PROPERTY & LIABILITY QUOTE



Pizza Delivery Insurance Questionnaire

GENERAL INFORMATION

*
*

BUSINESS INFORMATION

LOCATION INFORMATION

CURRENT COVERAGE

LOCATION INFORMATION

Food & Beverage Sales (not including Delivery)
Alcohol Sales
Catering Sales
Delivery Sales
Total Annual Sales
If own building, what is the Building Replacement Cost, including attached Signs
Replacement Cost of Business Personal Property
Replacement Cost of Leasehold Improvements

LOCATION INFORMATION (CONT'D)

Square Footage of Restaurant
Estimated Sq. Ft. of other tenants in building
Estimated Total Square Footage of Building
What percentage of building is Vacant?
Building Construction
Number of Stories
Building Age (Year Built)
If built more than 25 years ago, indicate year electrical, plumbing, roofing updated.
Is Restaurant Sprinkled?
Do you have a Burglar/Fire Alarm?
Is Alarm Local of Central Station?
Hours of Operation
Hours of Delivery
Is restaurant in Strip Mall or Free Standing
Do you have a backup power source?
Is there a Habitational Exposure within the building (apartments/condos)

GREASE LADEN FRYING/GRILLING

If Yes, answer the following:

LIQUOR LIABILITY

If Yes, answer the following:

DRIVING DETAILS

DELIVERY

If Yes, answer the following:

OWNED AUTO

OTHER

LOSS HISTORY INFORMATION

DRIVER INFORMATION

INSURANCE INFORMATION

WAGE AND TURNOVER DETAILS:

ANNUAL TURNOVER RATE - divide the number of voluntary separations during the year by the average number of employees during the year and multiply by 100.

BENEFITS INFORMATION

SAFETY PROGRAM:

APPLICATION COMPLETION