Carter & Company, L.L.P. 

 

 

 

(If not in Texas, please click here to view a list of states in which we currently have non-resident licenses.  If your state is not listed then we would not currently have a market for you.)

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Liquor Liability Quote
For the fastest and most accurate insurance quote, please provide as much information possible in the form below. This information will be kept confidential and will be used for quote purposes ONLY!
Applicant
Address: 
City:  State: Zip:
Phone Number:     Fax Number:  
Email Address: (Required)
*Social Security # or *FEIN 
*Required by insurance companies in order to quote
Description of Operations
Bar or Tavern
Hotel Club
Package Store
 Restaurant - Alcohol Sales Less than 30% of Receipts
 Restaurant - Alcohol Sales 30% - 50% of Receipts
 Restaurant - Alcohol Sales over 50% of Receipts
Other - Describe
Effective Dates of Coverage: To
Requested Limits:
                          		$ Each Cause/Aggregate
$ Each Cause/Aggregate
Receipts:  Alcohol Beverages   $ Last 12 Months Next 12 Months
Food & Other Bevs $ Last 12 Months Next 12 Months
Designated Premises:  List by street address all premises to be covered under this policy.  Premises not listed will not be covered.
1.
2.
3.
Premises Information:
Inside City Limits: Approximate Population: How Long This Location
Applicants Total Years Experience Hours of Operation: How Many Days Per Week
Dancing Area of Dance Floor Kind of Entertainment
Any Amusement Devices   Kind and Number
Underwriting Information:
Are employees to handle intoxicated customers & minors?
Has applicant/licensee ever had license revoked or suspended? If Yes, explain
Is applicant aware of any circumstances that might give rise to a claim?   If Yes, explain
Provide the following details on coverage for the last 3 years:
Company Policy Period

Premium

 Cancelled / Nonrenewed?
1.  If Yes, Explain
2.  If Yes, Explain
3.  If Yes, Explain
Provide a three year  loss history (include any claim, suit, or notice that may give rise to a loss):

DOL Description of Occurence or Claim

Amount Paid

Remarks:

 

Thank you for your time in submitting this Oil & Gas Insurance quote form. One of our representatives will respond to your submission as soon as possible!
 

 

Send mail to info@cartercompany.com with questions or comments about this web site.