Fillable Winery Pak Application Named Insured Mailing Address Website (Abram Interstate Insurance)

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Winery Pak Application Named Insured Mailing Address Website (Abram Interstate Insurance)

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Winery Pak
®
Application
Page 1 of 7
Named Insured
If multiple Named Insds, attach list of NI including how each entity is related, description of operations and ownership interests of each
Mailing Address
Website
Contact Name, Phone, and email
Estimated Total Gross Wine Sales Next 12 months $
Still %
Sparkling %
Wholesale %
Retail/Direct to Consumer %
Typical Markup for Wine you sell Retail/Direct %
Total # Cases to be sold Next 12 Months
Average Selling Price per Case $
Approx Cost of bottling, corks, labels, cardboard, labor, etc. per case $
Estimated Bulk Wine Sales Next 12 Months $
Average Selling Price per Gallon $
Total Grape Sales Next 12 Months $
Total Distilled Spirits Sales Next 12 Months $
Tasting Rooms/Direct to Consumer Sales
Total Revenue $
Total Wine Sales $
Total ‘Other than Wine’ Sales $
Total ‘Tastings’ Sales $
Do you have any Restaurant or Food Sales
Yes No
Total Food Sales $
Total Restaurant Wine/Alcohol/Beer Sales $
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Winery Pak
®
Application
Page 2 of 7
Do you provide Guest Lodging
Yes No
# of Rooms
Annual Revenue $
Do you offer Tours
Yes No
Are the Tours Escorted
Yes No
# Annual Tour visitors
Annual Tour Revenue $
Do you transport guests on or off-premises in any way
Yes No
If yes, describe
Special Events Hosted by You (Harvest Parties, Festivals, etc.)
Average # per Year
Average Attendance
Maximum Attendance
Annual Revenue $
Special Events Rented to Others (Weddings, Corporate Events, Etc.)
Average # per Year
Average Attendance
Maximum Attendance
Annual Revenue $
Do you utilize a Standard Contract
Yes No
If yes – please attach
Do you require proof of insurance for each event
Yes No
Do your employees pour Wine at these events
Yes No
Do any Events include Fireworks, Firearms, Organized Sports or Concerts
Yes No
Do you offer valet parking
Yes No
Using your own Employees
Yes No
Using an Outside Contractor
Yes No
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Winery Pak
®
Application
Page 3 of 7
Foreign Sales
Total Sales to Foreign Countries $
List Countries
Estimated # trips made outside US by employees
Purpose of these trips (Sales, Marketing, etc.)
Max # of employees travelling at any one time
Any employees based in Foreign Countries
Yes No
If yes, provide details
Who is your Winemaker
Years of Experience
Total # of Full-time Employees
Total # of Part-time Employees
Total # of Seasonal Employees
Do you Transport any of your Employees
Yes No
If yes, provide details
Do you provide any Employee Housing
Yes No
If yes, provide details
Do you have a written quality control program
Yes No
Do you have a program to comply with Fed/State Labeling requirements
Yes No
Are employees trained in safety procedures
(Chemical handling, tank cleaning, equip use)
Yes No
Have you ever had a product recalled
Yes No
Are tasting room servers certified in any alcohol training programs
Yes No
Do you have a written policy for responsible alcohol service
Yes No
Are all servers trained on this policy
Yes No
Have you ever been fined or cited for improper service of alcohol
Yes No
Any alcohol related claims during the last 5 years
Yes No
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Winery Pak
®
Application
Page 4 of 7
Do you Bottle your own Wine
Yes No
# of Bottling Lines
Capacity
Do you Bottle Wine for others
Yes No
# of cases
Annual Bottling Revenue $
Do you utilize a standard contract
Yes No
If yes – please attach
Do you Custom Crush for others
Yes No
# of customers
Total # of gallons
Annual Custom Crush Revenue $
Do you utilize a standard contract
Yes No
If yes – please attach
Who is responsible for insuring this wine at your premises
Do you Store Wine for others
Yes No
Total # of Gallons
Total # of Cases
Maximum value of all wine stored $
Annual storage revenue $
Do you utilize a standard contract
Yes No
If yes – please attach
Who is responsible for insuring this wine at your premises
Do you provide Consulting Services for others
Yes No
Total # of Clients
Annual Consulting revenue $
Do you utilize a standard contract
Yes No
If yes – please attach
Total # Acres Owned
Total # Acres Leased
Total # Acres Planted to Grapes
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Winery Pak
®
Application
Page 5 of 7
Do you use a Vineyard Management Company
Yes No
Do you require a written agreement
Yes No
If yes – please attach
Do you Manage Vineyards for others
Yes No
Do you utilize a standard contract
Yes No
If yes – please attach
Do you hire Farm Labor Contractors
Yes No
Do you require a written agreement
Yes No
If yes – please attach
Do you transport Farm Labor Contractors
Yes No
If yes – provide details
Do you apply your own Herbicides, Pesticides or Fertilizers
Yes No
Do you apply Herbicides, Pesticides or Fertilizers for others
Yes No
What do you typically apply
Are these applied by a licensed applicator
Yes No
Do you have an EPA program in place for all storage & applications
Yes No
Any applications conducted using Aircraft
Yes No
Any Chemical Drift losses or actions against you in the last 5 years
Yes No
Transit
What is your largest shipment of Bulk Wine # of gallons
Maximum value of Bulk Wine shipped at any one time $
What is your largest shipment of Cased Goods # of cases
Maximum value of Cased Goods shipped at any one time $
Do you use a Common Carrier or Trucker
Yes No
Is Carrier or Trucker responsible for Damaged Goods
Yes No
Do you require a written agreement
Yes No
If yes, please attach
Average # of Shipments per year
Average Value of each Shipment $
Average distance travelled of each Shipment
Do you Transport Wine for Others
Yes No
Do you utilize a standard contract
Yes No
If yes, please attach
Who is responsible for insuring this wine in transit
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Winery Pak
®
Application
Page 6 of 7
Tank Capacities # of Tanks
Up to 10,000 Gallons
10,001 to 12,000 Gallons
12,001 to 25,000 Gallons
25,001 to 75,000 Gallons
75,001 to 100,000 Gallons
Greater than 100,000 Gallons
Total Replacement Cost of all Tanks $
Maximum Leakage Exposure from any one tank gallons
Maximum Leakage Exposure from any one tank $
Barrels Total # of Barrels
French %
Current Replacement Cost per Barrel $
American %
Current Replacement Cost per Barrel $
Current Replacement Cost of all Winemaking Equipment $
Current Replacement Cost of Mobile Agricultural Equipment $
Wine Inventories
Replaceable Bulk Wine Average # Gallons
Maximum # Gallons
Average value per Gallon $
Irreplaceable Bulk Wine Average # Gallons
Maximum # Gallons
Average value per Gallon $
Cased Goods Average # Cases
Maximum # Cases
Library Collection # of Cases
Replacement Value $
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Winery Pak
®
Application
Page 7 of 7
Do you have any caves at your premises
Yes No
Square Footage
Use
Do you own any Registered Historical Buildings at your premises
Yes No
Describe
Do you ever store wine at any location not listed on your policy
Yes No
Maximum value stored at any one unlisted location $
Do you require off-site storage sites to provide you with regular inventories
Yes No
Any Named Insured have any business operations not detailed above
Yes No
If yes, describe
General Comments
Application Completed By
Title
Date
Additional Information Required
Statement of Values incl Building, Building Improvements, Equipment & Wine Values by location
Inventory of Cased Wine and of Bulk Wine, by location, for last 12 months
Schedule of Vehicles including Make, Model, VIN number, Class code, Garage Zip Code
Schedule of Drivers including Name, Date of Birth and Drivers license number
Loss History for the last three years
Summary of current coverage’s
Copies of current declaration pages
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Winery Pak Application Named Insured Mailing Address Website (Abram Interstate Insurance)

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Completed 10 July 2021

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