Restaurant Insurance Quote - Barragan Insurance Agency (Oscars sauce)

Name

Name Restaurant Business Name or DBA

Mailing Address (include city, state, zip) Physical Address if Different from above (include city, state, zip)

Phone

Email

Restaurant Type

Entity

Annual Gross Revenue:

Employee Payroll

Number of Full Time Employees 2 PT =1 FT:

Please describe the nature of your business and ANY unusual exposures:

Liability limit?:

Building limit?:

Amount of Business Personal Property (contents)?:

Total SqFt Bldg.:

Total Sq Ft Business:

What % of the building has interior automatic fire sprinklers?:

Construction Type:

Roof Type:

Type of Alarm?:

Are there any other restaurants in your building?:

List Any Losses or Claims in the last 5 years?:

Date of Claim / Loss	Amount Paid Out	Description of Loss or Claim

Are there any questions, comments, additional coverage, or service you require?: