Bar Application Submission of this information does not represent a binding of any insurance contract or agreement. Additional information may be required in order to get an accurate quote of insurance Legal Name of Establishment Your Name First Last Your Contact Number Email Website of Establishment Years in Business or Years Experience in Hospitality Industry (if no prior years in business please describe your past managerial experience in hospitality industry)Has The Establishment Ever Had an Insurance Claim?YesNoYES: Date, Description of Loss and Amount of Loss ($)Current Insurance Company Property DetailsAddress of Establishment Street Address City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Building Year Built Total Square Footage Restaurant Occupies How Many Stories Is There A Basement?YesNoIs The Building More Than 80% Sprinklered ?YesNoBuilding ConstructionExterior WallsFrame / Wood ConstructionFire Restive / Concrete + Steel BeamMasonry + Wood BeamOtherOther RoofWood – Ashphalt ShingleSteel – Tar & Gravel / MembraneOtherOther: Update Year PlumbingPEX / COPPER / PVCCOPPER / PVCGALVANIZED STEEL / CAST IRON / PVCOTHERUpdate Year Oher: Electrical – WIRINGCopperAluminumMix – Copper / AluminumOtherUpdate Year Other Wiring Electrical – PanelBreakersFusesBreakers & FusesOtherOther Panel Electrical – AMPs100 AMPLess than 100 AMP200 AMP200 AMP +Heating SourceGas – Furnace / RadiatorElectrical – Furnace / Baseboard / RadiatorOilOtherUpdate Year Other Establishment OperationsType of Establishment: Annual Revenue from Food ($) Annual Revenue from Alcohol($) Is There Any Other Revenue Other Than From Food & AlcoholYesNoOther Revenue ($) Other – Describe Service or Goods Sold In The Premises Is There A WETT Extinguishing System Which is ULC Compliant Fixed Fire Suppression System on Semi-Annual Maintenance Contract? Yes No K-Type Fire Extinguisher Located in Kitchen ? Yes No Is There Deep Fat Frying Yes No Range, Hood, Ventilating Duct Work, Exhaust Fans and Filter Screens Steam Cleaned by Professional Company Semi-Annually ? Yes No Do you Attend Any Fairs/Festivals/Events ? Yes No Is The Premises Monitored by Central Alarm System? Yes No Hours of Operation + Days Open Per WeekNumber of Seats Inside Number of Seats Outside Number of Full Time Staff Number of Part Time Staff Any Deleveries Done?YesNoSales from Delivery $ Delivery Done By Employees or Third Party ? Any Live EntertainmentYesNoLive Entertainment – YES – Please Describe:
