Additional Resources

Informational Brochure

Restaurant Questionnaire

Workers' Compensation Quote

Nevada Gaming and Hospitality Association

Restaurant Questionnaire

Please fill out this form in its entirety and click 'Submit' at the bottom.

Email *:
Formal Name of entity (Example: Abc, Inc. or Abc, LLC; etc.) *:
Street Address *:
Address Line 2:
City:
State / Province / Region:
Country:
Postal / Zip Code:
-
Name of principal contact (owner or manager) *:
Email for principal contact *:
Phone number for principal contact *:
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Number of years in business *:
When do you need coverage? *:
Other:
Workers Comp Questions
Estimated Annual Payroll *:
Are owners/officer to be included for work comp coverage? *:
Needed: NCCI Experience and Modification Worksheet Loss runs for past 3 years and current year.
Liability Questions
Square footage area used by customers *:
Liquor Receipts *:
Food & soft drink receipts *:
Other receipts (except slots). Please list *:
Number of slot machines *:
Any athletic events sponsored? If so list.:
Any recreations facilities (pool, darts, horseshoes):
Any dancing? If so dance floor square footage:
Live Music? Type (rock, blues, rap etc.):
Standard liability coverage is $1,000,000 per occurrence; $2,000,000 aggregate. Is more insurance required? If so, please specify limit:
Any citations by any gaming or alcohol control board in past 5 years?
If so, please list::
Property Questions
Amount of contents coverage requested: (Contents coverage includes furniture, office furniture, office computers and equipment, slot machines, bar, coolers, restaurant equipment, phone systems, inventory and cash registers) *:
Building construction:
(Are exterior walls wood covered with stucco; concrete block or brick; or concrete tilt up) *:
Roof construction:
(Is roof constructed of wood; or 100% metal) *:
Age of building (years old, approximately) *:
Are there fire suppression sprinklers in the ceiling of the building (yes or no) *:
Describe fire suppression systems over cook tops *:
Please describe security systems *:
Please describe safes *:
Amount of money coverage wanted *:
Any fine arts or antiques coverage needed? *:
Any Sign coverage needed? *:
Any food spoilage coverage needed? *:
List any claims in past 4 years for property, liability or liquor, including assault and battery, robbery, burglary, employee dishonesty, theft, fire, or any other claim. (Do not include workers comp claims) *: