Commercial Lines - Liquor Liability Supplemental Application

Company

This field is for validation purposes and should be left unchanged.

Legal Name of Insured*

The individual or company name that the policy will be under.

dba (if applicable)

Please list the dba that your company is listed as doing business as, i.e. Frankel & Associates dba Filmins.com

Does your organization own or lease LONG-TERM vehicles?*

Long term rental/leases are 6 months or more a year.

Do employees or volunteers regularly use their autos for company business?*

This is not commuting back and forth to work. This includes driving specifically for work purposes during working hours.

Please explain this vehicle usage in detail.*

Do you verify that insurance is in place with limits of at least $300,000 before employees or volunteers can use their vehicles?*

How many volunteers do you have driving personal autos for work purposes?*

What is your total number of employees?*

HIRED AUTO LIABILITY

Do you hire or rent vehicles during your fairs/festivals/events?*

What types of vehicles do you rent?*

How many vehicles do you estimate that you rent per year?*

What is the avarage duration of these rental vehicles?*

Please explain the usge of these vehicles for your business operations.*

Are any of these vehicles 12 or 15 passenger vans?*

How many of these vehicles are 12 or 15 passenger vans?*

Are any vehicles provided/donated for your use as part of a sponsorship or promotional agreement?*

Please provide a copy of the rental agreement and include a description of vehicle types, estimated number, duration and usage of these vehicles.*

Drop files here or

Accepted file types: doc, docx, pdf, xls, xlsx, jpg, gif, giff, Max. file size: 50 MB, Max. files: 5.

This information is required to determine the relationship between the sponsored/promotional company and your business operations by the underwriter.

Do either the volunteer/employees or sponsored/promotional companies require that you have primary liability?*

Please provide the names of the owners of these vehicles that require you to carry primary auto liability coverage.*

Please provide your email address for correspondance.*

Enter Email Confirm Email