Supplemental Application Hotels & Motels

Transcription

1 Supplemental Application Hotels & Motels Applicant Name: Location Address: Web Site: Date: Business Information: Years experience of mgmt. at this location: Total years experience in this industry: Any prior bankruptcies or liquidations? Premises Information: Number of rooms: Average room rate: Number of buildings at this location: Occupancy rate: Hour/Day/Week/Month: Minimum distance between buildings: When were updates for: - Electricity: Partial or complete? - Plumbing: Partial or complete? - Roofing: Partial or complete? - HVAC: Partial or complete? Are rooms accessible directly from outside? Are buildings sprinklered? Percentage: Are there smoke detectors? Hard wired or battery operated? Are there fire alarms? Central station, local or pull alarms? Is there aluminum wiring on premises? Is the aluminum wiring repaired? Clearly marked fire exits? Emergency lighting in common areas? Secondary means of egress for each floor? Dead bolt locks on doors to units? Are the locks re-keyed after occupancy? Are there elevators? Do you have an agreement with elevator company? Is there a parking lot located on premises? Is the parking lot owned, operated & maintained by applicant? What is the size of the parking lot? Is there a valet parking service? Is the valet parking provided by an independent service company? Is the valet service required to maintain indemnity insurance? 2006 Apex Insurance Managers, LLC 1 Hotels & Motels (09/12/08)

2 Pools: Check here if no Pools How many swimming pools? Are there any hot tubs? Do pools have self-latching doors or gates? Are there any diving boards or slides? Are there life guards on duty? How often? Is there rescue equipment such as a ring buoy, shepherds hook or pole? Are pool depths adequately marked? Are pool chemicals properly stored? Is there an automatic shutoff? Recreational Facilities: Check here if no Recreational Facilities Is there a playground? Is it fenced? Are there any lakes, ponds or boat slips? Are there any exercise facilities? Are there any daycare services? Are there any tennis, basketball or racquetball courts? Are there any saunas? Are there any recreational equipment rentals/checkouts? 2006 Apex Insurance Managers, LLC 2 Hotels & Motels (09/12/08)

3 Restaurant/Cooking Exposure: Check here if no Cooking Exposure Any sub-contracted cooking facilities? Is indemnity ins. required? Type of cooking - Deep Fat Fryers? - Griddles? - Grill/BBQ Pit? Does establishment serve any raw seafood? Are there any banquet facilities? Square footage: Maximum occupancy: Any off-premises catering? Is there an automatic suppression system Is there an automatic shutoff? over all cooking surfaces? Is there an independent cleaning contract for the automatic How often is system cleaned? extinguishing system? Is there an independent cleaning contract for hoods & ducts? How often is system cleaned? Have there been any Health Dept. violations? Liquor Liability: Check here if no Liquor is sold or furnished Have you ever had your liquor license revoked or suspended? Have your ever had any prior liquor citations or law violations? In the last 5 years, have you had any liquor or dram liability claims? Do all servers receive formal Alcohol Awareness training? Do you sponsor any drink specials (i.e., 2-for-1, ladies night, etc.)? Do you have any package sales? Do you have any drive-thru facilities? Do you admit anyone under 21? Age of clientele (percentages): Are patrons allowed to bring in their own alcoholic beverages? Are you open later than other establishments in the area? Do you provide cab service or have a designated driver program? Is there any off-premises liquor catering? Under thru thru 40 Over Apex Insurance Managers, LLC 3 Hotels & Motels (09/12/08)

4 Bar/Lounge: Check here if no Bar/Lounge Hours of operation: Mon. Thu. Fri. Sat. Sun. Is there a dance floor? Sq. footage: Are there any mechanical devices? Are there any gambling devices or tables? Are there any pool or billiards tables? Are there any athletic events? Are there any promotional events (such as Teen Night, Wet T-Shirt or Foam Contests)? Are there any special activities (such as mud wrestling, bungee jumping, Velcro suits or mosh pits)? Other special events or promotional activities (such as banquets, weddings, etc)? LIVE Entertainment: Check here if no LIVE Entertainment Is there a DJ? Is there karaoke? Is there any topless or Go-Go dancing? Are there any comedians or stand-up entertainers? Any live performers: - Country?. nights per - Piano/Solo Acts?. nights per - Rock/Disco?. nights per - Other?. nights per Are there any national known performers? Are there any promoters? Any special effects: - Lighting/Sound? - Smoke? - Pyrotechnics? Other live entertainment? 2006 Apex Insurance Managers, LLC 4 Hotels & Motels (09/12/08)

5 Security: Are there any surveillance cameras? Are there any ID checkers? Are there any bouncers or security guards? Are bouncers or security guards employees? Are they third-party bouncers or security guards? Does applicant require third-party bouncers or security guards to have insurance? Is applicant an additional insured on thirdparty bouncers or security guards insurance? Are there any off-duty policemen? Are there ever any weapons on premises? Bouncer possession? Security guards possession? Off-duty police possession? Other weapons? Describe: Gross Receipts: Hotel Operations Restaurant Bar/Lounge Sales/receipts Food Food Rentals Liquor Liquor Other Catering Catering Total Total Total Hired & n-owned Auto: Check here if not requested Do you verify each employee driving for business purposes has a valid government issued driver s license and carries sufficient personal insurance in accordance with minimum state insurance requirements? Do you prohibit business driving rights for any individual with prior incidence of license suspensions, revocations or DUI convictions? Do you provide off-site catering or delivery services? Have you had any hired and non-owned auto losses in the past 5 years? Please attach detailed list of losses Apex Insurance Managers, LLC 5 Hotels & Motels (09/12/08)

6 Representation & Warranty Statement: I have read this Application and I represent that all of the foregoing statements are true and accurate and that these statements are offered as the basis upon which Apex is considering issuance of an insurance policy. Any missing or erroneous information in this Application may jeopardize coverage in the event of a claim under any policy issued by Apex. WARNING: Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any materially false information, or conceals for the purpose of misleading, information concerning any fact material thereto, commits a fraudulent insurance act, which is a crime, and shall also be subject to a civil penalty not to exceed five thousand dollars and the stated value of the claim for each such violation. Applicant: Title: Date: 2006 Apex Insurance Managers, LLC 6 Hotels & Motels (09/12/08)