Workers Compensation Insurance | LAJ Insurance Agency

Name of Entity:

DBA:

EIN:

Business Type:

Physical Address:

Mailing Address:

Website:

What year did you open:

How many owners:

How many employees, Full Time & Part time:

Do you have any Subcontractors/1099:

What is your estimated Payroll breakdown:

Expected total Sales in the next 12 months?

What type of dining? (Fast food. Fine dining, casual):

Will there be customer seating:

Will you be serving alcohol? What percentage of your total sales:

Do you have a liquor license:

Does your building have fire sprinklers:

Alarm systems/ monitored?

What type of cooking is done:

How many deep fryers:

Are your hoods being cleaned by a company or you do it yourself?

What is your total Sq ft:

Have you had an GL or WC claims in the past 5 years:

Have you had any prior coverages cancelled or non-renewed:

Umbrella Insurance