Liquor Store Insurance Quote

Quote Request

Complete the following information if you would like to obtain a quote. Please understand this is not an application. An application will be sent to you if coverage is desired.

All information provided on this information sheet is confidential and will be used solely for the purpose of developing a quote for you.

    Personal Information

    *First Name

    *Last Name

    Business Name

    Street Address

    City/St/Zip

    *Phone Number

    Alternate Number

    *Email Address

    Underwriting Information

    Number of Owners

    Number of Employees

    Payroll of Owners

    Payroll of Employees

    Total annual gross receipts

    Total annual sub costs

    Business License Number

    License Type

    Years of experience

    Years operated under current name

    Other business names

    Is this business open 24 hours a day?

    YesNo

    Any deep frying (food)?

    YesNo

    Is there any manufacturing, mixing, re-labeling or repackaging of products?

    YesNo

    Is there filling of propane tanks?

    YesNo

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

    Building and Property Information

    Total square footage of the building your business is in

    Total square footage of your business only

    Total square footage of the customer area only

    How many stories is it?

     

    If two stories, what is the ground floor square footage?

    What is the construction type?

    What type of roof covering?

    Was the roof updated?

    YesNo

     

    If yes, what year?

    What is the distance to fire protection?

    Is the business in a brush area?

    YesNo

    Do you have a storage area more than 1500 sq. ft?

    YesNo

    Are there smoke detectors at this location?

    YesNo

    Are there fire extinguishers?

    YesNo

    Are there deadbolts on all doors?

    YesNo

    Are there circuit breakers?

    YesNo

    Is the electrical updated?

    YesNo

    Is the heating / air conditioning thermostatically controlled?

    YesNo

    Is the heating/ air conditioning central?

    YesNo

    Has the plumbing been updated?

    YesNo

     

    If yes, what yearwas the plumbing updated?

    Does the building have interior automatic fire sprinklers?

    YesNo

    Is there a theft alarm?

    YesNo

    Is there a fire alarm?

    YesNo

    Are there any restaurants in your building?

    YesNo

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

    YesNo

    Claims Information

    Were there any losses or claims in the last 5 years?

    YesNo

     

    If yes, what is the date, amount paid and description of each loss or claim?

    Coverage Information

    Current Insurance Company

    How much are you paying now?

    What is the liability limit requested?

    What is the building limit requested?

    What is the building deductible requested?

    What is the business personal property (contents) limit requested?

    What is the contents deductible requested?

    What is the loss of income requested??

    Questions or Comments

    Best Time To Contact You

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    MorningAfternoonEveningAnytime

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