•
GENERAL INFORMATION
Name of Insured:
Address of Insured Location:
City:
State:
Zip Code:
Phone #:
(
) -
Fax:
(
) -
Type of Business:
Years in Business:
Years Experience:
Entity Is:
Individual
Corporation
Partnership
Other
•
PROPERTY INFORMATION
Square Footage:
Type of Construction:
Glass Coverage:
Real Property Value:
Contents:
Deductible:
•
BUILDING INFORMATION
Year Built:
Alarm?
Yes-Local
Yes-Central
No
Alarm Company:
•
LIABILITY LIMITS
Liability Limits:
General Aggregate:
GKL Limits:
Liquor Limits:
DED:
Hired & Non-owned:
Umbrella Coverage:
•
QUOTING INFO
Number of Employees:
Annual Payroll:
Sales for Past Year:
Estimated Sales:
•
FOR RESTAURANT ONLY
Hours of Operation:
12
1
2
3
4
5
6
7
8
9
10
11
AM
12
1
2
3
4
5
6
7
8
9
10
11
PM
Friday & Saturday:
12
1
2
3
4
5
6
7
8
9
10
11
AM
12
1
2
3
4
5
6
7
8
9
10
11
PM
Estimated Sales:
% of Liquor Sales:
•
LOSSES
Please explain any losses within three year period:
Prior Carrier:
Expiring Premium:
Proposed Effective Date:
Referred By:
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For more Information, please call:
R.V. Howard & Associates, Inc.
8487 S. US 1 Port St. Lucie, FL 34952
Tel.: (772) 343-9878
Fax: (772) 343-9884
Email:
CommercialLines@rvhoward.com
