Restaurant/Tavern Supplemental Application Name Address Date Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 12345678910111213141516171819202122232425262728293031 Risk occupies what floor? Other occupanies? Seating capacity? Number of Exits? Any cooking done? Do they have an ansul system? Yes No Are flues cleaned at least semi annually by outside service? Yes No Are non-combustible filters cleaned at least weekly? Yes No Emergency Lighting? Yes No Entertainment or Adult Enterainment? Yes No Any Athletic devices or contests held? Yes No Any pool or card tables or dart boards? Yes No Business Hours? Yes No Any bouncers, guards, or armed personnel? Yes No Does the insured carry liquor liability coverage? Yes No |Home| |Services| |Applications| |Auto Form| |Bonds Form| | Boat Insurance Form| |Commercial Form| |Disability Form| |Home Form| |Motorcycle Form| |Property Form| |Restaurant Form| |Renter Form| |Workers Comp Form| |Contact Us|