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Generic Quote
Liquor Quote
Liquor Quote
LIQUOR LIABILITY FOR BARS, NIGHTCLUBS AND PUBS
General Information
Business Name
Contact Name
Address
City
Province
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland
Nova Scotia
Nunavut
NWT
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
Postal Code
Phone Number
Email
Type of Operation (check all that apply)
Neighbourhood Pub
Bar or nightclub with entertainment
Bar with exotic dancer
Food service provided
Liquor store or beer and wine store attached
Other (describe in detail below)
Operation Details
Annual Sales Information
Past 12 months
Next 12 months
Liquor on Premises:
$
$
Liquor, Beer & Wine Outlet:
$
$
Liquor, Beer & Wine Outlet:
$
$
Food Sales:
$
$
Automated Teller Machines:
$
$
Video Lottery Terminals:
$
$
Other:
$
$
Coverage Information
Liability Limit:
$
Building Limit:
$
Crime (Money & Securities):
$
Boiler and Machinery:
$
Glass:
Yes
No
Forcible Ejection:
Yes
No
Previous Coverage Information
Existing Liquor Liability Insurance Company:
Existing Insurance Broker:
Premium:
$
Limits:
$
Policy Number:
Effective Dates:
Other Information
Previous Claims or Losses in the past 5 years
(please include approximate date, details and claim payout amount)
Additional Comments
Please give any additional comments you feel appropriate for this quotation. If you have additional information where there was not enough space, please enter them here.
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