Restaurants with Delivery Driver Supplemental Application 08.19 Page 2 of 2
7. Do you offer guaranteed delivery times? Yes No
8. Open after midnight? Yes No
9. Do stores deliver after midnight? Yes No
If yes, please explain: ________________________________________________________________________
10. Are motor vehicle records (MVRs) checked at time of hire and annually for all employees who
drive as part of their job? Yes No
11. Do you have written MVR standards for your employees? Yes No
If yes, please provide a copy of those standards.
12. Any losses in the last three (3) years due to assault? Yes No
13. Are crime statistics reviewed prior to delivery to a new residential location? Yes No
14. Are all drivers over eighteen (18) years of age? Yes No
15. Have all drivers had a valid driver’s license for at least two (2) years? Yes No
16. Are employees drug tested prior to employment? Yes No
17. Are drivers drug tested post accident? Yes No
**The undersigned attests that all information provided is both accurate and truthful. All information provided is
subject to verification by way of an underwriting survey or inspection. You must notify All Risks, Ltd. of any significant
change in operations or payroll. Terms of insurance coverage may be canceled for misrepresentation if information
provided is inaccurate.**
Signature of Applicant: ___________________________________________________________________________
Title: _________________________________________________________________________________________
Print Name: _____________________________________________________ Date: _________________
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