If Yes, Describe:
Any Pool Tables?
 yes no
If Yes, How Many And Are They Coin Operated:
Any Bouncers, Doormen, ID Checkers, Armed Guard, Security Guards?
 yes no
If Yes, How Many Of Each, List Their Job Duties & Are They Your Employees:
Any Contests or Exhibitions?
 yes no
If Yes, Describe Events:
Any Audience Participation Events?
 yes no
If Yes, Describe Events:
Do You Sponsor Any Sporting Events?
 yes no
If Yes, Describe Events:
Did We Miss Any Other Type Of Entertainment, If Yes, Describe:
COOKING INFORMATION

Describe The Cooking Devices At Your Business:

Tableside Cooking?
 yes no
Automatic Suppression System?
 yes no
If Yes, Do They Protect All Hoods, Ducts & Griddles?
 yes no
Any Deep Frying (Food)?
 yes no
If Yes, Is There A High Limit Shutoff?
 yes no
Do You Have An Outside Cleaning Service For The Hoods & Duct System?
 yes no
How Often Are Hood & Duct Cleaned:
Is There Any Manufacturing, Mixing, Re-Labeling or Repackaging of Products?
 yes no
Any Delivery Service?
 yes no
Any Catering Service?
 yes no
MISC INFORMATION

Losses-Claims in the last 5 years: 

 

If yes, date, amount paid and description of each loss-claim
Current Insurance Company:
Current Renewal Date:
Has Insurance Ever Been Cancelled?
 yes no
If Yes, Describe:
Have You Ever Had Regulatory Violations or Citations?
 yes no
If Yes, Describe:
Are Employees Trained On How To Handle Minors or Intoxicated Customers?
 yes no
If Yes, Describe:
COVERAGE INFORMATION

Building Coverage:

Other Structures Coverage:

Business Contents Coverage:

Loss of Use Coverage:

Liability Limits Requested:

Policy Deductible:

Questions or Comments
to help the Agent:
Please press the Submit Button ONCE.
Then wait for online confirmation of your request.
Thank you for your interest.




17821 E 17th St, Suite 100, Tustin, CA 92780 :: LICENSE #0543173