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RSI Insurance    
Insurance Specialists for the Hospitality Business

Business Insurance Quotes
   
  Please fill out the form below, once completed and submitted a representative will be in contact with you within the next business day.
 
 

First Name :*

Last Name :*

        

Phone :*

       
E-mail Address :*        

Best Time to call :

AM PM

Business Name :*

Address :*

City :*

State : *

Zip :*

County :
Do you have any other locations other than listed above : Yes No

Business Web Site :

Nature of Business/ Description of Operations :

Legal Entity :
Years in business : * Years of experience :*
Current Insurance Carrier : * Policy # :* Premium :*$
From : * To : *
Has any coverage for this operation been declined, cancelled or non-renewed in the last 3 years? * Yes No Why?*
Please list the types of claim & the amount paid within in the last three years below :*
General Liability :
Liability Limit : *
Number of Full-Time Employees : * Number of Part-Time Employees : *
Payroll of Employee´s :*
Employee Dishonesty : *
 
Property :
Building Coverage : * Building Deductible :*
Building Owned or Leased : *
Business Personal Property : * Property Deductible : *
Replacement Cost Value Actual Cash Value

Loss of Income : *

ALS

Monthly Indemnity

 $ 
Construction Type : *
Roof Type : *
Year Built :*
Number of Stories : *
Total Square Footage of Building :*
Total Square Footage you occupy :*
Basement : * Yes No Finished : Yes No %  Finished
Updates : Year Total / Partial
Year Heating was updated :   
Heating :
 
Year Plumbing was updated :
Year Roof was updated :
Year Electrical was updated
Electrical :* Circuit Breakers Fuses
Fire Alarm :* Yes No
Burglar Alarm :* Yes No
Is building equipped with an automatic sprinkler system :* Yes No
Responding Fire Department : Miles to Fire Department :
How many feet to a fire Hydrant :
Smoke Detectors :* Yes No
Carbon Monoxide Detectors :* Yes No
General information :
Years under current ownership :
Years you have been in business at this location :
Is business being conducted at this time : Yes No
Have you ever filed for bankruptcy or outstanding liens or suits against you or your business : Yes No
Have you been cited or closed due to action of a public authority? Yes No
Do you live on premises? Yes No
Do you do any deliveries? Yes No
Do you carry a commercial automobile policy? Yes No
Do employees use their personal vehicles for business purposes? Yes No
Maximum amount of cash kept on premise overnight :                     $
Is a safe used for storage of cash?
Yes No
Frequency of bank deposits :
Hours of Operation :* AM PM To AM PM
Total sales receipts for Food :* $
Do you serve alcohol? * Yes No
Total Sales of Alcohol :* $
Do you do any Catering :* Yes No
Total Catering (Sales) :* $
Cooking Devices :     Number :
Broaster
Broiler
Charcoal Grill
Grill
Deep Fat Fryer
Oven
Range
Microwave Oven
Pizza Oven
Type of cooking oil used :
Is all cooking equipment covered by hood, duct and ventilating fan? Yes No
How often is ductwork cleaned?
By whom?
Type of filters :
How often are filters cleaned?
By whom?
Is all cooking equipment free from grease accumulation?
Is kitchen equipped with a UL 300 System : Yes No
Is all cooking equipment protected by an automatic extinguishing system? Yes No
Type of System :
Is automatic extinguishing system serviced on a semi-annual basis? Yes No
By whom?
Does power supply to cooking equipment have an automatic shutoff? Yes No
Is kitchen equipped with a "K" or "40BC" type portable extinguisher? Yes No
Any entertainment?* Yes No
If yes, select the type : *
Frequency of entertainment : *
Any Special Events? Describe :
Is dancing permitted?* Yes No
Total area of dance floor : * sq feet  
Horseshoe Pits Baseball Volleyball Boat Docks
Additional Interests :
Loss Payee Mortgagee
If yes, please list provider :
Comments :
   
 
 
 
 
 
 

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Name :   RSI Insurance
Phone :   914-332-1700
Fax :   914-332-9688
E-mail :   ira@rsi-insurance.com
Address :   505 White Plains Rd.
    Tarrytown, NY 10591