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Secure Restaurant Owners Insurance Quote

Fill out the following form as completely as possible. Once you have completed the form, click the Submit button to send your information. Your request will be handled promptly.

Business Information

Full Legal Business Name

DBA

Entity

Federal ID #

First Name *

Last Name *

Street *

City *

State *

ZIP / Postal Code *

Primary Phone Number *

Fax Number

E-Mail Address *

Type of Restaurant

Number Owners or Officers

Number of Full Time Employees

Number of Part Time Employees

Estimated Monthly Payroll

Number of Locations

Years at present location

Years in Business

Gross Annual Sales

Do you deliver?

If you provide entertainment describe types

If Alcohol Sales

TAMS or TIPS certified?

Liquor License Class & Number

Name on Liquor License

Any Liquor Violations?

If You Cater

Do you use someone else's kitchen?

Do you prepare food on site?

Do you use your personal vehicle(s)?

Do you have a cargo van insured for commercial use?

Do you review employees who drive his/her motor vehicle report annually?

Do you serve alcohol?

Building Information

Approx. Year Built

Total Est. Square Footage

Your Occupied Square Footage

Do you own the building?

Is the building free standing?

Is building located in a shopping center?

Do you have a free standing sign?

More than 1 free standing sign?

Indoor Fire Spinkler

Building Construction

Hood Inspection Co. & Frequency

Hood Duct Cleaning Co. & Frequency

Did you make improvements?

Contents/Equipment Limit

Food Spoilage Limit

Sign Limit

Current Insurance

Current Carrier Name

Current Policy Expiration

Prior/Current Policy Carrier

Do you know your worker compensationexperience mod?

Premium Amount

Coverage Description

Losses

Number of Losses Claimed

Additional Information

Agent Name (Optional)

How Did You Hear About Us ?

Preferred Contact Method

Additional Comments

Acknowledge "Important Notice" below was read *

Submission Validation

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Important Notice
Any submissions or payments made via this website do not constitute a binding agreement to your policy or coverages. Changes and payments to policies are not effective or binding until you, or any party involved, receive official notice from either your insurance agent, or your insurance company. If you have any questions, please feel free to contact us.

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1802 S Parrot Ave
Okeechobee, FL 34974

P: 863-763-7711
F: 863-763-5629