OFF PREMISES LIQUOR LIABILITY SUPPLEMENTAL APPLICATION

Name of Applicant:

First Last

Are Applicant’s operations limited to this state?

Yes

No

If No, list all states in which applicant operates:

Applicant is:

Off-premises Caterer

Event Organizer/Coordinator

Bartending/Waiter Service

Other

Is applicant licensed to sell and provide alcohol off premises?

Yes

No

If Yes, provide liquor license number:

If Yes, provide annual gross off-premise alcohol receipts:

What are annual off-premise food receipts?

Who supplies the alcohol?

Applicantw

Applicants’ Client

Other

Is all alcohol served by applicant?

Yes

No

Number of jobs handled annually:

Number of jobs entailing the sale of alcohol:

Types of jobs handled:

Weddings

Corporate Functions

Private Parties

Other

Types of private parties?

Does the applicant ever cater for a youthful clientele?

Maximum number of guests at jobs:

What is the latest time alcohol is sold or served?

Prior Policy

Prior Policy Date

_______ to ________

Carrier Name

Coverage Type: Liab/PHD/MTC

POLICY #

# of Units Insured

Any loses within the past 5 years?

If YES please upload on the related documents attaching box below.

Amount Paid

Driver Involved in Loss

Upload Your Current Insurance Policy or Related Documents

Drop files here or

Max. file size: 20 MB, Max. files: 10.

OFF PREMISES LIQUOR LIABILITY SUPPLEMENTAL APPLICATION

Prior Policy

Recents Articles

The Importance of Long-Term Care Insurance in Future Planning

Why Health Insurance is Essential for Every Business Owner and Their Employees

April Insurance Agency

Get A Quote

Helpful Links

For Clients

Liquor Liability Off Premise Quote

OFF PREMISES LIQUOR LIABILITY SUPPLEMENTAL APPLICATION

Prior Policy

Recents Articles

The Importance of Long-Term Care Insurance in Future Planning

Why Health Insurance is Essential for Every Business Owner and Their Employees

April Insurance Agency

Get A Quote

Helpful Links

For Clients