Hotel Questionnaire
Complete this form for a free, no-obligation, insurance quote. Please complete as much as possible – the information will be kept confidential.
APPLICANT INFORMATION SECTION
Hotel Name:
Legal Name:
Contact Name:
Mailing Address:
City, State, Zip:   
Location Address: 
City, State, Zip:   
County:
Years Experience in the Business:
Effective Date: 
Entity Type:
Phone:       Fax:
Mobile:   Home:
Email Address:
Federal ID or SS#:
Franchised Operation:
Current Carrier:
Years Experience at this Location:
BUILDING INFORMATION SECTION

#

Units

Stories
Building
Limit
Contents
Limit
Business
Income Limit
Construction
Type
Square
Feet
Year
Built
Deductibles: 
REVENUE SECTION
Revenue Source           Gross Sales
Room Receipts:
Restaurant Receipts:
Liquor Receipts:
Other:
GENERAL LIABILITY SECTION
General AGG:Each Occurrence:
OTHER INFORMATION
Sign Coverage Limit:
Sign Deductible:
Average Daily Room Rate:
LIQUOR LIABILITY SECTION
 Check if Liquor Liability is Requested
Limits:Deductible:
UNDERWRITING SECTION
Is there a Sprinkler System? Is there a Basement?
Are all Buildings Fully Sprinklered? Does Property have Exterior Corridors?
Is there a Local Fire Alarm? Any Units have Kitchenettes?
Is there a Central Station Fire Alarm? Any Policies Cancelled or Nonrenewed in last 3 years?
Hard Wired Smoke Detectors in Each Unit? Are there Security Guards?
Is there a Heating Boiler on Premises? Is there Aluminium Wiring?
Is Property Located Inside City Limits? Is there Exercise Equipment?
Fire Hydrant within 1000 feet of Property? Is there a Meeting Room?
Are there Security Cameras? If Building(s) is Over 20 years old:     YEAR     
Is there Emergency Lighting? When was Wiring updated?
Are there Electronic Locks? When was Plumbing updated?
Do all Entry Doors have Peepholes? When was Roofing updated?
Fire Extinguishers Present? When was Heating/Cooling updated?
POOL & RESTAURANT SECTION
Is there a Pool? Is there a Restaurant?
Is there a Diving Board or Slide? Is Restaurant/Lounge Leased Out?
Is the Pool completely Fenced or Indoors? Is Cooking Area covered by Duct System?
Is there a Self-Closing Gate or Door? Is the Automatic Fire System UL300 Listed?
Depth Markings Inside & Outside of Pool? Maintenance Contract for Vents & Fire System?
Are Rules Posted? Is Restaurant a Separate Building?
Is there adequate Life Saving Equipment? Is Beer, Wine, or Liquor Sold?
Is Pool open to Hotel Guests only? Is there Banquet Facilities?
Pool Chemicals checked regularly? Is there a Dance Floor?
Is there a Jacuzzi? (excluding in room) Sq. Ft. of Restaurant Leased Area?
WORKERS COMPENSATION SECTION
 Check if Worker's Compensation is Requested
Employers Liability:
Class           Annual Payroll    Current Carrier:
Hotel Employees: Experience Mod:
Clerical Employees: # of Full-Time Employees:
Restaurant Employees: # of Part-Time Employees:
Officer Section: NameTitle% Ownership 
UMBRELLA COVERAGE
 Check if Umbrella Coverage is Requested
Umbrella Limit: SIR:
OTHER COVERAGE REQUESTED
Equipment BreakdownEmployee PracticesFloodEarthquakeBusiness Auto
PRIOR LOSS EXPERIENCE
List all losses in the last 3 years Check if no losses in 3 years
Date of Loss:Description of Loss:Amount Paid:
ADDITIONAL INTEREST SECTION
 Mortgagee
 2nd Mortgagee Loss Payee
 Loss Payee Additional Insured

Remarks:

This web site provides a simplified description of coverages and is not a statement of contract.
Completing this questionnaire does not bind coverage for the applicant, the insurer, or program manager. Coverage may not apply in all states.