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Knoxville, TN 37932
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Hotel Insurance

Client Information

* Indicates required field

Hotel Ownership Name *

First

Last

Location Address *

Line 1

Line 2

City

State

Zip Code

Country

Mail Address ( if different from physical address ) *

Line 1

Line 2

City

State

Zip Code

Country

NonRenewals/Cancel/Bankrupcies *

Hotel Name (Franchise or Brand name) *

Exp Date *

FEIN: *

Business Type: (Corp, LLC, Ind.) *

Years in Business (Hotel) *

Experience ( years of hotel experience for operator? ) *

Description of Operations *

Current Carrier *

Premium *

No. of Employees *

Losses *

Property Coverage

Building Value *

Hotel Revenue *

Restaurant Revenue *

Rev Par *

Equipment Breakdown? *

Year Built *

Alarm *

Number of Buildings *

Workout Facility? *

Purchase Price or Consruction Cost *

Business Income/EE *

Total Revenue *

Earthquake coverage *

Deductable *

Square Footage *

Protection Class *

Basement? *

Hotel Seasonal? *

Total renovation cost if a PIP is required on purchase *

Business Personal Property value *

Average Daily Rate (ADR) *

Flood Coverage *

Co-Insurance % *

Number of RMS *

Sprinkler *

Type of roof? *

Personal services offered *

Sewer Backup? *

Construction type *

Updates? (When) *

Number of Stories *

Interior or Exterior *

Is there a concierge? *

Is there individual cooking facilities in any units? *

Is there an attic space? *

If so, is it sprinklered? *

Are there fireplaces in any units? *

If there are concealed spaces in the attic or roof, do builidings have 1 hour firewalls at least every 60 feet? *

GENERAL LIABILITY

If buildings are 3 stories or less, does each rm have a direct means of egress? (walkway) *

Are all interior stairwells enclosed and separately vented? *

Are there hardwired smoke detectors/fire alarms in each sleeping room and hallway? *

Is there emergency lighting? *

If yes, where? *

Are all exits marked & illuminated? *

Are bathrooms equipped with ground fault circuit interrupters (GFCI)? *

Are there Elevators? *

If yes, is there an elevator maintenance program? *

Do all the elevators return to the first floor in the event of a fire? *

Work Comp

Employer's Liability

Coverage limits requested (each accident) *

Coverage limits requested (disease-policy limit) *

Coverage limits requested (disease-each employee) *

Total estimated premium *

Total number of employees *

Full time *

Part time *

Code: Payroll associated with code *

Code: Payroll associated with code (3) *

Do we have 3 years loss runs on this property? *

Code: Payroll associated with code (2) *

Any Losses? *

Yes or No questions(explain all yes responses)

Does applicant own, operate or lease aircraft/watercraft? *

Do/Have past, present or discontinued operations involve storing, treating, discharging, applying, disposing, or transporting of hazardous material? *

Any work performed underground or above 15 ft? *

Any work performed on barges, vessel, docks, bridge over water? *

Is applicant engaged in any other type of business? *

Are subcontractors used? If yes, give % of work subcontracted *

Any work sublet without certificates of insurance? If yes, payroll must be included in the State rating worksheet *

Is a written safety program in operation? *

Any group transportation provided? *

Any Emplyees under 16 or over 80 years of age? *

any seasonal employees? *

Is there any volunteer or donated labor?(if yes, please specify) *

Any employees with physical handicaps? *

Do employees travel out of the State? If yes, indicate states of travel and frequency) *

Are athletic teams sponsored? *

Are physicals required after offers of employment are made? *

Any other insurance with this insurer? *

any prior coverage declined/canceled/non-renewed in the last three years?(Missiouri applicants do not answer) *

Are employeee Health plans provided? *

Do any employees perform work for other businesses or subsisiaries? *

Do you lease employees to of from other employers? *

Do any employees predominantly work at home? If yes, #of employees? *

Any tax Leins or bankruptcy withing the last five years? If yes, please specify *

Any undisputed and unpaid workers compensation premium due from you or any commonly managed or owned enterprises? If yes, explain including entity name and policy number(s). *

Swimming Pools

Are there any swimming pools? *

Number of pools *

Are there any hot tubs? *

Number of hot tubs *

is each pool/hot tub fenced with a self closing/self-locking gate? *

Is each pool/hot tub have depth markings? *

Are there any diving boards or slides? *

Are pool/hot tub hours posted? *

How often are chemicals checked in pool/spa or hot tub? *

Open to Hotel guest only? *

Life Guard on Duty? *

Restuarant

Is there a restaurant on premises? If yes, complete a Restaurant Questionaire? *

If the applicant is the owner/operator, does the applicant provide any banquet or catering? *

UL300 fire suppression system? *

Bar separate for restaurant? *

Bar open after restaurant? *

Hours of operation *

Annual restaurant Sales? *

Annual liquor Sales? *

SECURITY

Room Security:

Do all rooms have doors with peepholes? *

Do all sliding glass doors on ground level have secondary locking devices? *

Do all rooms have deadbolt locks? *

Does the applicant have any private security measures in place? *

private patrols? *

Are there TV monitors? *

Who does the monitoring? *

Are private patrols employees or subcontractors *

Are room entry doors equipped with self-closing hardware? *

Are security complaints investigated? *

Are all parking areas well lighted? *

By whom? *

Key Control

Please Describe the types of room keys used ( electronic etc ) *

Is there a master key program in place? *

Is there a process to identify a guest prior to replacing a lost key? *

Is the room number or hotel name listed on the keys? y/n *

How often is re-keying performed? *

Business Auto

Does the applicant provide transportation for guests? *

If yes, what vehicles are used? *

Vehicle 1 ViN # *

Vehicle 3 ViN # *

Vehicle 2 ViN # *

Vehicle 4 ViN # *

Maximum distance transported? *

Is there an accident investigation program? *

Are motor vehicle records reviewed annually? *

Are motor Vehicle records pulled on all drivers? *

Does the applicant want non-owned and hired auto coverage? *

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