COMMERCIAL GENERAL LIABILITY QUESTIONNAIRE

LIQUOR

Does applicant ever serve, sell or furnish alcoholic beverages to employees, customers or general public?

___ Yes ___ No

If yes, is the applicant in the business of selling, distributing, or serving liquor?

___Yes ___ No

NOTE: If yes, consider completing the Liquor Liability Questionnaire.

If no, what precautions are taken to prevent guests from driving while intoxicated?

__________________________________________________________________________

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LIQUOR LIABILITY

TYPE OF LIQUOR LICENSE(S)

_________________________ License No. ________________ Issue Date _____

_________________________ License No. ________________ Issue Date _____

_________________________ License No. ________________ Issue Date _____

Has the applicant’s liquor license ever been revoked? ___Yes ___ No

If yes, explain: ________________________________________________________

___________________________________________________________________

Describe operations: _____________________________________________

____________________________________________________________________

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ANNUAL RECEIPTS

NORMAL OPENING AND CLOSING HOURS (show a.m. or p.m. after time)

        Sun.   Mon.   Tue.    Wed.    Thu.    Fri.    Sat.
Open: _____ _____ _____ _____ _____ _____ _____
Close: _____ _____ _____ _____ _____ _____ _____

SEATING CAPACITY

Dining Room _____ Bar _____ Maximum legal occupancy _____

NUMBER OF EMPLOYEES

Number of employees during peak periods serving alcoholic beverages: _____

Of these, how many are:

bartenders _____ owners _____ waiters/waitresses _____

Number of security personnel during peak periods (include bouncers): _____

TRAINING OR GUIDANCE PROVIDED SERVERS

Is training or guidance provided for servers in the handling of minors or intoxicated customers?

___ Yes ___ No

If yes, give details: ___________________________________________________

____________________________________________________________________

____________________________________________________________________

Is this training certified by a professional training organization? ___ Yes ___ No

If yes, attach copy of certificate.

Are all servers of alcoholic beverages required to take such training? ___ Yes ___ No

If no, what percentage of servers have had such training? ______%

ALCOHOLIC BEVERAGE SERVING POLICIES

Describe service policy on serving intoxicated customers:

____________________________________________________________________

____________________________________________________________________

Are customers ever served without checking identification for age verification?

___ Yes ___ No

If yes, explain: ________________________________________________

____________________________________________________________________

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AMUSEMENT DEVICES (indicate all that apply)

___ Gambling machines # _____     ___ Video games # _____
___ Pool tables # _____             ___ Dart boards # _____
___ Pinball machines # _____     ___ Other # _____

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ENTERTAINMENT (indicate all that apply)

___ Juke box ___ Solo musician/vocalist ___ Live band
___ Piano/organ ___ Comedian/comedienne ___ Dancers

___ Other (Describe)__________________________________

DANCING

Is dancing permitted? ___ Yes ___ No

If yes, how many days per week? ______

Size of dance floor? ______ sq.ft.

SPECIAL PROMOTIONS

Are there any special alcoholic beverage consumption promotions? ___ Yes ___ No

(For example, Ladies' Night, 2-for-1, wet T-shirt, beauty contests, lingerie shows, showers, mud or Jello wrestling, etc.)

If yes, describe:_______________________________________________

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OFF PREMISES EXPOSURE

Does risk dispense or provide alcoholic beverages for off premises events?

___ Yes ___ No

If yes, provide for each event:

Name / date / location / duration / number of people expected

__________________________________________________________________

__________________________________________________________________

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VIOLATION OF LIQUOR LAWS

Has the applicant ever been fined or cited for violation(s) of a law or ordinance related to the sale of an alcoholic beverage (after hours, sale to minors, etc.)?

___ Yes ___ No

If yes, explain:

____________________________________________________________________

____________________________________________________________________

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LIQUOR LIABILITY CLAIMS

Has applicant or any owner, partner or executive officer incurred any claim for Liquor Liability in the past five years?

___ Yes ___ No

If yes, explain, showing date of incident / date of claim / amount paid / description / status (open or closed)

_________________________________________________________________

_________________________________________________________________

Is risk aware of any circumstances which may give rise to a Liquor Liability claim?

___ Yes ___ No

If yes, explain:_____________________________________________________

_________________________________________________________________

_________________________________________________________________

Have there been any fights among patrons in the last five years?

___ Yes ___ No

If yes, explain:_____________________________________________________

_________________________________________________________________

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OTHER

Is the risk required by contract or agreement to provide insurance protection of another entity (i.e., lessor of the premises)?

___ Yes ___ No

If yes, lessor's name/address: ________________________________________________

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