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🍷 Specialty Quote Form

Dine-In Restaurant Insurance Quote

Complete this questionnaire for your dine-in restaurant. A licensed broker will respond with coverage options within one business day.

✓ No obligation
✓ Multiple carriers compared
✓ Response within 1 business day
✓ 18+ years commercial experience
0% complete
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Policy Timing

Coverage start, takeover, or expiration date

Effective / Start Date * Reason for This Date * Select one... New restaurant / opening date Current policy expiration date Restaurant acquisition / takeover date Mid-term switch Other Current Policy Expiration Date (if renewing or switching) Do You Own or Lease This Restaurant? *
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Restaurant Identity

Legal name, DBA, EIN, and experience

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Property & Mailing Addresses

Restaurant / Property Address
Mailing Address (if different from above)
Mailing Street Address City State ZIP 👤 Owner / Contact Information Owner's Full Name * Owner's Cell Phone * Owner's Email Address * Hours of Operation * 🏗️ Building DetailsConstruction, size, and renovation history Year Building Was Built * Building Construction Type *
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Owner / Contact Information

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Building Details

Construction, size, and renovation history

Roof Material * Select... Asphalt shingles Metal Flat / built-up (BUR) EPDM / rubber membrane TPO / PVC membrane Tile Other Number of Stories * Select... 1 story2 stories 3 stories4+ stories Is There a Basement? *
Total Building Sq Ft * Dining Area Sq Ft (open to public) * Seating Capacity * Renovation History — Most Recent Year for Each System Plumbing Updated Wiring Updated Heating Updated Roof Updated ⚙️ Restaurant OperationsEmployees, receipts, alcohol sales, catering, and amenities Full-Time Employees * Part-Time Employees * Total Annual Payroll * Select range... Under $100,000$100,000 – $250,000 $250,000 – $500,000$500,000 – $1,000,000 $1,000,000 – $2,500,000Over $2,500,000 Annual Receipts / Total Gross Sales * Select range... Under $250,000$250,000 – $500,000 $500,000 – $1,000,000$1,000,000 – $2,500,000 $2,500,000 – $5,000,000$5,000,000 – $10,000,000 Over $10,000,000 Annual Alcohol-Only Sales (liquor, beer, wine) * Select range... None — no alcohol sold Under $25,000$25,000 – $50,000 $50,000 – $100,000$100,000 – $250,000 $250,000 – $500,000Over $500,000 Do You Do Catering? *
Renovation History — Most Recent Year for Each System
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Restaurant Operations

Employees, receipts, alcohol sales, catering, and amenities

Amenities & Special Features
Yes No Is There Entertainment? *
Yes No Is There Playground Equipment? *
Amusement Devices? (pool tables, video games, gambling, lottery, etc.) *
Yes No Is Frying Done with Trans-Fat-Free Oil? *
No Yes — describe Does Building Comply with ADA Requirements? *
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Values & Financial Details

Building, tenant improvements, inventory, and cash

Estimated Value of Building (includes permanently attached fixtures and equipment) Tenant Betterments & Improvements (if renting — value of renovations and improvements you made to the space) Estimated Value of Inventory (groceries, alcohol, furniture, equipment not permanently attached) * Do You Need Food Spoilage Coverage?
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Fire Suppression & Safety Systems

Sprinklers, UL 300, alarm, and suppression checklist

Why this matters: Fire suppression is a primary underwriting factor for restaurants. Incomplete or outdated systems can significantly affect coverage availability and premium.
Yes No Unknown Alarm System Type *
Automatic Extinguishing System — Coverage Checklist

Does the automatic extinguishing system protect all of the following?

Cooking surfaces
Yes No Deep fat fryers Yes No Other cooking appliances Yes No Exhaust ductwork Yes No Vent hoods Yes No Automatic gas / power cut-off Yes No Deep fat fryers have high-limit switches Yes No Baffle plate or ≥ 18 in. clearance between fryer and grill Yes No Extinguishing System Details Brand Name of System Year Installed Is the System UL 300 Approved? *
Deep fat fryers
Other cooking appliances
Exhaust ductwork
Vent hoods
Automatic gas / power cut-off
Deep fat fryers have high-limit switches
Baffle plate or ≥ 18 in. clearance between fryer and grill
Extinguishing System Details
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Inspection & Cleaning Agreements (Optional)

Fire System Inspection / Maintenance Agreement
Contractor / Company Name Inspection FrequencySelect...MonthlyQuarterlySemi-annuallyAnnuallyNo agreement Date of Last Inspection Duct & Hood Cleaning Agreement Contractor / Company Name Cleaning FrequencySelect...MonthlyQuarterlySemi-annuallyAnnuallyNo agreement Date of Contract / Last Service Hood & Grease Filter Cleaning Cleaning Method Cleaning FrequencySelect...WeeklyBi-weeklyMonthlyQuarterlySemi-annuallyAnnually Date of Last Hood Cleaning 🗂️ Current Insurance & Claims History Current Insurance Company Current Policy Number Any Claims in the Last 5 Years? *
Duct & Hood Cleaning Agreement
Hood & Grease Filter Cleaning
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Current Insurance & Claims History

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Lien Holders (Optional)

Banks or lenders with a financial interest in the property

Lien holder: Any bank or lender holding a mortgage or loan secured against this property. They must be listed on the policy.
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Certificate Holders (Optional)

Landlords or other parties requiring proof of insurance

Certificate holder: Any party that requires a certificate of insurance — typically your landlord or a franchisor.
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Upload Documents (Optional)

Attach current dec pages and/or loss runs to speed up quoting

Why upload? Your current declarations page shows existing coverage and carrier. Loss runs show your claims history. Both help us return a faster, more accurate quote.
Current Dec Page(s)
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Declarations Page

PDF, JPG, PNG, or DOC — max 10 MB

    Loss Runs
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    Loss Run Report

    3–5 years preferred — PDF, XLS, or DOC

      Max 10 MB per file  ·  You can also email documents directly to CommercialInsuranceAgency@gmail.com

      Ready to Submit?

      A licensed commercial broker will review your submission and respond within one business day with restaurant insurance options tailored to your operation.

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