Fillable COMMERCIAL COOKING SUPPLEMENTAL APPLICATION Please complete this supplemental (Risk Placement Services, Inc.)

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COMMERCIAL COOKING SUPPLEMENTAL APPLICATION Please complete this supplemental (Risk Placement Services, Inc.)

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The COMMERCIAL COOKING SUPPLEMENTAL APPLICATION Please complete this supplemental (Risk Placement Services, Inc.) form is 1 page long and contains:

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Core Product Commercial Cooking Supp v.Jan/2011 Page 1 of 1
COMMERCIAL COOKING SUPPLEMENTAL APPLICATION
Please complete this supplemental application for each location with commercial cooking equipment.
Named Insured
Name of the Facility or organ
ization_________________________________________________________________
Location Address:________________________________________________________________________________
1. Gross annual sales:______________
2. If food is not sold, how many meals are served annually? _________________
3. Please indicate all cooking equipment applicable at your premises?
Grill Deep Fryer Broiler Other commercial appliance(s):________________________________
4. Is automatic fire extinguishing system provided for all cooking surfaces? Yes No
5. Is cleaning and service provided under a service agreement with a contractor?
Yes No
6. Indicate all other fire protection applicable at your premises:
Fire extinguishers: How many? _________
Wet sprinklers
Dry sprinklers
Other:_______________________________________________________________
7. Ducts are located:
On an interior wall On an exterior wall
The undersigned represents that all statements and answers to questions are true, complete and accurate and that there has
been no suppression or misstatement of fact.
THE APPLICANT ACCEPTS NOTICE THAT HE/SHE IS REQUIRED TO PROVIDE WRITTEN NOTIFICATIONS TO THE
COMPANY OF ANY CHANGES IN THE RESPONSES GIVEN TO THIS APPLICATION THAT MAY HAPPEN BETWEEN
THE SIGNATURE DATE BELOW AND ANY PROPOSED EFFECTIVE DATE.
The undersigned is an authorized representative of the applicant and certifies that reasonable enquiry has been made to
obtain the answers to questions on this application. He/She certifies that the answers are true, correct and complete to the
best of his/her knowledge.
Date Signed Signature of Applicant
Name and Title
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COMMERCIAL COOKING SUPPLEMENTAL APPLICATION Please complete this supplemental (Risk Placement Services, Inc.)

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Completed 30 July 2020

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