Commercial Kitchen Insurance Application

Business Name:

Location Address:

City:

State:

ZIP:

Is your mailing address the same as physical address?

Yes

No

Mailing Address:

City:

State:

ZIP:

Website:

Years in Business:

Contact Name:

Years' Experience in Field:

Email:

Phone:

Entity:

How did you hear about us?

How did you hear about us - Other:

1.) Total Gross Annual Revenue?

If $0, provide an estimate for the coming year?

2.) Square footage of Your Operations?

3.) Are all cooking appliances including fryers covered by a Wet Ansul System?

Yes

No

N/A

This system would release wet agents onto the appliance in case of a fire.

4.) Is this Ansul System maintained and inspected at least every 6 months?

Yes

No

N/A

5.) Are all cooking APPLIANCES, SUCH AS RANGES, and DEEP FAT FRYERS that produce smoke/grease under a hood system that is maintained and cleaned at least every 6 months and vented to the exterior of the building?

Yes

No

N/A

6.) Are compliant and functional Class K Fire extinguishers provided and accessible within 10 feet of cooking equipment?

Yes

No

N/A

7.) Do you sign a lease with each individual business and/or tenant?

Yes

No

N/A

8.) Does your contract contain “Hold Harmless” or “Indemnification” language?

Yes

No

N/A

9.) Do you obtain certificates of insurance with you being named as an additional insured with limits equal or greater to $1 million per occurrence or $2 million aggregate?

Yes

No

N/A

10.) Is your facility accessible 24 hours?

Yes

No

N/A

Do clients reserve specific hours?

Yes

No

Do you have limited security access via keycard, code, or similar?

Yes

No

What are your hours of operation?

11.) Do you have central station monitored smoke, fire and security alarms?

Yes

No

N/A

If no, do you have local smoke, fire, and security alarms?

Yes

No

A local smoke alarm is an alarm system that does not report to a central station, but does have an alarm sound off at the location.

12.) Do you have dusk-to-dawn lighting in entrance areas, parking lots and loading docks?

Yes

No

N/A

13.) How often is the kitchen equipment inspected?

14.) Who is responsible for cleaning in-between each usage?

15.) Catering?

Yes

No

Please provide sales for this operation:

16.) Special event or banquet space?

Yes

No

Please provide sales for this operation:

17.) Retail Space?

Yes

No

Please provide sales for this operation:

18.) Restaurant or customer seating for on premise food consumption?

Yes

No

Please provide sales for this operation:

Have you had Liability Insurance before?

Yes

No

Current Insurance Carrier:

If no, Why not?

Number of Years Insured:

Expiring Premium:

Have you had any claims in the past 5 years?

Yes

No

Claim Information:

Is Excess Liability Insurance needed?

Yes

No

N/A

What Limit?

Do you need property coverage?

Yes

No

Construction Type:

Year Built:

Total Square Footage of Building:

Total Square Footage Occupied By You:

Is building over 20 years old?

Yes

No

Year of Update for Heating:

Year of Update for Electrical:

Year of update for Roof:

Year of update for plumbing:

Are you within 5 miles of a fire station?

Yes

No

If no, How many miles?

How close are you to a fire hydrant?

Is the building sprinklered (fire suppression system)?

Yes

No

What percentage?

Do you have an alarm?

Yes

No

What type of alarm?

Is property located within 5 miles of any coast?

Yes

No

Do you own your own building?

Yes

No

Limit of Insurance

Deductible

Limit of Insurance

Deductible

Limit of Insurance

Deductible

Do you have any Lien Holders, Mortgage Holders, or Additional Insureds?

Yes

No

Lien Holders/Mortgage Holders:

General Aggregate Limit	$2,000,000
Each Occurrence Limit	$1,000,000
Products & Completed Operations Aggregate Limit	$2,000,000
Personal & Advertising Injury Limit	$1,000,000
Damage to Rented Premises Limit	$300,000
Medical Payments	$5,000

Commercial Kitchen Application

Applicant Information:

Now, tell us a little bit about the specifics of how you operate your business.

Operations

Do you provide additional services? Tell us about it below.

Additional Operations:

Next, we will ask you a little about your prior coverage.

Prior Coverage

Next, we will confirm if you have any loss history or claims.

Prior Claims

Here is your chance to review our coverage details and see if you need additional liability coverage.

Limits of Insurance

Liability Coverage

Property Coverage

Owning your own building is a little different than renting a space. If you need coverage for your own building please let us know below.

Coverage Information: