RESTAURANT, BAR, TAVERN & NIGHTCLUB INSURANCE INTAKE FORM

RESTAURANT, BAR, TAVERN & NIGHTCLUB INSURANCE APPLICATION INSTRUCTIONS

Follow steps 1-4 below. Complete the application, save the PDF, then return to this page to upload the application and supporting documents securely.

Important Form Notice: This intake process is intended for restaurants, bars, taverns, nightclubs, lounges, hospitality venues, food service operations, liquor-serving establishments, and related food/beverage businesses. The application may be used for review of General Liability, Liquor Liability, Property Coverage, Assault & Battery, Umbrella/Excess, and related coverage needs.

Catering / Bartending Only? If you only provide catering services or bartending services, please use this intake form instead: Bartenders & Caterers Insurance Intake Form.

Complete, Save & Upload the Restaurant / Bar Application

First, complete the Restaurant and Bar Supplement Application. It will open in a new browser tab so you can return here after saving it.

After completing the application, save the completed PDF to your computer. Then return to this page and upload it in Step 4.

Important: No signatures are required on this application for quoting purposes. Please complete the application as thoroughly as possible, save it, and upload it in Step 4. Signatures may be requested later by an insurance carrier if coverage is offered and you decide to proceed.

Click Here First Open Restaurant / Bar Application ➜

RED BOXES Required sections. These boxes must be completed so underwriters can properly review the restaurant, bar, tavern, nightclub, or hospitality operation.

BLUE BOXES Complete only if the applicant wants the specific coverage shown in the blue boxed area, such as optional or supplemental coverage being requested.

GREEN BOXES Complete when the information applies to the business, location, operation, entertainment, alcohol service, security, property, or other relevant exposure.

NO SIGNATURE No signature is needed for quoting. Signatures may be requested later only if coverage proceeds.

REMARKS The Remarks section is on the last page of the Restaurant / Bar Application. Use it to explain liquor service, entertainment, security, hours, special events, dancing, live music, claims history, property, or special carrier requirements.

No Loss Statement

If the business has never experienced any claims, or if this is for a new business, complete a No Loss Statement.

Once submitted, it will automatically notify the Kelly Insurance Group team.

No Claims? Complete No Loss Statement ➜

Current Loss Runs

If you currently have insurance coverage, we will need copies of your current carrier loss runs.

Use the button to review how to request loss runs and copy the email wording below.

Loss Run Instructions

Loss runs are a statistical history of your claim history. Most underwriters require this information, even if you have had zero losses.

If loss runs are not available online through your carrier portal, send a request to your current carrier, agent, or broker.

Hi __________, We are currently reviewing our insurance program and would like copies of our claims history, also known as Loss Runs, for our internal review. Please provide this information for all lines we have on file with your company. We are looking for our five-year Loss Run history. Thanks for your help and your quick attention to this matter.

Email wording copied.

Upload Application & Supporting Documents

After completing and saving the Restaurant and Bar Supplement Application, upload it below. You may also upload loss runs, current policy documents, liquor license, property schedules, menu, entertainment schedule, security procedures, lease requirements, certificate requirements, or other supporting information.

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Disclaimer: Coverage availability and eligibility may depend on underwriting review, carrier guidelines, policy terms, state requirements, business operations, risk characteristics, and other information provided during the application or quoting process. Kelly Insurance Group cannot guarantee that every individual, customer, organization, or business seeking coverage will qualify for, receive, or successfully place insurance coverage. All policy coverages, exclusions, conditions, limits, endorsements, and terms should be carefully reviewed by the consumer, insured, or applicant to confirm that the coverage requested is the coverage being quoted, offered, or provided. Insurance coverage, policy changes, endorsements, cancellations, and other policy terms are not bound, changed, confirmed, or altered unless and until written confirmation is provided by a licensed Kelly Insurance Group team member, the applicable insurance carrier, or an authorized underwriter. This page is provided for general informational purposes only and does not provide legal advice, legal opinions, insurance coverage opinions, or policy interpretations.