Restaurant Quote Form HiddenSalesperson Contact InformationContact Name First Last Contact PhoneContact Email Business InformationBusiness Name Business PhoneBusiness FaxBusiness Website Physical Business Primary Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Business Entity Type Individual Partnership Corporation LLC Joint Venture Association Other FEIN Insurance InformationIs this an established business with previous insurance? Yes No In what year was the business established or acquired by the current owner? Are there Personal Lines Policies insured with Farmers®? Yes No Policy Number Are there other Commercial policies insured with Farmers®? Yes No Policy Number Is Business Vehicle Insurance needed? Business Vehicle Insurance is needed Owner's Drivers License Number Owner's Date of Birth MM slash DD slash YYYY Owner's Home Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Do you need Coverage for Auto Garage Keepers / Valet Service? Yes No Primary Location InformationPrimary Location Name or Number Primary Location Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country What is the primary occupancy type? Fast Food* Casual Dining* Fine Dining* Restaurants - No Cooking/No Frying Restaurants - Expanded Alcohol Sales Bars & Taverns Wine Bars Brew Pubs - With Commercial Cooking* Brew Pubs - No Cooking *These classes will require an additional Underwriting Supplemental Questionnaire to be submitted with a completed quote.Does this location have a playground? Primary Location Has A Playground Do you own the building? Yes No Is the building owned by a separate LLC? Yes No Primary Location Building ValuePlease enter a number greater than or equal to 0.Primary Location Contents ValuePlease enter a number greater than or equal to 0.Primary Location Liability LimitPlease enter a number greater than or equal to 0.Primary Location DeductiblePlease enter a number greater than or equal to 0.Primary Location Wind/Hail DeductiblePlease enter a number greater than or equal to 0.Wind/Hail States OnlyIs the primary location a franchise? The Main Location is a franchise. Primary Location Total Annual Sales/ReceiptsPlease enter a number greater than or equal to 0.Primary Location Total Annual Catering Sales/ReceiptsPlease enter a number greater than or equal to 0.Does your primary location serve Liquor or Alcohol? Yes No Primary Location Total Annual Liquor Sales/ReceiptsPlease enter a number greater than or equal to 0.Liquor License Number How many employees are certified in Liquor Training at the primary location?At the primary location, are all employees who serve alcohol given service training? Yes No At the primary location, is a written policy covering alcohol service guidelines made available to all employees? Yes No At the primary location, are all alcohol-related incidents documented? Yes No At the primary location, does the applicant ever sell or serve alcohol away from the premises? Yes No Year Primary Location Building was Built Primary Location Type of Construction Frame Masonry Non-Combustible Masonry Non-Combustible Modified Fire Resistive Primary Location Roof Type Shake Tile Composite Flat-Rubber Flat-Thermoplastic Number Of Employees (Primary Location)Please enter a number greater than or equal to 0.Number of Stories (Primary Location)Please enter a number greater than or equal to 0.Total Building Square Footage (Primary Location)Please enter a number greater than or equal to 0.Total Public Square Footage (Primary Location)Please enter a number greater than or equal to 0.Banquet Facility Square Footage (Primary Location)Please enter a number greater than or equal to 0.Seating Capacity of Primary LocationPlease enter a number greater than or equal to 0.Does the primary location have a Fire Sprinkler System? Yes No Are deep fat fryers used at the primary location? Yes No Do all deep fat fryers at the primary location have working automatic high temperature shut-off switches? Yes No Is there a minimum space of 16’’ between any deep fat fryer and any other open/surface flame appliance, such as a gas-fired range top or charbroiler at the primary location? Yes No Is there an 8’’ vertical steel or tempered glass barrier provided between the fryer and surface flames at the primary location? Yes No What type of Extinguishing System covers hoods, ducts, and all cooking equipment at the primary location? Dry Chemical Wet Foam Water Spray Other At the primary location, Is any table-side service provided which involves open flames? Yes No How often is the automatic fire extinguishing system inspected and serviced by a contracted outside firm? Monthly Quarterly Semi-Annually Annually Never How often are flues and ducts inspected and cleaned by a contracted outside firm? Monthly Quarterly Semi-Annually Annually Never How often are cooking equipment exhaust filters cleaned? Daily Weekly Two Times a Month Monthly Never Has the primary location undergone a comprehensive renovation since it was originally built? Yes No Wiring Renovation YearPlease enter a number greater than or equal to 0.Roofing Renovation YearPlease enter a number greater than or equal to 0.Plumbing Renovation YearPlease enter a number greater than or equal to 0.Heating Renovation YearPlease enter a number greater than or equal to 0.When did this business start operation at this location? MM slash DD slash YYYY Is the applicant responsible for the parking lot at the main location? Yes No Does the restaurant have a drive through? Yes No Are there publicly accessible indoor stairs? Yes No Where is the primary location located? Stand Alone Building Strip Shopping Center Enclosed Mall Habitational Structure Type of alarm at primary location None Local Central Station UL with Certificate Primary Location Hours of OperationDoes the applicant’s current General Liability policy exclude Assault & Battery? Yes No Does the applicant’s current Liquor Liability policy exclude Assault & Battery? Yes No Has the applicant had any notification of potential (not yet filed) Liquor Liability and/or Assault & Battery type claims within the past five years? Yes No Types of Entertainment and Game Exposures at this location: None DJ Band Karaoke Special Events Video Games Pinball Machine Pool Table Dart Boards Two or More TV's Gaming Tables Dance Floor Foam Machine Mechanical Rides PRIMARY LOCATION BUILDING COST ESTIMATOR (optional) - answer to obtain an estimate for proper coveragePermanently Installed Machinery Value:Please enter a number greater than or equal to 0.Fire Suppression Equipment:Please enter a number greater than or equal to 0.Refrigeration Appliances:Please enter a number greater than or equal to 0.Ventilation Equipment:Please enter a number greater than or equal to 0.Cooking Appliances:Please enter a number greater than or equal to 0.Dishwashing Appliances:Please enter a number greater than or equal to 0.Laundering Appliances:Please enter a number greater than or equal to 0.Additional Restaurant LocationsDo you have additional restaurant locations?(Required) No Yes Additional Restaurant Locations Location Name or Number Location Address Actions Edit Delete There are no Additional Restaurant Locations. Add Additional Restaurant Location Maximum number of additional restaurant locations reached. Please do not add your main location here, as that information has already been completed.To expedite your Proposal, we need the following for all risks:Loss History for the Past Five Years Drop files here or Select files Max. file size: 64 MB. We need this to provide discounts and for Underwriting approval. Claims History – aka “loss runs” are ordered by you from your current Agent and/or Insurance Company. It is a good business practice to order these yearly. Loss History is only provided to Owner / Property Manager, we do not have access or authority to requestCopies of your Property Liability and Umbrella Coverages, if any. Drop files here or Select files Max. file size: 128 MB. Consent(Required) I Agree to the Privacy Policy, Terms of Service, and Agree to Receive Communications. Δ
