Phone:

804-359-4568

Toll Free:

800-396-6226

Fax:

804-359-6994

E-Mail:

info@commund.com

Liquor Liability Online Quote

Please complete the following and press submit or call 800-396-6226 x202 for an instant phone quote

Agent Information
Commonwealth Underwriters Agent Code: *Note: this field is optional*

Agency Name:
Agent Name:
first and last name
Phone:
999-999-9999 format
Fax:
999-999-9999 format
Agent Email:
(A copy of the quote will be sent to this address)
Insured Information
Insured Name:
Insured Email: (will only be used to communicate regarding this account)
Insured's Mailing Address
Insured Zip
Is Location Address same as Mailing Address? (Click if Yes)
Location Address
Insured Zip
Would you like a finance quote? (Click if Yes)
Philadelphia? (Click if Yes)
Agency's Mailing Address
Agency City
Agency State
Agency Zip
Risk Details
Type of Establishment:
Total Liquor Receipts: $
Total Food Receipts: $
Would you like a double aggregate? (Click if Yes)
Common Qualifiers
Is liquor license in name of the insured? (Click if Yes)
Have all servers received adequate alcohol awareness training (i.e. TIPS or other approved ABC, LCB courses)? (Click if Yes)
A list of employees and copy of TIPS Certificate or other state approved course for each employee must be received within 30 days of inception.
Is establishment open past 2AM (including Poker/Card rooms)? (Click if Yes)
Does establishment primarily attract patrons under the age of 25? (Click if Yes)
Does establishment allow "Bring Your Own Bottle"? (Click if Yes)
Is establishment a Bar with 200+ capacity and/or open past 2:00 AM? (Click if Yes)
Was risk previously written on a claims-made basis? (Click if Yes)
Any liquor license suspensions or revocations, fines and citations? (Click if Yes)
Any history of police calls? (Click if Yes)
Is risk a new venture? (Click if Yes)
Are Firearms kept on premises? (Click if Yes)
Has risk had 1 or more ABC violations? (Click if Yes)
Is establishment operating without a liquor license? (Click if Yes)
Does risk run catering operations? (Click if Yes)
Do catering operations have an open bar (giving away liquor at no charge to the consumer)? (Click if Yes)
Does risk do more than 25% weddings and/or bartender(s) are supplied by others? (Click if Yes)
Any New Year's Eve, St. Patrick's Day or wedding receptions or parties at a private residence and/or high profile events (Super bowl parties, Mardi Gras, etc.) or Open Bars or Motorcycle-related events? (Click if Yes)
Is there table service? (Click if Yes)
Any 2 for 1 drinks or drinks less than $1.50 offered? (Click if Yes)
Any happy hour lasting more than 3 hours or later than 7PM (includes reverse happy hours or one price all-you-can-drink specials, beer bust, drown night, etc.)? (Click if Yes)
Any Male or Female Dancers? (Click if Yes)
Does establishment have a casino (Poker/Card rooms)? (Click if Yes)
Does the casino stay open past 2:00 a.m. OR provide free drinks? (Click if Yes)
Any mechanical bull or interactive activities where patron participates? (Click if Yes)
Any bouncers or armed guards employed as a method of security including I.D. Checkers, Off/On Duty Law Enforcement? (Click if Yes)
Any cover or door charge? (Click if Yes)
Are rides provided to patrons? (Click if Yes)
Any Flame Shows, Flame Shoots or Pyrotechnics? (Click if Yes)
Any Bartenders for Hire? (Click if Yes)
Is establishment a nightspot, or does establishment have venues? (Click if Yes)
Is establishment an exhibition or rental hall, banquet facility, arena, stadium, auditorium, sports field, fairground or concession stand? (Click if Yes)
Does establishment have pool tables? (Click if Yes)
Does establishment have 11 or more pool tables? (Click if Yes)
Does establishment host nights of entertainment? (Click if Yes)
Are there more than 3 nights of weekly entertainment - including karaoke? (Click if Yes)
Does establishment contain a dance floor? (Click if Yes)
Does establishment contain a dance floor of 500 square feet or more? (Click if Yes)
Is risk a hunt club, guide, or outfitter that serves alcoholic beverages in lodge after hunts or excursions? (Click if Yes)
If establishment is a convenience store, is store open 24 hours with liquor sales stopping at 2AM? (Click if Yes)
Are distributed products (other than beer) alcoholic? (Click if Yes)
How many samples are given to a single taster?
How many ounces of wine are supplied in a sample?
What type of food is given with the sampling?
Does establishment host Special Events? (Click if Yes)
Does establishment have less than 3 years of management experience? (Click if Yes)
Does establishment promote Drink Specials (i.e. "happy hours", "two-for-ones") that extend longer than three hours? (Click if Yes)
Do employees operate on commission or a tips-only basis? (Click if Yes)
Is establishment Owner/Manager NOT actively involved in the establishment's operations? (Click if Yes)
Does establishment have more than two locations? (Click if Yes)
Does establishment serve as a Fraternal Club, Gun Club, Lodge, or Gentlemans's/Strip Club? (Click if Yes)
Does establishment sell alcohol for off-premises consumption and not have clearly established procedures regulating the sale of alcohol to minors or customers under the influence? (Click if Yes)
Does establishment ever host live rock, rap or hip-hop bands? (Click if Yes)
Is the hotel / motel four or more stories? (Click if Yes)
Is there a swimming pool? (Click if Yes)
Risk Details
Any additional insureds? (Click if Yes)
Any loss in the last 3 years? (Click if Yes)
Number of losses in the past 3 years?
Any loss in excess of $25,000? (Click if Yes)
Is Loss Ratio from the past 3 years greater than 50%? (Click if Yes)
Additional Comments
Additional Comments:



For higher limits or coverage options not listed, please contact Cindy Rios, Ext 127.

Any questions or problems with the form? Please contact Cindy Rios



Only Commonwealth Underwriters, Ltd. has binding authority. Coverage will not be bound until application has been received, reviewed, and accepted by Commonwealth Underwriters, Ltd.