Business Application | Hospitality Risk Consultants

1. Applicant Information Step 1 of 8

First Name *

Last Name *

Email Address *

Business Name *

Business Phone *

Mailing Address *

Mailing City *

Mailing State *

Mailing Zip *

Mailing County *

Premises Address *

Premises City *

Premises State *

Premises Zip *

Premises County *

Applicant Type *

FEIN#

Website Address

Inspection Contact

Inspection Phone

Entity Type

Club Corporation Individual Joint Venture Limited Liability Company Trust Other

Entity Type Other

Number of years in business at this location
2. Liability Information Step 2 of 8

Receipts: Food Total

Receipts: Liquor Total

Receipts: Other Total

Number of Employees: Full Time

Number of Employees: Part Time

Off-Premises Parking

Valet Parking

Off-Premises Parking Address

Catering: percentage of total receipts

Delivery

Delivery: percentage of total sales

Hours: Monday

Hours: Tuesday

Hours: Wednesday

Hours: Thursday

Hours: Friday

Hours: Saturday

Hours: Sunday

Type of Cooking

Type of Fire Suppression System

Wet Dry Water Based Solid Fuel
3. Underwriting Information Step 3 of 8

Seating Capacity

Number of bartenders

Number of Waiters/Waitresses

Average length of employment

Outdoor area for socializing

Square footage of outdoor area

Seasonal Operation
4. Entertainment Information Step 4 of 8

Entertainment at this location

Entertainment Other

Type of entertainment

Band DJ Karaoke Solo Entertainer Other

Frequency of entertainment

Estimated number of occasions annually

Dance Floor

Age: percentage under 21

Age: percentage 21-25

Age: percentage 26-30

Age: percentage 31-40

Age: percentage over 40

Is there security of any type

Altercations in the last 12 months
Number of altercations that have occurred on premises in the last 12 months

Cover Charge

Entertainment: number of dart boards

Entertainment: number of horseshoes

Entertainment: number of jukeboxes

Entertainment: number of poker machines

Entertainment: number of pool tables

Entertainment: number of shuffleboards

Entertainment: number of video games

Entertainment: number of volleyball courts
5. Property Information Step 5 of 8

Property Square Footage: Building Total

Property Square Footage: Occupied Area

Number of apartments

Building Limit

Business Personal Property Limit

Year Built

Construction Type

Year of any property updates

Security Cameras

Security Camera Locations

All public areas are covered by security cameras All interior area are covered by security camera, including storage areas Limited exterior areas are covered by security cameras All exterior areas are covered by security cameras, including all parking lot area(s)
6. Financial Information Step 6 of 8

Financial: entity involved in
Entity currently involved in or has entity ever been involved in

Bankruptcy Business Failures Foreclosure Litigation Tax Liens
7. Liquor Liability Step 7 of 8

Type of liquor license

Regularly close before time on license

Time kitchen closes for full food service

America/New_York

Sells packaged goods

Packaged goods: percentage of liquor receipts

Alcohol awareness training program
Are all employees required to complete an alcohol awareness training program?

Alcohol awareness training program description

Written policy on selling/serving alcohol

Ride policy
Policy to call taxi or provide rides for those who are intoxicated

Documentation kept on each incident

Liquor Violations

Liquor violation Suspended license Revoked license None

Liquor violation details

Designated driver program in place

Minors are allowed on premises

Age verification system

Age verification system details

Any police calls to this location

Police calls to this location details

Regular price for a bottle of domestic beer

Regular price for a well drink
8. Workers Compensation & Submit Step 8 of 8

Workers compensation individuals to be included

Workers compensation individuals to be excluded

Target Premium

Claims contact person

Claims contact person: phone number

Audit contact person

Audit contact person: phone number

Limit of Insurance

Are you human?