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?

If yes, what was the prior name?

for 9.1 patrons,

2.6 Do you provide table service?

2.8 What is the operating season? IF Seasonal add the from___ and to___ in the boxes below.

Year-Round
Seasonally

From

2.9 Have the police, or any emergency service provider, been called to the premises in the past three (3) years?

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?

2.11 Does the Applicant business ever open after 8:00 PM on any given day?

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.

3.1 Is there a swimming pool on the premises?

3.2 Do you own or maintain any apartments or other rental units on the premises?

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?

3.3 Is this a waterfront property?

IF Yes: a. Do you own or maintain any beach front or waterfront areas?

b. How many boat docking slips are available for patrons?

3.4 Do you have any balconies, decks, or rooftop areas?

3.5 Are firearms allowed on the premises (by customers or staff members)?

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?

4.2 Has your license ever been suspended or revoked?

4.3 Have you ever been fined or cited for a critical or severe violation of your license or the local/state health code?

4.4 Is Applicant in compliance with local and state laws and regulations governing food establishments?

4.5 Do you keep records on stock rotation and cooler temperatures?

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?

4.7 Do you have written policies and procedures for the proper handling, preparation, and service of raw seafood and meat?

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?

If yes, has your license ever been suspended or revoked, or have to ever been fined or cited for violating your license?

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?

5.3 Do you ever offer any drink specials that extend past 9:00 PM?

5.4 Do you offer bottle service (i.e. purchasing of a bottle of liquor to be consumed on the premises) other than wine?

5.5 Do you allow customers to bring their own alcohol on premises for consumption?

5.6 Do you serve any single drink larger than 24 ounces?

IF Yes, provide details:

5.7 Do you sell alcohol to customers for off-premises consumption?

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?

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?

5.10 Do you have written guidelines and procedures in place for cutting off patrons, and not over-serving patrons, that are visibly intoxicated?

Are all staff members trained on the written guidelines and procedures?

5.11 Do you brew or distill your own alcohol on or off premises, for sale to customers, or other parties?

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)?

5.13 Are you located on or near a college campus, or do you target college-aged clientele?

5.14 Do you have bouncers or other security staff?

IF Yes: What type(s) of weapons are they armed with?

Are there bag checks, pat downs or frisking at the door?

5.15 Do you have a metal detector at any entrance to the premises?

VI. ENTERTAINMENT

6.1 Do you have a dance floor area?

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?

6.4 Do you host any special events that allow for increased capacity, or which utilize space around the building?

IF Yes, provide details.

6.5 Do you have any mechanical bulls, nude or topless dancing, or pyrotechnics?

6.6 Do you have any athletic facilities, sports courts, or playgrounds on the premises?

IF Yes, describe and indicate how many?

If you indicated Musical Acts/Bands, are any of these performing rap, hip hop, punk rock or heavy metal music?

If you indicated DJs or Musical Acts/Banks, are any of these performing electronic dance music?

VII. TABLE SIDE COOKING / OPEN COOKING / HIBACHI

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?

7.2 Are hot coals used in cooking process?

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?

7.4 Is there a Class K fire extinguisher in the dining area?

7.5 Is there a staff member dedicated to overseeing the dining area?

7.6 Does Applicant have any live flame demonstrations (other than onion volcano)?

7.7 Are there any stunts involving alcohol and flame?

7.8 Are warning signs posted which state “Hot Surface” around all cooking areas?

VIII. HOOKAH

8.1 What is the minimum legal age for tobacco use / sales in the state which Applicant operates in?

8.2 Are individuals under this age allowed in the hookah area at Applicant’s establishment?

8.3 Are individuals under this age allowed to smoke / hookah at Applicant’s establishment?

8.4 Does Applicant verify age by checking the identification of all persons prior to providing hookah services?

8.5 Are disposable and individually wrapped mouthpieces provided for each new user?

8.6 Does Applicant have all required licenses or permits to operate a hookah lounge / establishment?

Has such license or permit ever been suspended or revoked?

8.7 Are working fire extinguishers in the hookah area?

8.8 Is the hookah area ventilated in compliance with applicable law?

8.9 Is hookah area supervised by an employee of Applicant at all times during operating hours?

8.10 Are all coals lit and handled / delivered by an employee of Applicant?

8.11 Are coals completely extinguished following customer use?

8.12 Are coals disposed of in a non-combustible container?

8.13 Is safety cover / wind-guard required by law for the coal?

IF Yes, is such safety cover / wind-guard in place?

IX. ADDITIONAL OPERATIONS

9.1 Do you offer valet parking?

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?

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?

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?

ii. What limits do you require?

iii. Do you require the coverage to be direct and primary, or legal liability only?

9.2 Do you offer off-site catering services?

If yes, what are the annual sales?

9.3 Do you rent your facility, or make it available for private parties or events?

9.4 Does Applicant business deliver food?

9.5 Does Applicant business deliver alcohol?

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?

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?

10.3 Are any barbeque grills, barbeque pits, fire pits, open fires for cooking, smokers, or smokehouses utilized on the premises?

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?

b. Do you use commercial grade appliances and detergents to launder greasy and soiled rags on premises?

c. Is a professional laundry service used which specializes in laundering greasy and soiled rags?

10.5 Are you in compliance with local and state fire codes and regulations?

10.6 Do you have wall-mounted fire extinguishers in place in all high-risk areas?

10.7 Do you have an automatic fire suppression system in place above all cooking surfaces?

IF Yes: a. Are security personnel?

Employee
Independent Contractor

b. Do all security personnel sign waivers?

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?

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?

11.2 Does the applicant engage police officers for work in or about the premises?

IF Yes, how are they engaged and paid?

With Municipality
Secondary Employment Company

11.3 Are security personnel responsible for I.D checks?

11.4 Are incident logs documenting when person was refused service or other alcohol related events maintened?

11.5 Does Applicant have video surveillance?

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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