KMRD Restaurant / Bar Exposure Profile

* Required

First Name: *

Last Name: *

Email: *

Phone Number: *

Name of Entity: *

Are their other Entities with Insurable Interest? *

FEIN: *

Food Sales $: *

Alcohol Sales $: *

Liquor License #: *

Property Location:

Street: *

City: *

County: *

State: *

Zip: *

Mailing Address (if different than above):

Street:

City:

State:

Zip:

Description of Operations:

Entertainment: *

If Yes, describe type(s) of Entertainment:

Amusement Games: *

If Yes, describe type(s) Amusement Games:

Hours of Operation: *

Doorman: *

Last Call Given: *

Alcohol Awareness Training: *

Shots Served: *

Seating Capacity:

Bar: *

Restaurant: *

Building Informatoin:

Total Square Feet: *

Total Square Feet of Insured Area: *

Age of Building in Years: *

Year of Improvements:

Roof: *

Plumbing: *

Electric: *

HVAC: *

Alarms:

Burglar: *

Yes

Fire: *

Yes

Smoke: *

Yes

Current Insurance Information

Current Carrier:

Expiration Date of Current Policy(ies): +

Current Agent:

Upload Current Policy if Available: 🛈

Loss History

Overview of Loss History: *

Thank you for utilizing this system. You should recieve confirmation of your request via email. A KMRD representative will reach out to you with questions if we have them. If you do not hear from us, feel free to call at 866-957-KMRD (5673) or contactus@kmrdpartners.com

This form is for communication purposes only. This form does not bind coverage

Thank you for your interest in working with KMRD. The completion of this profile is for KMRD's information purposes to see if your operation fit our and our carrier's appetite.

Completing this form does not bind insurance coverage.

If you do not hear from us in 24 hours feel free to reach out to 866-957-KMRD (5673) or send us an email at contactus@kmrdpartners.com.