Liquor Liability

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GENERAL INFORMATION
Fields marked (*) are mandatory
ABOUT YOUR BUSINESS

TYPE OF OPERATION

MISCELLANEOUS INFORMATION

SALES INFORMATION (PAST 12 MONTHS)

SALES INFORMATION (NEXT 12 MONTHS)

COVERAGE INFORMATION

PREVIOUS COVERAGE INFORMATION

Underwriting Information
LIABILITY
Seating Capacity
Does your establishment have any of the following (check all that apply)
Pinball Machines
Video Games
Pool Tables
Does your establishment offer any entertainment (check all that apply)

MISCELLANEOUS INFORMATION
Hours of Operation
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday

EMPLOYEE INFORMATION
Number of employees (per shift):
Number of bouncers / security
Current / Previous Insuror

ADDITIONAL COMMENTS
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