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December 5, 2019
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Hotel/Motel Insurance Quote
CONTACT INFORMATION
Contact Name *
Contact Email *
Business Name *
DBA Name (if any)
Mailing Address *
City
State
Zip
County
Business Phone
Cell Phone
Fax
Preferred Method of Contact?
Business Phone
Cell Phone
Email
Fax
GENERAL INFORMATION
FEIN #
Business Type
Corporation
LLC
Joint Venture
Trust
Partnership
Sole Proprietor
Other (describe)
How Long in Business? (yrs)
Do you have a website?
Yes
No
What is the URL of your website?
Is the hotel operated under a franchise agreement?
Yes
No
If yes to above, who is the franchisor?
What is the occupancy rate for the past 12 months?
Do you hae hourly rates?
Yes
No
Do you have weekly rates?
Yes
No
Do you have monthly rates?
Yes
No
If yes above - what is the maximum length of stay permitted?
Do any guests consider the hotel tehir permanent residence?
Yes
No
How many full time employees?
How many part time employees?
What are the annual gross receipts?
What is the annual payroll?
CURRENT INSURANCE
Name of current insurance company
Policy expiration date
Any claims for the prior 4 years?
Yes
No
If yes above - please explain:
PROPERTY
Property Address (If different from mailing address)
City
State
Zip
County
Year Built
Construction Type
Frame
Brick Veneer
Stucco
Metal
Concrete
Tilt Wall
Type of Roof
Central Station Alarm
Yes
No
# of Stories
Total Building Square Footage
Building coverage amount requested
Business Personal Property or contents coverage amount requested
Is there an automatic sprinkler system?
Yes
No
Unknown
What percent of the building is sprinklered?
Not applicable
90-100%
50-89%
Less than 50%
Unknown
Age of the sprinkler system?
Not applicable
Less than 10 years
10-25 years
25-49 years
50 or more years
Unknown
Type of sprinkler system:
Not applicable
Life safety system
Full fire system
Wet
Dry
Other
Unknown
Was sprinkler system designed for current occupancy?
Yes
No
Unknown
Is a subcontractor responsible for sprinkler system inspection, testing and maintenance?
Yes
No
Unknown
How often is sprinkler system maintenance and inspection performed?
Monthly
Quarterly
Semi-Annually
Annually
Unknown
Are sprinkler alarms installed?
Yes
No
Unknown
If yes above - are they:
Water flow
Valve closure
Unknown
Is there a Closed Circuit TV system?
Yes
No
Unknown
If yes above - is it monitored 24 hours a day?
Yes
No
Unknown
Are there any flammables, aerosols, propane or other chemicals stored on the premises?
Yes
No
Unknown
If yes above - please describe
Are there any fireplaces?
Yes
No
Unknown
If yes above - are they:
Wood
Gas
Wood and Gas
Pellet Stove
Has there been any water damage in the past 3 years, including plumbing leaks?
Yes
No
Unknown
Are facilities building systems, equipment maintenance and overall facilities inspections performed?
Yes
No
Unknown
If yes above - when are they performed?
Scheduled
As needed
Breakdown
Unknown
INSPECTIONS
If any inspections are done, what areas are reviewed?
How Often
What is the year of last improvement or upgrade?
Roof
Electrical
Plumbing
HVAC
Common Areas
Emergency Lighting
Exit Signs
LOCATION DETAILS
Please answer the following
Total # of Units
# of Bldgs at this location
Location 1
PROPERTY - UPDATES & IMPROVEMENTS
If any improvements or updates been done to the following - what year were they done?
Wiring
Roof
Plumbing
Heating & A/C
Location 1
LIABILITY
Is there is a restaurant or bar?
Yes
No
If yes above - is it operated by you or leased to another entity?
Operated by you
Leased to another entity
Check all of the following drink specials that may apply:
Happy Hour
2 for 1
Dancing
Live Entertainment
None of the above
Unknown
What are the annual receipts from the restaurant?
What are the annual liquor/alcohol receipts?
Do you provide valet parking or shuttle service?
Yes
No
Unknown
If yes above is it handled by your employees?
Yes
No
Do you have any activities sponsored by the hotel/motel for guests?
Yes
No
If yes above - please describe:
Are firearms/weapons kept on premises?
Yes
No
Unknown
Is there any security staff on the premises?
Yes
No
If yes - are they:
Employees
Contractors
Unknown
If yes - are they:
Armed
Unarmed
Unknown
Are independent contractors hired to perfom maintenance, repair or other construction work?
Yes
No
There is a standard written contract between the hotel/motel and the contractor
Yes
No
Unknown
The contract requires the contractor to name the business as an additional insured for both operations and completed operations.
Yes
No
Unkown
The contractor agrees to hold the hotel/motel harmless.
Yes
No
Unknown
The contractor provides a certificate of insurance with proof that the contractor has workers compensation and General Liability insurance with limits of at least $1,000,000.
Yes
No
Unknown
Is there a parking garage?
Yes
No
If yes to above - is the garage:
Above ground
Below ground
Do tubs and showers have non-slip surfaces?
Yes
No
Do tubs and showers have grab bars?
Yes
No
Do guest rooms have peepholes?
Yes
No
Is there a hotel safe?
Yes
No
Does the hotel manager/owner live on the premises?
Yes
No
Are there any unuseable or unrentable rooms?
Yes
No
If yes above - how many rooms and why?
What type of security measures are in place - check all that apply:
Closed Circuit TV
Alarms
Security Patrols
Police Patrols
Guard
Cardkey
None
Unknown
Are all doors except the main entrance locked to outsiders at night?
Yes
No
Is there an evacuation plan?
Yes
No
Unknown
Are there at least 2 emergency exits in the building?
Yes
No
Unknown
Are there at least 2 enclosed sraiwells in the building?
Yes
No
Unknown
Is there emergency lighting in the building?
Yes
No
Unknown
How is smoke/fire detected? Check all that apply:
Battery operated smoke detectors in all units
Manual pull station
Hard wire smoke detectors in hallways & common areas
Central station alarm
Connected to annuciator panel
Local alarm
Unknown
If the area is subject to snow and ice accumulation, is the occupant responsible for snow and ice removal?
Not applicable
Yes
No
Unknown
What are the snow and ice removal proceedures?
Contracted with a local contractor
Maintenance staff
Nothing formal
Unknown
Does th building have self-closing doors?
Yes
No
Unknown
If yes above - are they in the:
Hallways
Individual units
Both
Unkown
Does the hotel use an electronic access system using cards rather than keys?
Yes
No
Unknown
Is there a playground?
Yes
No
Unknown
If yes above - what year was it installed?
Is there any exercise equipment?
Yes
No
Unknown
What type of exercise equipment? Check all that apply:
Free weights
Elliptical trainer
Weight machine(s)
Stair climbing machine(s)
Treadmill(s)
Staionary bike(s)
Rowing machine(s)
Unknown
Is exercise equipment also open to non-hotel guests?
Yes
No
Unknown
SWIMMING POOL/HOT TUBS/SAUNA
If you have a swimming pool, hot tub or sauna, please complete this section
Do you have any of the following - please check all that apply:
Swimming pool
Hot tub/Jacuzzi
Suana
Lake
Pond
If yes above - please check all that apply:
Lifeguard on premises
Indoor pool/hot tub
Outdoor pool/hot tub
If outdoor - is it fully fenced
Fence has a child proof latch
Diving board
Slide
Depth markers
Rules posted
Pool has an anti-vortex drain
Corded off swimming area
If you have a hot tub/Jacuzzi - do you have signage limiting the time to 30 minutes and warning labels?
Yes
No
If you have a Sauna - do you have signage limiting the time to 30 minutes and warning labels?
Yes
No
COOKING
If any cooking is done, please complete this section
Is there any cooking on premises?
Yes
No
Unknown
Are all hoods, ducts, grease filters and surface cooking equipm,ent (including deep fat fryers) protected by a UL listed automatic fire suppression system?
Yes
No
Unknown
Is there a service/maintenance agrement in place for the protective systems?
Yes
No
Unknown
If yes above - name of the firm:
Is the fire suppression system professionally inspected and serviced at least every six months?
Yes
No
Unknown
If yes above - date last serviced?
How often are exhaust systems, hoods and ducts cleaned?
Quarterly
Semi-Annually
Annually
Unknown
How often are filters cleaned?
Weekly
Bi-weekly
Monthly
Unkonwn
Does the system automatically shut-off all sources of fuel and heat to equipment protected by the suppression system (including electrically heated deep fat fryers)?
Yes
No
Unknown
Does the system have a manual pull fuel shut-off valve readily accesible?
Yes
No
Unknown
If yes above - Is there a 16 inch separator between fryers and adjacent cooking appliances and/or equipment?
Yes
No
Unknown
Is there a deep fat fryer?
Yes
No
Unknown
UMBRELLA
Do You Have An Umbrella Policy Now?
Yes
No
Current Insurance Company
Current Policy Expiration Date
Amount of Coverage Requested
* = Required Field
Disclaimer Notice
- The premiums quoted are estimates based on information you provided. This quotation does not constitute a contract of insurance, nor does it provide coverage for any loss or claim. Coverage can only be bound by an agent with a signed application and a down payment.
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