Request a Quote for Liquor Liability Insurance

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Welcome to our Liquor Liability Insurance Quote Request form. This simple process takes just 5-15 minutes.

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Business Information

Business Name:
Contact Name:
Address:
City:
State:
Zip:

Best Way To Contact You?

Phone:
Fax:
Email:

Best Time To Contact You?

Time:
AM PM

Note: We will require additional personal information from you (such as your Social Security Number, etc), which we will collect when we contact you. We don't collect this online so that we can help protect your privacy.

General Information

Nature of Operations:
Restaurant    Neighborhood Bar    Sports Bar    Night Club    Private Club    Retail Stores

Gross Receipts:
Food
Liquor
Catering
Other

Hours of Operation:
Monday - Thursday
Friday & Saturday
Sunday

Location:

Commercial
Residential

Urban
Rural

Clientele:

Family
Business
Tourist

Neighborhood
College Students

Amusement Devices:

Pool Tables       If yes, how many:
Video Games       If yes, types:
Darts       If yes, how many boards:
Other       Describe:

Sponsor athletic teams?
Yes No If yes, describe:

Dance floor?
Yes No If yes, dimensions:

Entertainment?

Any firearms on premises?
Yes No
Do you employ bouncers?
Yes No

Kitchen Exposure?

Liquor Exposure Name of licensee:
License number:
Has applicant ever had a liquor license refused, suspended or revoked?
    Yes    No
Has applicant ever had a liquor violation?
    Yes    No

Prior carrier information for Liquor Liability:
Company Name/Policy No.:
Policy period:
Policy limits:
Premium: $
Ever cancelled or non-renewed?
    Yes    No
Has applicant had any liquor liability claims in the past three years?
    Yes    No
If yes, explain:

Promotional Events:
Type:

How often?	Duration?
Happy Hour Ladies Night Sports Night Other:

Have bartenders and servers completed a course in alcohol awareness? Yes No
How do bartenders and servers prevent sale of alcohol to intoxicated persons?

Disclaimer

Your rate quote depends on the accuracy of the details you provide on our form. Please be aware that not all limits and coverage selections are appropriate for everyone.

Not all situations and needs can be addressed by our form. If you require personal assistance, please contact us.