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Restaurant Insurance 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 Restaurant
Your Name
First
Last
Your Contact Number
Email
Website of Restaurant
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 Restaurant Business Ever Had an Insurance Claim?
Yes
No
YES: Date, Description of Loss and Amount of Loss ($)
Current Insurance Company
Property Details
Address of Restaurant
Street Address
City
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
Province
Postal Code
Building Year Built
Total Square Footage Restaurant Occupies
How Many Stories
Is There A Basement?
Yes
No
Is The Building More Than 80% Sprinklered ?
Yes
No
Building Construction
Exterior Walls
Frame / Wood Construction
Fire Restive / Concrete + Steel Beam
Masonry + Wood Beam
Other
Other
Roof
Wood - Ashphalt Shingle
Steel - Tar & Gravel / Membrane
Other
Other:
Update Year
Plumbing
PEX / COPPER / PVC
COPPER / PVC
GALVANIZED STEEL / CAST IRON / PVC
OTHER
Update Year
Oher:
Electrical - WIRING
Copper
Aluminum
Mix - Copper / Aluminum
Other
Update Year
Other Wiring
Electrical - Panel
Breakers
Fuses
Breakers & Fuses
Other
Other Panel
Electrical - AMPs
100 AMP
Less than 100 AMP
200 AMP
200 AMP +
Heating Source
Gas - Furnace / Radiator
Electrical - Furnace / Baseboard / Radiator
Oil
Other
Update Year
Other
Restaurant Operations
Type of Restaurant
Annual Revenue from Food ($)
Annual Revenue from Alcohol($)
Is There Any Other Revenue Other Than From Food & Alcohol
Yes
No
Other Revenue ($)
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 Week
Number of Seats Inside
Number of Seats Outside
Number of Full Time Staff
Number of Part Time Staff
Any Deleveries Done?
Yes
No
Sales from Delivery $
Delivery Done By Employees or Third Party ?
Any Live Entertainment
Yes
No
Live Entertainment - YES - Please Describe:
