This is a restaurant & hospitality questionnaire. We will review the questionnaire before we contact you so we may better understand your business and your insurance needs.

Business Information

Type of Business Ownership

Select Corporation Limited Liability Corporation Individual Partnership Joint Venture Subchapter S Corp. Not For Profit Organization Other

Proposed Effective Date: Proposed Expiration Date:
Years in Business:
Indicate Types of Coverages Applicable

Property
Glass and Sign
Valuable Papers
Crime
Transportation
Electronic Data
Commercial General Liability
Business Auto
Vehicle Schedule
Boiler and Machinery
Workers Compensation
Umbrella
Delivery
Liquor Liability
Employment Practice Liability
Directors & Officers Liability
Spoilage

Number of Locations:

Nature of Business (Description of Operations)

Use this area for any special comments or coverages which need special attention.

Please select an agent: Select... Bernie Preamble Kevin Jackson Bob Pierce Jim Sellmansberger