Restaurants - Hutch

Restaurants- Hutch

Business

Business name:

Legal entity:

Number of employees:

Contact name:

First Last

Phone:

Address:

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Other location(s):

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email:

Website / Social Media:

Annual sales:

Annual payroll:

Federal tax ID number:

Franchise:

Current carrier:

Years with current carrier:

Policy expiration date:

Number of claims:

Claim(s) details:

Type of restaurant:

Seating capacity:

Square foot area:

Number of employees:

Receipts for Alcohol:

Receipts for Food:

Total:

Underwriting

Has the Applicant ever been canceled (incl. nonpay) or refused insurance of any kind by ERIE or any other insurance carrier?

If yes, please explain:

Has the Applicant filed for bankruptcy in the past 5 years?

If yes, please explain:

All Restaurants

Is restaurant(s) open past midnight?

What are the hours of operation?

Is restaurant(s) seasonal?

If yes, list dates closed:

Is restaurant(s) part of a franchise?

Is food or alcohol delivered by vehicle?

By foot or bicycle?

Is more than 5% of food served raw fish or meats?

(i.e. sushi, oysters, steak tartare, etc.)

Do designated employees receive annual training on safe food handling practices?

Any critical or high food service or health board violations?

Score / Date:

Is there a written procedure to document slips and falls, objects in food, food poisoning and other complaints?

Are all floors in good repair and nonslip precautions in place?

(look for tripping hazards)

Are slicer safety features in place?

Is cleanliness of the food preparation area good?

Are exit doors easily accessible, unblocked, and lit?

Are the sidewalks, entry areas and parking lot in good condition?

Kitchen Fire Protection

(Complete this section ONLY if commercial cooking is performed.)

Are all cooking surfaces and deep fryers covered by a metal exhaust hood with ductwork?

Is there a written contract for commercial cleaning of the exhaust hood, including ductwork and filters?

If Yes, what is the schedule?

(i.e. monthly, quarterly, semi-annually, annually?)

Date of last inspection:

Are all commercial cooking surfaces and deep fryers protected by a WET automatic chemical extinguishing system?

Is the automatic extinguishing system(s) serviced under a written maintenance contract at least every 6 months?

Date of last inspection:

Is the automatic extinguishing system ever disconnected?

If yes, why?

Are the filters, hood, rear wall and appliances free of grease accumulation?

Are the outside wall, roof and bell housing free of grease accumulation?

Does restaurant(s) have banquet hall facilities seating more than 50 people?

If yes, what is the seating capacity?

Is any tableside cooking performed?

Are there any open pits/hearths or open flame grills?

If yes, please describe in detail:

Are there Class K fire extinguishers and are they serviced annually?

Is there a fire alarm?

If yes, Central or Local:

Entertainment

Check all that apply:

Types of entertainment and how often?

Example: The restaurants supports club sports… “What type of club sport, and how often?”

Liquor Liability

Limits of liability requested:

Each Common Cause:

Policy Aggregate:

Does business have a formal alcohol awareness training program?

If yes, what is the name of the program?

(TIPS, TOPS, etc.)

If yes, are all servers/bartenders required to attend the program within 60 days of hiring?

If yes, do you make written material available to reinforce the skills learned in the training program?

Has the Applicant submitted any claims in the past 5 years regarding liquor liability coverage or had any incidents that might give rise to a claim?

If yes, provide details:

Has Applicant been cited or fined by a government agency for any liquor violations?

If yes, provide details:

Has the Applicant ever had their liquor license suspended or revoked?

Has liquor liability coverage ever been canceled, non-renewed or denied in the past?

If yes, provide details:

Is there a separate bar or lounge area?

Does business have any bouncers, security guards, doormen, or ID checkers?

Does business supply the bartender/ servers for catered events?

Are receipts from catering operations more than 25% of your total receipts?

If yes, provide details:

Check all that apply:

Happy hour

Drink specials

Flaming drinks

Ladies’ /Men’s nights

Cover charge

None

Property

Blanket

Contents:

Deductible:

Additional Property (signs, lights, clocks, fences, playgrounds, etc.)

Construction type:

Protection class:

Year built:

Building square footage:

Applicant square footage:

Number of stories:

List other tenants:

Building designed for current use?

Sewer / Drain:

Employee dishonesty:

Computer coverage:

Include enhancement endorsement

Premises Exposures

Smoke Alarms:

Fire Alarm:

Money on premises:

How often are bank deposits?

Money in safe:

Year of roof:

Roof type:

Roof condition:

Roof concerns:

Burglar Alarm:

Outside lighting:

Peeling / Flaking paint?

If yes, where?

Any Deterioration / Dry Rot?

If yes, where?

Foundation condition:

Walking surfaces:

Heating type:

Heating condition:

Age:

Electrical condition:

Age:

Overall Housekeeping?

General Liability Limit

Select one:

Umbrella?

Rating basis:

Sales / Receipts:

Payroll:

Data Breach liability:

Employee benefit liability:

Employment practices liability:

Deductible:

Number of Employees (full-time):

Number of Employees (part-time):

Third-party coverage?

Workers’ Compensation

Expert modification factor:

Expert modification date:

Sole proprietor / Partners coverage?

Corporate officer coverage?

List

Class code #:

Payroll =

Average length of employment:

Safety:

Safety meetings

Lifting training

Forklift training

PPE training

(check all that apply)

Eye washing stations?

Autos

Auto used in business?

Autos titled to?

Hired / Non-owned?

Do your corporate officers maintain a personal auto policy?

If no, consider adding the corporate officers named coverage endorsement.

Included at direct primary

Limit is actual loss

Liability

Med Pay

Um / Uim

Comp

Coll

List

Year

Make

Model

VIN

Documents

Check each box when complete:

Exterior photos of front and back

Interior photos (bar area, seating area, kitchen cooking line, hood cleaning sticker, automatic extinguishing system service tag, entertainment, if any)

Loss runs

Copy of cleaning contract

Restaurants – Hutch