Nightclub, Bar, & Tavern Application

 

When submitting your applications, please note we will require five (5) years of currently valued loss runs which you can obtain from your current agent. These loss runs must be company/carrier loss runs. We will also require a financial statement (profit and loss statement or balance sheet).

Please take time to fill out the form on the right, entirely.  This form is electronically submitted, but you can also download the form and submit it at a later time via email.

Electronic Fillable Application Form

Printable Application Form

 
Name *
Name
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Physical Address of Business
Physical Address of Business
Date you started your business at this location *
Date you started your business at this location
Do you own or lease the building? *
Effective renewal date of Insurance Policy
Effective renewal date of Insurance Policy
Parking Lot? *
New Venture? *
Is the building sprinklered?
Does Location have any of the following exposures? *
check all that apply
Will the applicant be closed for business for a period greater than 21 consecutive days? *
Has the applicant ever been cited for health code violations in the past 3 years? *
Will the applicant be involved in any special events or other activities away from location? *
Does the applicant provide off-premise catering services? *
Does applicant have an employee handbook? *
Does the applicant rent or lease the venue for private parties? *
Gross Sales
receipts generated from liquor for one year
$
receipts generated from food for one year
$
receipts generated from admissions for one year
$
$
receipts from one year
$
receipts from one year
$
receipts from one year
$
receipts from one year
$
receipts from one year
$
Description of Operation *
Entertainment:
Music Genres for Live Concerts *
check all that apply
Does you business contain:
check all that apply
Do you permit or allow dancing? *
Does the applicant have a swimming pool, suana, or hot tub on premise? *
Will the applicant allow, permit or hold pyrotechnic displays on premise *
Does the applicant have a valid liquor license? *
*Has applicant ever been cited for liquor violation?
*Has the applicant or any owner, partner or member ever had a liquor license suspended or revoked?
*Does the applicant manufacture alcohol on premises?
*Does the applicant require all alcohol servers to have a valid certificate from an accredited or recognized alcohol awareness training program?
Name of Certification Program?
*Does the applicant allow employees or contractors to consume alcohol while working?
*Does the applicant allow employees or contractors to consume alcohol after their work shift?
*Does the applicant allow employees or contractors to consume alcohol after their work shift on premise?
*Does the applicant have bottle service or the sale of whole bottles of hard liquor to a table?
*Does the applicant allow or permit BYOB on premise?
*Does the applicant ever offer flaming or ignited drinks?
*Does the applicant serve drinks including liquid nitrogen?
*Does the applicant subscribe to any program or provide any form of available 3rd party transportation
*Will the applicant ever allow or sponsor drinking Olympics or any form of drinking games?
*Will the applicant ever allow or sponsor the use of equipment to entice patrons to drink faster, Such as beer bongs or funnels?
*Will the applicant allow patrons under the age of 21, but over the age of 18 on premises in the evening?
*Will the applicant use wristbands with all patrons over the age of 21 when allowing patrons over 18 on premise?
*Will the applicant allow patrons under the age of 18 or allow and/or sponsor teen night?
*Will the applicant ever hold or allow Foam Parties on premises?
*Does the applicant offer Happy Hour?
*Will the applicant offer any drink prices reduced to less than a $1.00?
Number of Security on each day
Are Securty, Bouncers, ID Checker: *
Does the applicant perform background checks on all Security, Bouncers, Door People, or ID Checkers?
Will the applicant ever employ Security personnel with prior convictions for assault and/or battery?
IF Contractors, does the applicant have a written agreement with Security Contractor?
If Contractors, does the security company provide a certificate of insurance evidencing equal General Liability limits and listing the applicant as their landlord as Additional Insureds?
If Contractors, does the applicant allow security to carry any form of weapons?
Will the applicant ever engage policy officers to be on premise?
Is the location currently under or are there any plans for construction or renovation?
Is the location within 5 miles of a college or university?
Kitchen
Are all cooking devices installed with a minimum of 18” safe clearances to combustible surfaces?
UL 300 listed auto fire extinguishing system provides surface protection for all cooking surfaces?
Are all gas equipment and deep fat fryers equipped with automatic fuel shut off?
All hoods and ducts cleaned every 6 months by a contractor under an agreement?
Are automatic fire extinguishing systems serviced no less than every 6 months?
Does the insured sub-lease any or all kitchen services to another entity?
Parking Lot
Is there lighting?
Does the insured charge a fee for parking?
Will the insured hold special events or other functions in the parking lot?
Property
Construction of Building?
List year of update
List year of update
List year of update
List year of update
Limits desired to insure the following:
$
$
$
$
$
$