Ace Members

General Liability

Liquor Liability

Products and Completed Operations

Assault and Battery

Employee Benefits

Hired Auto and Non-Owned Auto Liability

Do you want to increase Damage To Rented Premises Limit?

Excess Liability Quote Requested

Is there cooking on any premises?

Is there any table side cooking?

Has the Member(s) ever been cited by the Board of Health?

Does the Member ever engage in 24 hour operations?

Does the Member have a parking lot?

Does the Member provide complimentary transportation either to or from their location(s)?

Does the Member offer valet parking?

Is valet parking provided by Employees or a Third Party Contractor?

Does the Member engage in facility or room rentals for private events?

Are patrons permitted to dance?

Does the Member allow patrons to dance or stand on any raised equipment, including but not limited to, speakers, furniture, tables, chairs, or bar-top?

Does the Member ever have or plan to have any type of stunt activity on any premises? (Stunt activity includes but is not limited to any type of acrobatics, carnival acts such as flame or sword swallowing, etc)

Does the Member ever allow open flames and/or incendiary devices on the premises?

Does the Member have or plan to have during the policy period any of the following interactive amusement device or activity on premises? (select all that apply)

Does or will the Member ever allow persons other than employees trained in a properly accredited alcohol awareness program to serve alcohol to patrons (e.g., patrons, guest bartender, etc.)?

Does the Member ever permit or sponsor alcohol consumption games (e.g., beer pong, flip cup, etc.) or permit the use of alcohol consumption enticing equipment (e.g., beer bongs, funnels, etc.)?

Does or will Member engage in any type of alcohol promotions during the policy period?

Does or will the Member offer any drink prices reduced to $1.00 or less?

Does or will the Member adhere to all statutes and regulations regarding drink specials?

Does the Member ever permit “BYOB” on the insured location?

Does the Member ever have package alcohol sales for off-premises consumption?

Does or will the Member permit patrons who are over 18 but under 21 on the premises after 10:00 PM?

Does the Member ever permit employees or other persons serving alcohol to consume alcohol during their hours of employment or service?

Does the Member ever permit the service of alcohol after the established legal operating hours?

Are patrons ever allowed on premises one hour after the established legal alcohol service cut-off time?

Has the Member been fined or cited for violations of law or ordinances related to illegal activities or the sale of alcohol?

Are firearms kept or permitted on premises by anyone other than police officers?

Does the Member have any person(s) whose primary role is security, bouncer, ID checker and/or door person?

If provided by contractor, do they provide certificates of insurance evidencing EQUAL General Liability limits and naming the Member and their landlord entities as additional insured?

Does the Member have a written policy regarding the striking and/or assaulting of patrons that is signed by all employees?

Does the Member engage police officers for work in or about the insured location?

Are there secondary means of egress for each floor having public access at all locations?

Are there functioning and operational fire extinguishers and smoke detectors in all common areas?

Is the building armed with a functioning and operational automatic sprinkler system?

Is there a central station fire alarm?

When is the last time electrical wiring was updated? (mm/dd/yyyy)*

Please check the appropriate box(es) to indicate how the police officers are engaged and their services invoiced

Number of security per:

FRAUD STATEMENT: Any person who knowingly and with the intent to defraud any insurance company or other person, files an application for insurance or statement of claim containing any materially false information, or conceals for the purpose of misleading information concerning any fact material thereto, commits a fraudulent insurance act, which is a crime. The Member hereby certifies, based upon reasonable and diligent investigation and to the best of the knowledge of the Member, its owners, officers, employees and representatives, that with respect to the insured operation(s) and location(s) for which this application is being submitted:

Have there been two or more claims in any single period?

Have there been, at any time, any alcohol related claims?

Have there been claims during any policy period exceeding $25,000 in value based upon either the accumulated reserve or paid settlement amount?

WARRANT: THE UNDERSIGNED REPRESENTS AND WARRANTS, TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF, BASED ON REASONABLE INQUIRY, THAT THE PARTICULARS AND STATEMENTS SET FORTH ON THIS APPLICATION ARE TRUE, CORRECT AND ENTIRELY COMPLETE, AND THERE ARE NO OTHER RISK FACTORS THAT HAVE NOT BEEN DISCLOSED HEREIN. IF ANY PARTICULARS OR STATEMENTS ARE MATERIALLY MISREPRESENTED OR MATERIAL INFORMATION HAS BEEN OMITTED INTENTIONALLY OR ACCIDENTALLY, SUCH MISREPRESENTATION OR OMISSION WILL VOID ANY ISSUED COVERAGES AND THE INSURANCE COMPANY WILL HAVE NO DUTY TO DEFEND ANY CLAIMS, PAY ANY DAMAGES, OR PAY SUMS OR PERFORM ACTS OR SERVICES. THE UNDERSIGNED AGREES AND ACKNOWLEDGES THAT THE PARTICULARS AND STATEMENTS SET FORTH HEREIN ARE MATERIAL TO THE ACCEPTANCE OF THE RISK ASSUMED BY THE INSURANCE COMPANY AND THAT THE INSURANCE COMPANY IS RELYING UPON THE TRUTH AND COMPLETENESS OF THE RISK FACTORS DISCLOSED HEREIN. IT IS AGREED BY THE UNDERSIGNED THAT THIS APPLICATION, INCLUDING ANY MATERIAL SUBMITTED HEREWITH, SHALL BE THE BASIS OF THE CONTRACT SHOULD A POLICY BE ISSUED, AND THIS APPLICATION SHALL BE ATTACHED TO AND BECOME A PART OF THE POLICY. IF THE INFORMATION IN THIS APPLICATION MATERIALLY CHANGES PRIOR TO THE EFFECTIVE DATE OF THE POLICY, THE MEMBER WILL NOTIFY THE UNDERWRITER IMMEDIATELY IN WRITING AND THE UNDERWRITER MAY MODIFY OR WITHDRAW ANY OUTSTANDING QUOTATION OR PROPOSAL.