SUPPLEMENTAL APPLICATION – RESTAURANTS

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NEXT: PLEASE FILL OUT THE SUPPLEMENTARY APPLICATION BELOW

RESTAURANT AND BAR SUPPLEMENTAL APPLICATION
I. APPLICANT
1.1 Applicant (Proposed Named Insured):
1.2 DBA (Name of Restaurant or Bar):
Website
Name *
First
Last
Phone Number
Email *
1.3 Location of Restaurant or Bar Address:
City
State
Zip
II. GENERAL BUSINESS INFORMATION
2.1 Does Applicant own or rent the property listed in the Location Address above?
Own
Rent
2.2 Annual Food Gross Sales:
Annual Alcohol Gross Sales:
Other Sales:
Describe Other Sales:
Seating Capacity:
2.3 What is the latest business closing time?
Midnight or earlier
After Midnight and by 2:00 AM
After 2:00 AM
Open 24 hours
2.4 How long has the location shown above been open, under the current ownership? __Years or __months
If less than three (3) years under current ownership, describe Applicant’s prior restaurant / bar ownership or management experience, including length of time.
2.5 Has the name of the business changed in the last five years?
YES
NO
If yes, what was the prior name?
2.6 Do you provide table service?
YES
NO
2.8 What is the operating season? IF Seasonal add the from___ and to___ in the boxes below.
Year-Round
Seasonally
From
To
2.9 Have the police, or any emergency service provider, been called to the premises in the past three (3) years?
YES
NO
If yes, provide details on incident(s), include in attachment if necessary.
2.10 Has the Applicant had any prior foreclosure, repossession or bankruptcy, or is the Applicant currently involved in any pending foreclosure, repossession or bankruptcy proceeding?
YES
NO
2.11 Does the Applicant business ever open after 8:00 PM on any given day?
YES
NO
If yes, provide details:
III. PREMISES
All questions below refer to the Location Address of the restaurant or bar listed in the first section of this Application.

what with at

3.1 Is there a swimming pool on the premises?
YES
NO
3.2 Do you own or maintain any apartments or other rental units on the premises?
YES
NO
IF Yes: a. How many apartment units on the premises do you own or maintain?
b. Are any of these units student or senior housing?
YES
NO
3.3 Is this a waterfront property?
YES
NO
IF Yes: a. Do you own or maintain any beach front or waterfront areas?
b. How many boat docking slips are available for patrons?
YES
NO
3.4 Do you have any balconies, decks, or rooftop areas?
YES
NO
3.5 Are firearms allowed on the premises (by customers or staff members)?
YES
NO
IV. FOOD SERVICE
4.1 Does Applicant have a current and active permit or license, as required under local and/or state laws, to provide food service at its restaurant or bar?
YES
NO
4.2 Has your license ever been suspended or revoked?
YES
NO
4.3 Have you ever been fined or cited for a critical or severe violation of your license or the local/state health code?
YES
NO
4.4 Is Applicant in compliance with local and state laws and regulations governing food establishments?
YES
NO
4.5 Do you keep records on stock rotation and cooler temperatures?
YES
NO
4.6 Do you have posted warnings on the premises or on the menus (whichever is required by local law) alerting customers to the hazards associated with consuming raw or undercooked foods?
YES
NO
4.7 Do you have written policies and procedures for the proper handling, preparation, and service of raw seafood and meat?
YES
NO
How often are staff members trained on such procedures:
V. ALCOHOL SERVICE
5.1 Does Applicant have a currently and active liquor permit or license, as required by local and/or state laws, to serve and sell alcoholic beverages at its restaurant, or bar?
YES
NO
If yes, has your license ever been suspended or revoked, or have to ever been fined or cited for violating your license?
YES
NO
5.2 Have you or any employee ever been cited or fined for being in violation of any liquor law, alcoholic beverage control law, or similar law?
YES
NO
5.3 Do you ever offer any drink specials that extend past 9:00 PM?
YES
NO
5.4 Do you offer bottle service (i.e. purchasing of a bottle of liquor to be consumed on the premises) other than wine?
YES
NO
5.5 Do you allow customers to bring their own alcohol on premises for consumption?
YES
NO
5.6 Do you serve any single drink larger than 24 ounces?
YES
NO
IF Yes, provide details:
5.7 Do you sell alcohol to customers for off-premises consumption?
YES
NO
If yes, what are the annual gross sales from this?
5.8 Are all individuals who serve alcohol required to have active certification through TIPS or another certified program, prior to serving customers alcohol?
YES
NO
5.9 Do you have written guidelines and procedures in place for verifying the age of patrons, to prevent the sale of alcohol to minors?
YES
NO
5.10 Do you have written guidelines and procedures in place for cutting off patrons, and not over-serving patrons, that are visibly intoxicated?
YES
NO
Are all staff members trained on the written guidelines and procedures?
YES
NO
5.11 Do you brew or distill your own alcohol on or off premises, for sale to customers, or other parties?
YES
NO
IF Yes: a. What are the gross annual sales from brewing / distilling operations?
b. How do you package the alcohol?
Bottles
Cans
Keg/Drum
Other:
5.12 Do you offer or allow drinking games (e.g. beer pong, shot games)?
YES
NO
5.13 Are you located on or near a college campus, or do you target college-aged clientele?
YES
NO
5.14 Do you have bouncers or other security staff?
YES
NO
IF Yes: What type(s) of weapons are they armed with?
Are there bag checks, pat downs or frisking at the door?
YES
NO
5.15 Do you have a metal detector at any entrance to the premises?
YES
NO
VI. ENTERTAINMENT
6.1 Do you have a dance floor area?
YES
NO
IF Yes, what is the square footage?
6.2 What is your total licensed capacity?
6.3 Do you have any entertainment that attracts crowds larger than 250 people on premises?
YES
NO
6.4 Do you host any special events that allow for increased capacity, or which utilize space around the building?
YES
NO
IF Yes, provide details.
6.5 Do you have any mechanical bulls, nude or topless dancing, or pyrotechnics?
YES
NO
6.6 Do you have any athletic facilities, sports courts, or playgrounds on the premises?
YES
NO
IF Yes, describe and indicate how many?
6.7 What live entertainment do you offer? (Check all that apply)
Karaoke
DJs
Musical Acts/Bands
Raves
Foam Parties
Other:
If you indicated Musical Acts/Bands, are any of these performing rap, hip hop, punk rock or heavy metal music?
YES
NO
If you indicated DJs or Musical Acts/Banks, are any of these performing electronic dance music?
YES
NO
6.8 What amusement devices are on the premises?
Pool Tables
Arcade Games
Darts
Juke Box
Gambling Games
Mechanical Rides
Other:
VII. TABLE SIDE COOKING / OPEN COOKING / HIBACHI
N/A
7.1 Indicate which applies to Applicant’s restaurant:
Table Side (Cold) Food Prep
Table Side (Hot) Cooking
Open Cooking (Diners can see cooking)
Hibachi
7.1 Are all cooking appliances permanently installed?
YES
NO
7.2 Are hot coals used in cooking process?
YES
NO
7.3 Is there a functioning exhaust hood over all cooking surfaces?
YES
NO
7.3 Is there a functioning exhaust hood over all cooking surfaces?
IF Yes, is there a semiannual service contract in place to clean and service the exhaust hood?
YES
NO
7.4 Is there a Class K fire extinguisher in the dining area?
YES
NO
7.5 Is there a staff member dedicated to overseeing the dining area?
YES
NO
7.6 Does Applicant have any live flame demonstrations (other than onion volcano)?
YES
NO
7.7 Are there any stunts involving alcohol and flame?
YES
NO
7.8 Are warning signs posted which state “Hot Surface” around all cooking areas?
YES
NO
VIII. HOOKAH
8.1 What is the minimum legal age for tobacco use / sales in the state which Applicant operates in?
18
21
8.2 Are individuals under this age allowed in the hookah area at Applicant’s establishment?
YES
NO
8.3 Are individuals under this age allowed to smoke / hookah at Applicant’s establishment?
YES
NO
8.4 Does Applicant verify age by checking the identification of all persons prior to providing hookah services?
YES
NO
8.5 Are disposable and individually wrapped mouthpieces provided for each new user?
YES
NO
8.6 Does Applicant have all required licenses or permits to operate a hookah lounge / establishment?
YES
NO
Has such license or permit ever been suspended or revoked?
YES
NO
8.7 Are working fire extinguishers in the hookah area?
YES
NO
8.8 Is the hookah area ventilated in compliance with applicable law?
YES
NO
8.9 Is hookah area supervised by an employee of Applicant at all times during operating hours?
YES
NO
8.10 Are all coals lit and handled / delivered by an employee of Applicant?
YES
NO
8.11 Are coals completely extinguished following customer use?
YES
NO
8.12 Are coals disposed of in a non-combustible container?
YES
NO
8.13 Is safety cover / wind-guard required by law for the coal?
YES
NO
IF Yes, is such safety cover / wind-guard in place?
YES
NO
IX. ADDITIONAL OPERATIONS
9.1 Do you offer valet parking?
YES
NO
IF Yes: a. Who is responsible for valet parking?
Employees
Independent Contractor
b. Do you verify, prior to hire, that all employed valet parking attendants have a current and valid driver’s license?
YES
NO
c. Do you, prior to hire, review the public driving record of all employed valet parking attendants, to confirm that they have no DUI / DWI violations, criminal or civil traffic violations, citations or other offences on their driving record?
YES
NO
Single Line Text
i.Do you require evidence of the third party’s garage-keeper’s liability insurance (via a Certificate of Insurance (COI) or otherwise), at least annually?
YES
NO
ii. What limits do you require?
iii. Do you require the coverage to be direct and primary, or legal liability only?
YES
NO
9.2 Do you offer off-site catering services?
YES
NO
If yes, what are the annual sales?
9.3 Do you rent your facility, or make it available for private parties or events?
YES
NO
9.4 Does Applicant business deliver food?
YES
NO
9.5 Does Applicant business deliver alcohol?
YES
NO
9.6 Does Applicant business contract or partner with a third-party delivery service (e.g. Uber Eats, Grubhub, etc.) to deliver food or alcohol?
YES
NO
9.7 Please describe any other operations or activities of, or services provided by Applicant, which are not otherwise inquired about in this application:
X. PROPERTY
10.1 Are there any wood burning stoves or fireplaces on the premises?
YES
NO
10.2 What types of cooking are done on the premises? (Check all that apply)
N/A
Grilling
Deep Fat Frying
Open Broiling
Solid Fuel Cooking
Roasting
Tableside Cooking Barbecue
Smokehouse
Other:
10.3 Are any barbeque grills, barbeque pits, fire pits, open fires for cooking, smokers, or smokehouses utilized on the premises?
YES
NO
10.4 If any grilling, frying or other grease laden cooking is done on premises, please indicate if any of the following steps are taken to reduce spontaneous combustion/fire hazard:
a. Do you store greasy and soiled rags in metal cabinets or containers with closing lids?
YES
NO
b. Do you use commercial grade appliances and detergents to launder greasy and soiled rags on premises?
YES
NO
c. Is a professional laundry service used which specializes in laundering greasy and soiled rags?
YES
NO
10.5 Are you in compliance with local and state fire codes and regulations?
YES
NO
10.6 Do you have wall-mounted fire extinguishers in place in all high-risk areas?
YES
NO
10.7 Do you have an automatic fire suppression system in place above all cooking surfaces?
YES
NO
IF Yes: a. Are security personnel?
Employee
Independent Contractor
b. Do all security personnel sign waivers?
YES
NO
c. Do you, prior to hire, review the public record of all employed security, to confirm that they have no criminal or civil violations, citations or other offenses on their record?
YES
NO
d. If security is contracted to a third party:
i.Do you require evidence of the third party’s general liability liability insurance (via a Certificate of Insurance (COI) or otherwise), at least annually?
Employee
Independent Contractor
ii. What limits do you require
Do you require written agreement with independent security contractor?
YES
NO
11.2 Does the applicant engage police officers for work in or about the premises?
YES
NO
IF Yes, how are they engaged and paid?
With Municipality
Secondary Employment Company
11.3 Are security personnel responsible for I.D checks?
YES
NO
11.4 Are incident logs documenting when person was refused service or other alcohol related events maintened?
YES
NO
11.5 Does Applicant have video surveillance?
YES
NO
11.6 IF Yes, how many days do you keep the video tapes?
11.7 Please describe describe procedures in place for entry control (capacity limits)?:
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