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Home > Restaurant > Secure Restaurant Owners Insurance Quote
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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
Required

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.

Per the terms of our online privacy policy we will not resell your information to any third-party.
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1802 S Parrot Ave
Okeechobee, FL 34974
P: 863-763-7711
F: 863-763-5629

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