Fillable Craft-Brewery-Supplemental-Application-02.17 - Craft Brewery Supplemental App

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Craft-Brewery-Supplemental-Application-02.17 - Craft Brewery Supplemental App

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Craft Brewery Supplemental Application
APPLICANT/INSURED
INFORMATION
Applicant/Insured
Name:
Website:
Main
Contact:
Title:
Phone:
Please
elaborate on any questions via additional pages.
GENERAL
INFORMATION
1. Yelp Star Rating 1 2 3 4 5
2.
Year
Established:
3. Does your firm operate as a (please check all that apply)
Regional Brewery
(15,000
–
2,000,000 bbls/annum)
Microbrewery (<15,000bbls/annum)
Contract Brewer (all product produced exclusively by others)
Brewpub (25% or more production consumed on premises)
4. Annual revenue - Total of all
ope
r
a
ti
ons:
•
Cu
rr
ent
yea
r
(
p
r
o
jec
te
d
ye
ar
-
end
)
$
/
#
ba
rr
e
l
s
•
Previous
y
ea
r
$
/
#
ba
rr
e
l
s
• 2
nd
prior
yea
r
$
/
#
ba
rr
e
l
s
•
Projected
next 12
m
on
t
hs
$
/
#
ba
rr
e
l
s
5.
Revenue Sources: (current
yea
r)
• Beer
manufacturing
r
e
cei
pt
s
$
_________________________
• % bottles
%
• % cans
%
• % kegged / bulk
%
Restaurant
Food: $ ___________
Alcohol:$ ____
_
Total:$ __________
_
• Gift Shop
$ ___________________
_
• Tasting room
$ ___________________
_
• Other (specify): ___________
$ ___________________
_
6.
How
many
of
the
last
5
years
did
your
firm
attain
an
operating
profit?
PREMISES
/
OPERATIONS
Hours
of
operation:
to
Number
of
days
of
the
week
1. Do you produce or sell any other alcoholic beverages (cider, liquor, wine, etc.)? Yes
No
If
Yes,
please
explain:
2. Total square footage of the space you occupy? sq.
ft.
3. Are you the sole tenant in the building you occupy? Yes
No
If
No,
what
other
types
of
operations
occupy
the
same
building:
Craft Brewery Supplemental Application - 02.17
Page 1 of 4
*Please visit www.allrisks.com/submit-a-risk or contact your
current All Risks, Ltd. producer to submit applications.
4. Do you occupy multiple floors of the building? Yes
No
5. What
is
the
maximum
annual
capacity
(#
of
Barrels)
of
your
facility
based
on
current
configuration?
6. What
is
the
capacity
of
your largest
product
tank
or
vessel?
7. Is your facility located in a building of historical significance? Yes
No
8. Do you operate multiple facilities? Yes
No
9. Is your facility fully protected by a smoke detection system that rings to a Central Station? Yes
No
10. Is your facility fully protected by an automatic sprinkler syst
em? Yes
No
11. Does your brewery have a clean-in-place
(CIP)
system? Yes
No
12. Do floors have a non-skid surface? Yes
No
13. Do floors have built-in drains? Yes
No
14. Are pressure relief
valves
on all tanks? Yes
No
If
Yes,
how
often
are
the
valves
cleaned?
15. Do you have a tasting room? Yes
No
If Yes:
a.
Number
of
seats:
b.
Number
of
drinks
or
samples
offered:
c.
Size
of drinks or samples served: oz.
d.
Who
serves
the
tasting
room
samples:
16. Do you have a tap room (onsite or another location)? Yes
No
If Yes:
a.
What
are
the
hours
of
operation
and
days
open:
b.
How
many
servers/bartenders:
c. Are the servers/bartenders
TIPS
(or equivalent) trained? Yes
No
d. Do you have any live entertainment? Yes
No
o
If
Yes,
how
many
times
a
week?
o
Describe
music
type:
______________________________________________________________
17. Do you offer brewery tours? Yes
No
If Yes:
a.
How often? _________________________________________________________________________
b.
Are brewery tours supervised by employees?
Yes No
c. Are the tours allowed on the production floor during
production?
Yes No
d. Are samples given?
Yes No
e. Are ID’s checked?
Yes No
f.
What safety
precautions do you take to help prevent slips, trips and falls?
18. Have you conducted any special events over the past twelve months? Yes
No
If
Yes,
please explain below or by attachment
(Examples
–
concerts, bicycle race, etc.):
Craft Brewery Supplemental Application - 02.17
Page 2 of 4
19. Do you plan on conducting any special events in the upcoming twelve months? Yes
No
If
Yes,
please provide
date(s)
and descriptions, expected participants and revenue
expected:
20. Do you ever contractually
assume
liability for events you sponsor but are
conducted
b
y others? Yes
No
21. Do you utilize contractors in the course of your business? Yes
No
If
Yes,
do you obtain Certificates of
Insurance
from all prior to work starting? Yes
No
22. Do you operate a
Restaurant/Brew
Pub? Yes
No
If
Yes,
please complete the Brew Pub Supplemental
Application.
23. Do you lease out your facility for weddings, parties or corporate events? Yes
No
If
Yes,
how
much
revenue
do
you
generate
from
leasing
out
the
facility?
24. Do you perform routine maintenance and cleaning on all of your brewing equipment? Yes
No
25. Do you batch test your beer at every stage in the process? Yes
No
26.
How
long
are
the
batch
test
records
retained?
27. How long are your ingredients kept on your premises before use?
<1 month 1-2 months >2
months
28. Do your employees demonstrate excellent hygiene and
cleanliness
in housekeeping? Yes
No
29. Do you have a formal, written quality control process? Yes
No
30. Do you import any ingredients? Yes
No
If
Yes,
which
ingredients
and
country
and
origin:
PACKAGING & TRANSPORTATION EXPOSURES
1. How is your beer packaged (indicate by percentage and type): % Bulk %
Keg
%
Bottle
%
Can
%
Other
(please
describe):
2. Do you hire others to transport your products? Yes
No
Does the company
assume
liability during the shipping process? Yes
No
Do you require certificates of liability insurance annually from this firm? Yes
No
3. Do
you directly distribute any product y
ourself?
Yes
No
If
Yes,
number
of
vehicles:
Maximum
distance
traveled:
Craft Brewery Supplemental Application - 02.17
Page 3 of 4
Applicant’s Warranty Statement
I warrant that the information provided in this Application, and any amendments or modifications to this Application are true and correct. I
acknowledge that the information provided in this Application is material to acceptance of the risk and the issuance of the requested policy
by Company. I agree that any claim, incident, occurrence, event or material change in the Applicant’s operation taking place between the
date this application was signed and the effective date of the insurance policy applied for which would render inaccurate, untrue or
incomplete, any information provided in this Application, will immediately be reported in writing to the Company and the Company may
withdraw or modify any outstanding quotations and/or void any authorization or agreement to bind the insurance. Company may, but is not
required, to make investigation of the information provided in this Application. A decision by the Company not to make or to limit such
investigation does not constitute a waiver or estoppel of Company’s rights.
Fraud Statement
Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or knowingly presents false information in
an application for insurance may be guilty of a crime and may be subject to fines and confinement in prison.
Signature of Applicant_________________________________________________ Date: _______________________________________
The undersigned hereby warrants and certifies that all information contained herein is correct; that this form was completed and then signed
by the Applicant; that a completed copy hereof has been given to the Applicant; and that the undersigned is retaining a duplicate signed copy
hereof.
Retail Agency: __________________________________________________________ City:_______________________________________
Retail Agent Signature: ____________________________________________________ Date: _____________________________________
Craft Brewery Supplemental Application - 02.17
Page 4 of 4
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Completed 28 May 2020

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