Restaurants/Bars/Taverns
RJ United Business Insurance Agency
13711 Van Nuys Boulevard Suite 4, Pacoima, CA 91331 | Phone (818) 834-8562 | Fax (866) 834-4442
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Contact
javier@rjunited.com
California Restaurants
General Info
Company Name:
*
Contact Name:
*
Address:
*
City:
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State:
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Zip:
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Phone:
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Cell Phone:
Fax:
E-mail:
Ownership:
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Choose...
Sole Proprietor
Partnership
Corporation
LLC
LLP
Ltd.
Coverages
Liability:
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Choose...
$500,000
$1,000,000
$2,000,000
Business Personal Property (optional):
Choose...
$30,000
$40,000
$50,000
None
Other (specify)
Other BPP:
Assault & Battery (optional):
Choose...
$25,000
$50,000
$100,000
$300,000
None
Current Insurance Carrier:
*
Policy Expiration:
Click for Workers Compensation
Federal Tax ID:
First Employee Hired Date:
General Description
Description of Operations:
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% of Food Sales:
% of Alcohol Sales:
If Alcohol Sales, Explain:
Beer and Wine Only
Beer, Wine, and Hard Liquor
Full Bar with Separate Area
% of Other (must equal %100):
Any Catering?:
Yes
No
If Yes, What %?:
Any Delivery?
Yes
No
If Yes, What %?
Any Claims in the past 3 years?
*
Yes
No
If any Claims, please Explain:
Gross Sales:
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# of Employees (full):
# of Employees (part):
Employee Payroll (excluding owners):
Years in Business:
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Years of Experience:
Hours of Operation:
Entertainment
Any Entertainment:
Live Music
Disc Jockey
Dancing
Karaoke
Other Entertainment:
Pool Tables
TVs
Arcades
Darts
Other (specify)
Other:
If any Entertainment, please Explain:
Security Personnel:
ID Checkers
Full Security
Are Security Personnel Armed?:
Yes
No
Property Information
Location:
*
Tenant
Owner
Building Coverage (if owner):
Year Built:
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Last Updates:
Construction Type:
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Choose...
Wood Frame
Concrete
Joisted Masonry
Non-Combustible
Total Square Feet:
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Seating Capacity:
Sprinkler System:
Yes
No
Ansul System:
Yes
No
Alarm System:
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Central Monitored
Local Alarm
None