Commercial Questionnaire - Tony Castle Insurance Agency

Commercial Insurance Request

Name(Required)

First Last

Email(Required)

Enter Email Confirm Email

Business Name

Company Name

Company Structure

Sole Proprietorship

Partnership

LLC

Corporation

Date Business Started

EIN or Tax ID

Owners Industry Experience

Business Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Insurance Services Desired(Required)

Commercial Building

General Liability

Liquor Liability

Workers Compensation

Employer Liability / Professional Liability

Gross Sales (All locations under same company)

Gross sales, if under separate LLC or structure please complete a second form

Sales Breakdown (By Percentage per category)

Percent of Sales for - Bowling - Snack Bar & Vending - Pro Shop - Bar Sales (liquor & Beer separately) Other income sources

Description of Operations

If multiple locations please give as many details as possible including each location address, staff and position of staff

Types of Customer & Age groups

Percentage of age group that participates overall, does not have to be nightly (ie. Families, College students, Military, etc. Also age group average age of customer

Any Happy Hour Specials

If so, please explain

Hours of Operation

Please detail anything after midnight

Other Entertainment

Juke Box, DJ's, Karaoke, anything outside of the normal scope of operations

Equipment

Please list if any thing like pool tables, gaming machines, mechanical rides, other sports facilities like volleyball, axe throwing, or something

Building Information

Year Built

Construction Type

Floors

Any upstairs or basement area? Are these areas accessible by public?

Total Square Footage

Square Footage Accessible by Customers

Most Recent Updates

Last time Roof, Electrical, Plumbing, were updated. Is plumbing PVC or PEX?

Roof Type

Flat Roof, PVC, etc

Estimated Business Property Value

Please estimate all business personal items, this does not include pin setters or lanes

Claims History

Please list any and all claims for Liability, Building, Product Liability, as well as any judgements, bankruptcy, felony convictions of owners, basically anything bad...