Fillable Winery Supplemental Questionnaire All Operations Name of Appli (Risk Placement Services, Inc.)

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Winery Supplemental Questionnaire All Operations Name of Appli (Risk Placement Services, Inc.)

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Winery Supplemental Questionnaire – All Operations
Name of Appli
cant______________________________________ Date___________________
SECTION I – General Operations – This Section applies for ALL Locations (complete once at Account Level)
Total Acreage: _____________Vineyards ______________Owned ______________Leased
Total Ga
llons of Still Wine Produced Annually: ____________gallons
Does applicant custom crush for others? ______yes ______no If yes, how many gallons annually? ________ gallons
Do you bottle wine for others? ____yes ____no If yes, what is the annual revenue from bottling for others? $________
Do you store wine for others? _______yes ________no If yes, what is the annual payroll for wine storage? $_________
What percentage of wine is sold retail through the tasting room? _____%
What is the capacity of the largest wine holding tank? ___________________gallons
Annual Sales Revenue
$_________Still Wine $_________Sparkling Wine $_________Harvested grapes/library wines/staged release wines
$_________Tasting Room Charges $_________Retail/Merchandise $_________Bed & Breakfast/Lodging
$_________Custom Crush for Others $_________Other Sales (describe):____________________________________
Underwriting Questions
Yes
No
Premises and Alcohol Service
Does the applicant allow tours of the winery? If yes, are the tours escorted? ____yes ____no
Does the applicant provide on premises transportation to the general public (trams, hay wagons, etc.)?
Are all tasting room servers and other staff responsible for serving wine certified in a formal alcohol training
course (e.g. TIPS, TAM, ServSafe, etc.)?
Does the applicant have a written policy for serving alcohol? If yes, does management review this written policy
with employees on a regular basis? ____yes ____no
Has the applicant ever been fined, cited or criminally charged in connection with improper serving of alcohol?
Yes
No
Employees
Are employees trained in all pertinent safety protocols (i.e. chemical handling, tank cleaning, mobile equipment)?
Does the applicant transport any of their employees? If yes, please attach a description of the modes of
transportation provided, including any buses or vans over 7 passengers.
Yes
No
Off Premises Wine Storage
Do off-site storage operators provide applicant with quarterly inventory reports of their wine products (including
total number of cases/barrels stored in each building) and an annual physical inventory reconciliation?
What type of temperature monitoring system is used at each off-site storage facility? ______________________
Which type of reporting system notifies the operator and refrigeration service company? ___Local ___Central
Yes
No
Products Liability
Does the applicant have a written quality control program and testing at each stage in the wine making process?
Does the applicant buy and/or sell wine from other distributors or use this wine in the making of their own wine?
Yes
No
Pesticide/Herbicide Application
Does the applicant use pesticides, herbicides, and/or fertilizers? If yes, describe _______________________.
If yes, are chemicals applied by a licensed applicator?
Do all used chemicals meet EPA and/or state regulatory guidelines?
Yes
No
Miscellaneous
Does the applicant have backup-generators (or other backup protection) in place in the event of loss of power
and failure of critical equipment and temperature control systems?
Special Events
Yes No
___ ___ Are special events held on the winery premises? If yes, please complete the following:
___ ___ Does the applicant require proof of insurance from all third parties who use the premises for special events
and sign a contract that contains indemnification and hold harmless wording?
___ ___ Do you prepare and serve food for weddings or other special events?
Number of Annual Events for all locations (including events hosted by applicant or third party)
Weddings – all sizes __________ Concerts including musical festivals __________
Club Member Release Parties __________ Other music events with attendance over 50 persons __________
Regional or Appellation Events __________ All other events with attendance over 50 persons __________
(i.e. ‘Barrel Tasting’, Passport)
*Count each Event, not Days
Winery Supplemental Questionnaire – Per Location
Name of Appl
icant______________________________________ Date___________________
SECTION II – Location Specific – Complete this section for each Scheduled Location
Locatio
n # _______ of ________
What is the dominant occupancy for this Location? ____ Winery ____ Wine Storage
____ Off-Site Warehouse or Wine Storage ____ Other, please describe: ______________________________________
What quanti
ty of wine product exists or is stored at this location?
______Aver
age # of Cases ______Average # of Barrels
______Maximum (Peak) # of Cases ______Maximum (Peak) # of Barrels
______Average Value per Case ______Average Value per Barrel
What is
the maximum value of wine in-process at this location?
______Average # of wine ferment tanks
______Average tank volume in gallons
______Average value of wine ($/gallon)
Yes No
___ ___ D
oes this location have exposed plastic foam insulation? If yes, please answer the following:
Type: ___ Foil Panels ___Spray-on Polystyrene ___Other:__________________________
Distribution: ___On Walls ___On Ceilings ___Both Walls & Ceilings ___Other:________________________
Yes No
___ ___ Does this location utilize refrigeration equipment? If yes, please check the fields that apply below:
Refrigerant: ___Ammonia ___Glycol ___Group 1 ___Other Type:________________ ___Unknown
Compressor: ___Separated from production or storage ___Open to production/storage ___Unknown
Back Up: ___Standby power system available ___No Standby Power System ___Unknown
Reliability: ___Inspection and servicing: ___Annually ___Semi-Annually ___None ___Unknown
Yes No
___ ___ D
oes this location generate solar power? If yes, what is the total capacity of the system? ________Kilowatts
Where is the solar power generated? ___Roof ___Fields ___Roof & Fields ___Other:_________________
Yes No
___ ___ Is this location protected by Fire Door Protection – Building Divisions?
___ ___ Is this location protected by Power Outage Alarms (if unattended)?
Yes
No
If location is in Public Protection Class (PPC) 8 through 10, please check all that apply:
Private water supply (tower, pond, reservoir, lake or well) - on-site with Fire Department connection
On-Site Fire Pump - please attach description of fire pump and source of water supply
Fire Sprinkler System - please attach description of system design and source of water supply
Nearby pond, reservoir, lake, or well on-site without Fire Department connection
Paid or Volunteer Fire Department Engine response with on-board water
Multiple fire extinguishers - rechargeable and inspected annually by an independent fire protection contractor
Multiple ingress/egress access roads to the premises
Brush control and fire break at least 100 feet around any structure. If less than 100 feet, what distance? ______ft
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Completed 30 July 2020

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