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Restaurant & Bar Questionnaire
Call Us Today At
(281) 550-5864
Restaurant & Bar Questionnaire
Basic Information
Legal Name of Business
DBA
Tax I.D. #
Restaurant Main Phone #
Website Address
Legal Structure of Business Entity
Select
Association
Corporation
Government Entity
Individual / Sole Proprietor
Limited Liability Company (LLC)
Limited Liability Partnership (LLP)
Non-Profit
Partnership
Professional Corporation
Subchapter S
Join Venture
Trust
Franchise
Owner Name
Main Contact Name
Personal Residential Address (Street, City, State, ZIP) (Owner Only)
Title
Title
Date of Birth
Date of Birth
Highest Level of Education
Highest Level of Education
Mobile Phone
Mobile Phone
Email
Email
What is your preferred method of communication?
Voice/Phone
Email
Text
Fax
Physical Address for Business Location (Street, City, State, ZIP)
Mailing Address for Business Location (Street, City, State, ZIP)
What is the date you started your business?
MM slash DD slash YYYY
Do You Have More Than One Location?
Yes
No
Please click 𛲜 on right side to add even more locations
Physical Address for Business Location (Street, City, State, ZIP)
Mailing Address for Business Location (Street, City, State, ZIP)
Please click 𛲜 on right side to add even more locations
Physical Address for Business Location (Street, City, State, ZIP)
Mailing Address for Business Location (Street, City, State, ZIP)
Physical Address for Business Location (Street, City, State, ZIP)
Mailing Address for Business Location (Street, City, State, ZIP)
If there is any relevant or pertinent information you would like to share with us pertaining to the information you have provided in this section so far, please type in the box below.
Can you give us an idea of your 5-year history of being in business. For example, prior establishments that you have been employed by or owned and what your role was in those businesses?
Will you be starting any new business ventures in the next 12 months that would be considered 50% owned by you or the entity that owns the restaurant that we will be providing a quote proposal for?
Yes
No
Is your business currently up for sale or are you planning to sell your business in the next 12 months?
Yes
No
Please provide detailed information
How many years have you been in business with this establishment?
How many years of experience do you have as a restaurateur?
Do you have 50% or more common ownership in any other business?
Yes
No
Do you have any outside or silent investors? In other words are there any individuals or entities that have an ownership stake in your business but are not involved in day-to-day operations? (These individuals or entities should not have been listed previously.
Yes
No
Please let us know what those businesses are, if you have any partnerships, and give as much detail about them as possible.
Tell Us About Your Current Insurance
Please indicate the coverage you currently have in force by indicating YES besides each coverage below.
Commercial Liability Coverage
Yes
No
Commercial Umbrella Coverage
Yes
No
Commercial Auto Coverage
Yes
No
Workers Comp Coverage
Yes
No
Employment Practice Liability Coverage
Yes
No
Cyber Insurance Coverage
Yes
No
Food Borne illness Insurance Coverage
Yes
No
Who is your current insurance carrier for this coverage?
How long have you been insured by this carrier for this coverage?
Do you have loss runs available to send if necessary for this coverage?
Yes
No
What is your expiration date for this coverage?
Have you had any claims or losses in the last 5 years for this coverage?
Yes
No
Who is your current insurance carrier for this coverage?
How long have you been insured by this carrier for this coverage?
Do you have loss runs available to send if necessary for this coverage?
Yes
No
What is your expiration date for this coverage?
Have you had any claims or losses in the last 5 years for this coverage?
Yes
No
Who is your current insurance carrier for this coverage?
How long have you been insured by this carrier for this coverage?
Do you have loss runs available to send if necessary for this coverage?
Yes
No
What is your expiration date for this coverage?
Have you had any claims or losses in the last 5 years for this coverage?
Yes
No
Who is your current insurance carrier for this coverage?
How long have you been insured by this carrier for this coverage?
Do you have loss runs available to send if necessary for this coverage?
Yes
No
What is your expiration date for this coverage?
Have you had any claims or losses in the last 5 years for this coverage?
Yes
No
Who is your current insurance carrier for this coverage?
How long have you been insured by this carrier for this coverage?
Do you have loss runs available to send if necessary for this coverage?
Yes
No
What is your expiration date for this coverage?
Have you had any claims or losses in the last 5 years for this coverage?
Yes
No
Who is your current insurance carrier for this coverage?
How long have you been insured by this carrier for this coverage?
Do you have loss runs available to send if necessary for this coverage?
Yes
No
What is your expiration date for this coverage?
Have you had any claims or losses in the last 5 years for this coverage?
Yes
No
Who is your current insurance carrier for this coverage?
How long have you been insured by this carrier for this coverage?
Do you have loss runs available to send if necessary for this coverage?
Yes
No
What is your expiration date for this coverage?
Have you had any claims or losses in the last 5 years for this coverage?
Yes
No
Date of Occurrence Type, Description Date of Claim Amount of Claim
Date of Occurence
Type, Description
Date of Claim
Amount of Claim
Date of Occurrence Type, Description Date of Claim Amount of Claim
Date of Occurence
Type, Description
Date of Claim
Amount of Claim
Date of Occurrence Type, Description Date of Claim Amount of Claim
Date of Occurence
Type, Description
Date of Claim
Amount of Claim
Date of Occurrence Type, Description Date of Claim Amount of Claim
Date of Occurence
Type, Description
Date of Claim
Amount of Claim
Date of Occurrence Type, Description Date of Claim Amount of Claim
Date of Occurence
Type, Description
Date of Claim
Amount of Claim
Date of Occurrence Type, Description Date of Claim Amount of Claim
Date of Occurence
Type, Description
Date of Claim
Amount of Claim
Date of Occurrence Type, Description Date of Claim Amount of Claim
Date of Occurence
Type, Description
Date of Claim
Amount of Claim
If there is any relevant or pertinent information you would like to share with us pertaining to your current insurance needs related to the above or anything else that you have provided in this section please type in the box below.
Lets talk about additional insures or companies that have other interests in your establishment.
Are you required to name any entity as an Additional Insured and provide them a certificate of insurance or evidence of insurance?
Yes
No
If yes please list entity full address & contact info for person we should send proof of insurance to. Please check the box that applies & provide.
Additional Insured
Employee As Lessor
Lienholder
Loss Payee
Mortgage
Name
Address (Street, City, State, Zip)
Evidence of Certificate?
Reference / Loan #
Tell Us About Your Establishment
Which of the below would be the most accurate description of your business?
Restaurant
Fine Dining
Diner
Baquet Hall
Bar or Night Club
Tavern
Dinner Theater
Is your establishment located on a Boat, including Dinner Cruises and Floating Restaurants
Is your establishment located on a Wharf or Pier?
Is your establishment a Hookah Lounge
Adult Entertainment
After Hours Club/Venue
Bartending/Waiter Service
Catering Service
Coffee Shop
Comedy Club
Drive-thru Daiquiri
Grocery Store/Convenience Store
Host of Hostess Bar/Club
Microbrewery/Brew Pub
Restaurant Located in a Food Court
Other
If selected (Other) please specify and elaborate.
What are your hours of operation?
From
To
What is your seating capacity?
What is the public square footage (all areas that are not employees only)
Number of days of the week you are open?
Number of days per week or per year for activity?
Do you have any of the below on your property currently?
Playground equipment
Arcade or game room
Rideable amusement devices
None of the Above
Do you serve alcohol?
Yes
No
What is the minimum age requirement to enter the establishment?
Are all employees trained for responsible service and sale of alcohol through use of an outside resource? (ex.TIPS, ServSafe)
Yes
No
Do you allow BYOB?
Yes
No
Have you had any liquor liability claims or citations against your liquor license or suspension of your liquor license in the past 3 years?
Yes
No
Please explain the details and be as specific as possible.
Is valet parking available?
Yes
No
Are there any habitational or hotel/motel occupants in the same building as your establishment?
Yes
No
Are the valets employed or is the valet service contracted?
Employed
Service Contracted
Do you provide live music?
Yes
No
Is the restaurant open on a seasonal basis or open all year?
Seasonal
Year Round
Do you provide table service complete with servers & waitstaff?
Yes
No
Is the restaurant open 24 hours or past 2 am?
Yes
No
Do you have a cover charge for entry at least one day per week?
Yes
No
Do you use bouncers or security guards?
Yes
No
What is the total percentage of sales from delivery and off-site catering on a percentage (%)Â basis?
(Do not count deliveries made by third parties such as Uber Eats, Seamless, Door Dash, Grubhub, etc.)
Do you offer food delivery services by any means other than automobile?
Yes
No
Please provide details.
Have there been any food code violations in the last five years?
Yes
No
Please provide details.
Are there door men or I.D.Checkers at the door at all times?
Yes
No
Are firearms allowed on the premises?
Yes
No
Are security personnel utilized (bouncers, armed guards, unarmed guards, etc)?
Yes
No
Has there been any prior assault or battery incidents at the premises within the last five years?
Yes
No
Are animals, including dogs, allowed on the premises?
Yes
No
Please provide details.
Here are some questions regarding the entertainment aspect of your establishment.
Is live music provided?
Yes
No
Please provide music type
Classic Rock
Punk
Black, Death, or Thrash Metal
Jazz or R&B
Alternative Rock Hip Hop
Top 40's/Pop
Country or Folk
Rap
Other
If selected other please provide details.
Is entertainment provided?
Yes
No
Please indicate type of entertainment
Adult Entertainment
Sports Court Facilities
Karaoke/Open Mike Night
Live Music Acts
Other
Please provide details.
Are there foam parties or similar events on the premises at any time?
Yes
No
Please provide details.
Is there a swimming pool on the premises?
Yes
No
Do you have a dance floor?
Yes
No
Please provide square footage.
Are there any pyrotechnics used?
Yes
No
Please provide details.
Are there electronic or mechanical amusement devices on premises?
Yes
No
Please provide details.
Tell Us About Your Cuisine & Cooking
What type of cuisine is served at your restaurant?
American
Asian (other than Chinese)
Chinese
Hamburger
Italian
Seafood
Mexican
Pizza
Steak
Other
Please select all of the cooking methods you use at your restaurant.
Wood burning oven
Tandoor
Table-side hibachi
Open pit barbeque
None of the above
Please provide cuisine type and elaborate with any helpful comments for us.
Do you cook with deep fat fryers?
Yes
No
Is there any tableside cooking?
Yes
No
Are customers allowed to cook their own food?
Yes
No
Is any cooking performed using open fire pits or smokers?
Yes
No
Are the deep fat fryer(s) at your restaurant equipped with an automatic fuel shutoff for temperatures above 475 degrees?
Yes
No
Do you have a baffle (steel or glass) of at least 8 inches or 16 inches between the fryer and adjacent cooking surfaces?
Yes
No
Tell us about the Fire Protection at your restaurant
Does any of your cooking involve grilling, open broiling, deep-fat frying, roasting, barbecuing, solid fuel cooking ( i.e. mesquite, charcoal or hardwood) or other processes capable of producing grease-laden vapors requiring an exhaust system?
Yes
No
Does your restaurant have an ANSUL Kitchen Automatic Fire Suppression System Installed in your restaurant?
Yes
No
If you have a Fire Suppression System installed other than an ANSUL system what is the brand name?
Fike
Hockiki
Siemens
Other
Are all cooking appliances at your restaurant that produce smoke or grease laden vapors placed under a hood and duct system?
Yes
No
Please provide details.
Is there an Automatic Extinguishing System covering all cooking areas and surfaces?
Yes
No
Are all commercial cooking appliances at your restaurant covered by a UL 300 Automatic Extinguishing System (AES) that is serviced every 6 months?
Yes
No
If yes, is there a professional service contract in place to service and inspect the system at least semi-annually?
Yes
No
With regard to your cuisine and cooking is there any explanations or comments that you would like to make that would be helpful for the underwriters as they are considering the quote proposal?
Do you have a written semi-annual service contract to service and inspect both your automatic extinguishing system and the hood and duct systems?
Yes
No
Is the hood, filter and duct system(s) at your restaurant inspected daily and professionally cleaned regularly by staff when grease residues appear in the system?
Yes
No
Are BC Extinguishers available in your restaurant?
Yes
No
Does your restaurant have automatic Gas and/or Electric Shut Offs for all cooking equipment?
Yes
No
What is the cleaning schedule for staff to clean your Hoods and Duct systems for your restaurant?
Lets talk about your employees, payroll, and sales
Please indicate sales by category
Food
Liquor
Other
Total Sales
Now some questions about employees and payroll
What's is the total number of employees?
Do you obtain any employees from or contract with a temp staffing company, employee leasing company or employment agency?
Yes
No
Do you perform background checks on all employees?
Yes
No
Do you hire volunteer workers from time to time?
Yes
No
What's the total annual W-2 payroll for your employees?
Do you currently have a Workers' Compensation insurance policy in effect?
Yes
No
When was your last policy in effect?
Has there been any worker injuries or accidents since the last policy was in effect?
Yes
No
Do you have people working for you on a regular basis that are not W-2 employees, in other words Do you pay them as independent contractors or subcontractors and issue them a 1099 at the end of the year
Yes
No
Do you pay any employees with cash only?
Yes
No
Please indicate what those employees do and do they have their own insurance?
Hired And Non-Owner Liability
Do you think you have a need for hired and non-owned liability?
Yes
No
Does your business currently have a commercial auto policy in force?
Yes
No
What range in miles does the company owners or employees travel using hired or non-owned vehicles?
Local ( up to 50 miles )
Intermediate (50 to 200 miles )
Long distance (over 200 miles)
Do you have employees run errands for you in the business using their own vehicles or do you or your employees rent vehicles in any way when on business.
Yes
No
What is the use of hired or rented vehicles?
Please select from below.
Limited to the occasional use of rental cars for out of town travel
Requirement for a contract
Other
How many employees are required to use their personal auto more than times a week for their job requirements?
1-3
4-10
10 Plus
Would you like us to provide a quote proposal for workers comp coverage for you?
Yes
No
Any Work Performed Underground Or Above 15 Feet?
Yes
No
Any Work Performed On Barges, Vessels, Docks, Bridge Over Water?
Yes
No
Are You Engaged In Any Other Type Of Business?
Yes
No
Are Sub-Contractors Used?
Yes
No
If "Yes", Give% Of Work Subcontracted.
Any Work Sublet Without Certificates Of Insurance?
Yes
No
Any Group Transportation Provided?
Yes
No
Any Seasonal Employees?
Yes
No
Do Employees Travel Out Of State?
Yes
No
If "Yes", Indicate State(s) Of Travel And Frequency
Is There Any Volunteer Or Donated Labor?
Yes
No
Any Employees With Physical Handicaps?
Yes
No
If "Yes", Please Specify
Are Physicals Required After Offers Of Employment Are Made?
Yes
No
Are Athletic Teams Sponsored?
Yes
No
Any Prior Workers Comp Coverage Declined/ Cancelled / Non-Renewed In The Last Three (3) Years?
Yes
No
Are Physicals Required After Offers Of Employment Are Made?
Yes
No
Are Employee health Plans Provided?
Yes
No
Do You Lease Employees To Or From Other Employers?
Yes
No
Do Any Employees Perform Work For Other Businesses Or Subsidiaries?
Yes
No
Any Undisputed And Unpaid Workers Compensation Premium Due From You Or Any Commonly Managed Or Owned Enterprises?
Yes
No
If selected Yes, please give details
Commercial Building/Content Information
Do you own the building that the restaurant is in?
Yes
No
Do you want to insure the contents of the building?
Yes
No
Commercial Building Construction Types
Please indicate applicable commercial building construction type
Frame Construction
Frame - exterior walls constructed of wood or other combustible materials such as brick veneer, stone veneer, wood and stucco on wood.
Joisted Masonry
Joisted Masonry - exterior walls constructed of masonry materials such as brick, concrete, block, stone or similar materials and the floors and roof are of wood construction.
Non Combustible
Non-Combustible - exterior walls, floors and roof constructed of metal, gypsum or other non-combustible materials.
Non Combustible Masonry
Masonry Non-Combustible - exterior walls, floors and roof constructed of masonry or fire resistive materials with fire resistance rating of not less than 1 hour.
Fire Resistive
Fire Resistive - exterior walls, floors and roof constructed of masonry or fire resistive materials with a fire resistance rating of not less than 2 hours.
What is the year the building was built?
Roof Type
Concrete
Flat Roof (Asphalt / Rubber)
Flat Roof (PVC / TPO)
Metal
Shingle (Asphalt / Fiberglass)
Slate / Tile
Poured
Wood Shake
Tile
Unknown / Other
Poured Slate
Year Roof Updated
Year Electrical Updated
Year HVAC Updated
Year Plumbing Updated
Smoke Detectors
None
Wired
Battery
Sprinklered Percentage
Less Than 80%
80 TO 99%
100%
Distance To Fire Hydrant (Feet)
Miles From Fire Dept
Number of Stories
Security Cameras
Yes
No
Security Guard on Premise When Closed at Night?
Yes
No
Has Bldg Been Certified By a Registered Design Professional
Yes
No
Local Alarm
Smoke Detectors
Burglar
Central Station Monitored Alarm
Fire
Burglar
Are you responsible for Common Area Maintenance?
Yes
No
Is the building undergoing structural renovations currently or are any extensive renovations planned?
Yes
No
Is there a playground on the premises?
Yes
No
Is there a pool on the premises?
Yes
No
Are you responsible for Common Area Maintenance?
Yes
No
Total building coverage needed (If you own the building):
Total contents or business property coverage needed:
Are you in a Standalone building, strip center, or office building?
What is the total square foot for the building you operate in?
Any area leased to others?
Yes
No
How is the property legally titled?
Total occupied area?
Total sq. footage open to the public
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