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Hospitality Business Application


Fill out the following form as completely as possible. Once you have completed the form, click the Submit button to send your information. Your request will be handled promptly.

ZIP / Postal Code
Required
First Name
Required
Last Name
Required
Phone Number
Optional
E-Mail Address
Required
Full Applicant Name
Required
DBA Name
Optional
Premises Address
Optional
City
Optional
State
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FEIN (Required if Workers Compensation is desired)
Optional
Type of Business
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***If other - Please describe
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BRIEF DESCRIPTION OF BUSINESS OPERATIONS
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Years in business at this location
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If less than 3 years, please describe previous industry ownership or management experience
Optional
General Liability Limit
Optional
Food Receipts
Optional
Liquor Receipts - On Premises Consumption
Optional
Liquor Receipts - Off Premises Consumption
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Other Receipts (Video Gaming/Cover Charge/Etc)
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Describe Other receipts
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Total building square footage
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Area occupied by your business (sq ft)
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Is there a basement present
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If Yes - Is the basement finished?
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Other area (Describe - lessors risk, other tenants, square footage, etc)
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Number of full time employees
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Number of part time employees
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Off premises parkiing?
Optional
If yes, provide address and square footage
Optional
On premises banquets?
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If yes, provide the # of events annually and % of gross sales
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Off premsies catering or delivery exposure?
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If yes, provide the % of gross receipts
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Any food delivery?
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Any other unique or unusual exposures?
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If yes, please describe:
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Business is located:
Optional
Hours of operation
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Any commercial cooking exposure (***if yes, answer the following 4 questions)
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Is there a UL300 approved automatic fire extinguishing system present?
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Is there a K-Type extinguisher in the kitchen?
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Do the hood & ducts cover all cooking equipment?
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Have the fire protection systems been serviced by a qualified technician within the last 6 months?
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Have there been any claims in the last 3 years? If so please provide date of loss, type of loss and amount paid:
Optional
What is the seating capacity?
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Is there any entertainment (bands, DJ, karaoke, dancers, etc)? If yes, please describe:
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Is there a dance floor?
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Is there security or bouncers?
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Number of pool tables
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Other amusements devices? Please describe:
Optional
Amount Requested on Building Coverage
Optional
Building
Optional


Amount Requested on Contents
Optional
Contents
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Amount requested on Tenants Imrpovements & Betterments
Optional
Tenants Imprvoements & Betterments
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Year Built
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Construction Type
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Number of Stories
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Year of last electrical system update
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Year of last plumbing system update
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Year of last HVAC system update
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Year of last roofing update
Optional
Is there a central station alarm system present?
Optional
Any other property coverage desired (Outdoor fences, decks, signs, awnings, etc)?
Optional
Workers Compensation desired?
Optional
WC limits desired
Optional
Officers to be included or excluded
Optional
Other Comments or Details
Optional
Submission Validation
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