Fillable Supplemental Application Hotels & Motels

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Supplemental Application Hotels & Motels

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© 2010 Promont Advisors, LLC 1 Hotels & Motels (08/25/14)
Supplemental Application – Hotels & Motels
Applicant Name:
Date:
Location Address:
Web Site:
Business Information:
Years in business : Years of experience in this industry:
Any prior bankruptcies or liquidations? Yes No Describe:
Who is responsible for day to day operations: For how long:
Are employees screened: Yes No
References: Yes No Prior Jobs: Yes No
Credit check: Yes No Criminal check: Yes No
Clientele (percentages):
Elderly Spring Break Crowd Resident Housing
Room Registration
(percentages):
Monthly Weekly Daily Hourly
Premises Information:
Number of rooms: Occupancy rate:
Average room rate: Hour/Day/Week/Month:
Number of buildings at this location: Minimum distance between buildings:
When were updates for: - Electricity: Partial or complete?
- Plumbing: Partial or complete?
- Roofing: Partial or complete?
- HVAC: Partial or complete?
Are buildings sprinklered? Yes No Percentage:
Are there smoke detectors? Yes No Hard wired or battery operated?
Are there fire alarms? Yes No Central station, local or pull alarms?
Is there aluminum wiring on premises? Yes No Describe:
Is the aluminum wiring repaired? Yes No Describe:
Clearly marked fire exits? Yes No
Secondary means of
egress for each floor?
Yes No
Emergency lighting in common areas? Yes No
Dead bolt locks on doors to units? Yes No
Are the locks re-keyed
after occupancy?
Yes No
Are there elevators? Yes No
Do you have an agreement
with elevator company?
Yes No
Is there a parking lot located on premises? Yes No
Is the parking lot owned, operated & maintained by applicant? Yes No
What is the size of the parking lot?
© 2010 Promont Advisors, LLC 2 Hotels & Motels (08/25/14)
Is there a valet parking service? Yes No
Is the valet parking provided by an independent service company? Yes No
Is the valet service required to maintain indemnity insurance? Yes No
Pools:
Check here if no Pools
How many swimming pools?
Are there any hot tubs? Yes No
Is there an automatic shut-
off?
Yes No
Do pools have self-latching doors or
gates?
Yes No
Are there any diving boards or slides? Yes No Describe:
Are there life guards on duty? Yes No How often?
Is there rescue equipment such as a ring
buoy, shepherds hook or pole?
Yes No
Are pool depths adequately marked? Yes No
Are pool chemicals properly stored? Yes No
Recreational Facilities:
Check here if no Recreational Facilities
Is there a playground? Yes No Is it fenced? Yes No
Are there any lakes, ponds or boat slips? Yes No Describe:
Are there any exercise facilities? Yes No Describe:
Are there any daycare services? Yes No Describe:
Are there any tennis, basketball or
racquetball courts?
Yes No Describe:
Are there any saunas? Yes No Describe:
Are there any recreational equipment
rentals/checkouts?
Yes No Describe:
Restaurant/Cooking Exposure:
Check here if no Cooking Exposure
Any sub-contracted cooking facilities? Yes No Is indemnity ins. required? Yes No
Type of cooking - Deep Fat Fryers? Yes No - Grill/BBQ Pit? Yes No
- Griddles? Yes No
Does establishment serve any raw
seafood?
Yes No Describe:
Are there any banquet facilities? Yes No Square footage:
Maximum occupancy:
Any off-premises catering? Yes No Describe:
Is there an automatic suppression system
over all cooking surfaces?
Yes No
Is there an automatic shut-
off?
Yes No
Is there an independent cleaning
contract for hoods & ducts?
Yes No How often is system cleaned?
Have there been any Health Dept.
violations?
Yes No Describe:
© 2010 Promont Advisors, LLC 3 Hotels & Motels (08/25/14)
Liquor Liability:
Check here if no Liquor is sold or furnished
Have you ever had your liquor license
revoked or suspended?
Yes No Describe:
Have your ever had any prior liquor
citations or law violations?
Yes No Describe:
In the last 5 years, have you had any
liquor or dram liability claims?
Yes No Describe:
Do all servers receive formal Alcohol
Awareness training?
Yes No Describe:
Do you sponsor any drink specials (i.e.,
2-for-1, ladies night, etc.)?
Yes No Describe:
Do you have any package sales? Yes No Describe:
Do you have any drive-thru facilities? Yes No Describe:
Do you admit anyone under 21? Yes No Describe:
Age of clientele
(percentages):
Under 21 21 thru 30 31 thru 40 Over 40
Are patrons allowed to bring in their
own alcoholic beverages?
Yes No
Are you open later than other
establishments in the area?
Yes No
Do you provide cab service or have a
designated driver program?
Yes No
Is there any off-premises liquor
catering?
Yes No
Bar/Lounge:
Check here if no Bar/Lounge
Hours of operation:
Mon. – Thu. Fri. Sat. Sun.
Is there a dance floor? Yes No Sq. footage:
Are there any mechanical devices? Yes No Describe:
Are there any gambling devices or
tables?
Yes No Describe:
Are there any pool or billiards tables? Yes No Describe:
Are there any athletic events? Yes No Describe:
Are there any promotional events (such
as Teen Night, Wet T-Shirt or Foam
Contests)?
Yes No Describe:
Are there any special activities (such as
mud wrestling, bungee jumping,
Velcro suits or mosh pits)?
Yes No Describe:
Other special or promotional activities? Yes No Describe:
© 2010 Promont Advisors, LLC 4 Hotels & Motels (08/25/14)
LIVE Entertainment:
Check here if no LIVE Entertainment
Is there a DJ or karaoke? Yes No Describe:
Is there any topless or Go-Go dancing? Yes No Describe:
Are there any comedians or stand-up
entertainers?
Yes No Describe:
Any live performers: - Country? Yes No
No. nights per
week:
- Piano/Solo Acts? Yes No
No. nights per
week:
- Rock/Disco? Yes No
No. nights per
week:
- Other? Yes No
No. nights per
week:
Are there any national known performers? Yes No Describe:
Are there any promoters? Yes No Describe:
Any special effects: - Lighting/Sound? Yes No
- Smoke? Yes No
- Pyrotechnics? Yes No
Other live entertainment? Yes No Describe:
Security:
Check here if no Security
Are there any employee bouncers? Yes No
Are they
armed?
Are there any security guards? Yes No
Are they
armed?
Are there any third-party bouncers or
security guards?
Yes No
Are they
armed?
Are there any off-duty uniformed
policemen?
Yes No
Are they
armed?
Are there any ID checkers? Yes No Describe:
Are there any weapons on premises? Yes No Describe:
Gross Receipts:
Hotel Operations Bar/Lounge Restaurant
Sales/receipts Food Food
Rentals Liquor Liquor
Other Catering Catering
Total Total Total
© 2010 Promont Advisors, LLC 5 Hotels & Motels (08/25/14)
Hired & Non-Owned Auto:
Check here if not requested
Do you verify each employee driving
for business purposes has a valid
government issued driver’s license and
carries sufficient personal insurance in
accordance with minimum state
insurance requirements?
Yes No
Do you prohibit business driving rights
for any individual with prior incidence
of license suspensions, revocations or
DUI convictions?
Yes No
Do you provide off-site catering or
delivery services?
Yes No
Have you had any hired and non-owned
auto losses in the past 5 years?
Yes No Please attach detailed list of losses.
Do you provide guest shuttle services?
Yes
No
Number of employees
Representation & Warranty Statement:
I have read this Application and I represent that all of the foregoing statements are true and accurate and that these
statements are offered as the basis upon which Promont is considering issuance of an insurance policy. Any missing or
erroneous information in this Application may jeopardize coverage in the event of a claim under any policy issued by
Promont.
WARNING: Any person who knowingly and with intent to defraud any insurance company or other person files an
application for insurance or statement of claim containing any materially false information, or conceals for the purpose of
misleading, information concerning any fact material thereto, commits a fraudulent insurance act, which is a crime, and
shall also be subject to a civil penalty not to exceed five thousand dollars and the stated value of the claim for each such
violation.
Applicant:
Title:
Date:
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Supplemental Application Hotels & Motels

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Completed 3 March 2021

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