317 Pequot Avenue
PO Box 528
Southport CT 06890
203-255-2877 P
203-254-8427 F
Restaurant Insurance Quote
CONTACT INFO:
NAME:
PHONE NUMBER: TYPE: ALT PHONE: TYPE: EMAIL:
PHONE NUMBER: TYPE: ALT PHONE: TYPE: EMAIL:BUSINESS NAME:
MAILING ADDRESS:
FEDERAL EMPLOYERS ID # (FEIN):
RESTAURANT DINING CLASS:
TOTAL GROSS RECEIPTS:
ALCOHOL SERVED:
TOTAL GROSS LIQUOR RECEIPTS:
FULL TIME EMPLOYEES:
PART TIME EMPLOYEES:
ANNUAL EMPLOYEE PAYROLL:
YEAR BUSINESS ESTABLISHED:
PRIOR INSURANCE CARRIER:
PRIOR POLICY EXPIRATION:
CURRENT DEDUCTIBLE:
ANY CLAIMS IN PAST 5 YEARS:
QUESTIONS & COMMENTS:
TOTAL SQUARE FOOTAGE:
PUBLIC AREA SQUARE FOOTAGE:
SEATING CAPACITY:
HOURS OF OPERATION:
LOCATION (BUILDING) TYPE:
VIDEO SURVEILLANCE:
SPRINKLER SYSTEM:
TYPE OF ENTERTAINMENT:
DANCE FLOOR:
SQUARE DANCE FOOTAGE:
TYPE OF AUTOMATICE FIRE SYSTEM:
HOW OFTEN IS FIRE SYSTEM INSPECTED:
DEEP FAT FRYERS:
UNDERWRITING INFO: PROPERTY LOCATION INFORMATION
