Restaurant Insurance Quote 
In order to provide you with a quote and to determine your eligibility for our programs that we offer through various carriers, our agency and/or companies we represent may use information contained in credit, MVR reports, insurance loss history, and other various consumer reports.  In order to provide you with a quote, our carriers may also develop a credit-based insurance score using these reports and sometimes this is accomplished by using a third party.  For additional information on collection and disclosure of personal information, and your right to see and have the opportunity to correct any personal information in your files, please contact our office.   The reports provide us and/or our carriers with information that assists with determining your eligibility for insurance and the final price you are charged.  By completing these forms, you agree to this process in making a request for a quote.
Contact Information
Contact Name
 *
Address
 *
City
State
Zip
Business Phone
 *
Fax Number
Contact Email Address
 
Current Insurance Information
Current Insurance Carrier
Premium
Expiration Date
 
Business Information
Name of Business
 *
Number of years in business under current ownership
 *
Types of cooking
 *
What are the hours of operation
 *
Number of employees
 *
Has the owner ever been involved in a bankruptcy or business failure?
lf needed will financial statements be provided prior to binding?
Is the business seasonal?
Is there a bar or lounge?
If yes please describe
Happy Hour?
If liquor is served describe the training protocol for liquor servers
Is there live entertainment?
If yes please describe
Is there a dance floor(s)?
If yes what size
Are there any operations away from the premises such as catering?
If yes please describe
Any tableside cooking or food preparation?
Was the building originally built as a restaurant?
If no has wiring etc. been updated for restaurant occupancy?
If Yes When?
Maximum seating capacity of restaurant:
 *
Maximum seating capacity of lounge
Number of exits
 *
Are all exits free of obstruction lighted and marked with exit signs?
Is there emergency lighting?
Has insured ever been cited by Board of Health?
If yes please explain
Housekeeping
Valet Parking?
Is there a coat check room?
Are all areas over ranges grills fryers and all other cooking surfaces and hoods and ducts protected by a ULB00-compliant automatic fire extinguishing system?
Is there a maintenance agreement to regularly inspect and service the system?
If yes times per year
If no please explain
How often are the grease filters cleaned by the employees?
 *
Input field
Any live entertainment?
Any amusement devices such as pool tables or video games or darts?
Gross Sales for the past 3 years
Year
 *
Food Sales $
 *
Liquor Sales $
 *
Year
Food Sales $
Liquor Sales $
Year
Food Sales $
Liquor Sales $
Any additional comments or information that might be helpful
 
By completing this form you are acknowledging your understanding of and agreement with the following terms:
1. No coverage of any kind is bound or implied by submitting information via this online form.
2. Information from you and other sources such as your driving claims and insurance histories may be used to calculate an accurate price for your insurance.
3. We will not distribute information to other parties other than for insurance underwriting purposes.
4. We value your privacy. Every precaution has been taken to insure your privacy and security.
5. By submitting this form you agree to release us from any liability should this information be accidentally viewed by others.
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Have questions or concerns about your insurance?
We can help.
Call 1-800-352-3416

For a quick quote, call us today!
We currently provide insurance services in: 
  • North Carolina
  • South Carolina
  • Virginia

    Please note: Changes to policies via this website are not effective or binding until you, or any party involved, receive official notification from your insurance agent, or your insurance company. If you have any questions, please feel free to contact us.

    First Casualty Insurance Group, Inc.
    190-A Turner Street
    Southern Pines, NC 28387
    1-800-352-3416
    fciginfo@fcignc.com
     
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