RESTAURANT / TAVERN INSURANCE QUOTATION APPLICATION

Today's restaurant environment is more complex than ever and you want to know you're covered for the unexpected occurrence. We offer Insurance Packages which includes Business Liability, Property and Crime coverage's designed to meet your needs. Whether your restaurant is elegant, trendy, traditional, ethnic or homestyle we have the package for you.

    Coe Insurance specializes in providing insurance for the following types of restaurants:
  • Restaurants
  • Delis / Sandwich shops
  • Cafes
  • Diners
  • Cafeterias
  • Drive-ins
  • Carry-out restaurants
  • Fast food
  • Coffee shops
  • Food bars
  • Fine dining restaurants
  • Family-style
  • Luncheonettes

Complete the Restaurant/Tavern insurance form below to receive free quote(s).
Get a great quote from Coe Insurance today!

To help us supply you with the most accurate quote possible, please answer as many questions as you can with the most accurate information available to you.

Information submitted will be held confidential and will be used for quote purposes only. Submission of application information in no way obligates you to purchase any product or insurance, nor does it represent any agreement to provide coverage under any insurance policy.

Owners Information
Owner Name(s):
E-Mail:
Phone Numbers:
Daytime:
Evening:
Fax:
Contact Preference: Daytime Evening Fax E-mail
When is the best time to reach you?:
Address:
City: State: Zip Code:
Date of Birth: Height: Weight: Sex:
Occupation:
Social Security Number: (optional)
Restaurant/Tavern Location and Policy Information
Location Address :
City: State: Zip Code:
Website: Business Phone:
Mailing Address (if different):
Effective/Renewal Date: Current/Target Premium:
Current Carrier: Has Current Policy Been Canceled?:
Restaurant/Tavern Type
Application is a: Application Type is a: Located in:
Number of years at this location: Number of years in Restaurant/Tavern Business:
If less than 3 years at this location, list previous experence:
Federal EIN#:
Liquor License Number:
Legal Building Occupancy:
Franchise, Chain & Operations Information
Franchise: Chain:
Is Operations open now?: If "No", Explain:
Hours of Operation (From-To & Number of Days open per week):
Is Operations Seasonal?: If "Yes", Explain:
Distance to Ocean or Nearest Body of Water:
Financial Information
Is Owner or Corporation now or ever involved in Bankruptcies?:
Is Owner or Corporation now or ever involved in Foreclosures?:
Is Owner or Corporation now or ever involved in Tax Liens?:
Is Owner or Corporation now or ever involved in Business Failures?:
Is Owner or Corporation now or ever involved in Any Litigations?:
If "Yes", to any of the above please explain:
Physical Location Section
Age of: Building Construction Protection Class # of stories
Age of: Wiring Plumbing Heating Roofing
Other Occupants:
If "Yes", Explain:
Smoke Detectors:
If "Yes", Type:
Fire Alarm:
If "Yes", Type:
Burglar Alarm:
If "Yes", Type:
Video Cameras :
Volunteer Fire Dept:
Distance to: Hydrant: Fire Dept:
Kitchen Fire Protection:
U.L. Approved Automatic Extinguishing System under Semi-Annual Contract:
Above System Covering all cooking surfaces: If "Yes", System Name:
Automatic Gas or Electric Shut off for cooking:
Hood and Filters cleaned Weekly by Staff:
Hoods and Ducts over all cooking equipment:
Hoods and Ducts Maintenance Contract Schedule: If "Yes", # per Month:
Fire Extinguishers Tag Dates:
Is Kitchen Sub-Leased: If "Yes", Name:
Table Cooking or Tableside Cooking: If "Yes", Name:
Entertainment Section
Entertainment: If "YES", entire section must be completed.
List Nights w/Entertainment: (example: Thu & Friday only)
Type of Entertainment:
If "Other", Explain:
Coverage Charge:
If "Yes", describe when/why:
Dance Floor/Stage :
If "Yes", Square Ft & Dancing Permitted?:
Amusement Devises (Pool Tables, Video Games, etc):
If "Yes", Describe Devises:
Liquor Legal Liability Section
Does Applicatant Serve Alcohol?: If "YES", entire section must be completed.
Liquor License Number/Type:
# of Bar Steats:
Max # of staff per shift:
Bartenders: Wait Staff: Avg Employment Exp (yrs):
Alcohol Server Training:
If "Yes", Explain Training:
Liquor Policies
Does Applicant have written Policy on Serving Alcohol to Customers?:
Is Management Notified Prior to Shutting Off Patrons?:
Is Documentation kept on each Incident?:
Is there a steady bar clientele?: # of Bars on Premises:
Is there a happy hour?:
Reduced Price Drinks?:
Is last call given?: If "Yes", what time?:
Have there been any ABC Violations, if so please list ALL violations:
Note: Additional Information will be required, such as Insurance Limits and Deductibles, Liability Selection and an Additional Interests, Your Coe Insurance Representive will contact you shortly.
Questions, Comments or Additional Restaurant/Tavern Information?