LIQUOR LIABILITY COVERAGE FORMS EXPOSURE ANALYSIS CHECKLIST

(November 2019)

INTRODUCTION

This checklist is designed to assist in beginning the analysis of the Insurance Services Office (ISO) Liquor Liability Coverage Forms. This is only a starting point, and additional risk specific questions may arise as the exposures are developed. This analysis should be combined with exposure analysis checklists for other coverages to develop a complete picture of the insured’s operations.

This checklist is designed to supplement the ACORD application.

A list of endorsements may be helpful as you discuss exposures with your client.

Liquor Liability Coverage Forms Available Endorsements and Their Uses

Liquor Liability Coverage Forms Endorsements Checklist

GENERAL INFORMATION

Legal business name(s)

____________________________________________________________________________________

Mailing address:

____________________________________________________________________________________

Email: _______________________________________________________________________________

Website: _____________________________________________________________________________

Type of entity:

___ Individual	___ Corporation	___ Sub-S Corp.
___ Partnership	___ Joint Venture
___ Not-for-profit	___ Limited Liability Company

SIC Code(s): _________________________________________________________________________

NAICS Code(s):_______________________________________________________________________

Federal ID Number: ____________________________

When did the applicant start business operations? ___________________________________________

When did the present management assume control? _________________________________________

How many years experience does the owner have in this type of business? _______________________

How many years experience does the manager have in this type of business? _____________________

Has the applicant ever been involved in a bankruptcy procedure? ___ Yes ___ No

If yes, explain including the type of bankruptcy, the filing date, and the resolution.

____________________________________________________________________________________

Names of subsidiary companies or joint ventures that are not part of this application:

____________________________________________________________________________________

Important People	Name	Phone Number
Owner/Principal	____________________________	______________
Other Decision Makers	____________________________	______________
Plant and Grounds	____________________________	______________
Financial	____________________________	______________
Legal	____________________________	______________
Claims	____________________________	______________

The applicant’s primary operations are:

____________________________________________________________________________________

The applicant’s secondary and/or incidental operations are:

____________________________________________________________________________________

The applicant used to be involved in the following operations, but they have been discontinued:

____________________________________________________________________________________

The hours of operations are: _____________________________________________________________

How many days per week is the applicant open? ___

Is this a seasonal operation? ___ Yes ___ No

If yes, what is the season? From: _____________ to: _____________

Does the applicant have a safety program? ___ Yes ___ No

If yes, answer the following:

Name of safety director: _________________________________________________________

Safety director phone number: __________________________________________________

Safety director email address: ____________________________________________________

Attach a copy of the safety program.

Does the applicant have a disaster plan? ___ Yes ___ No

If yes, answer the following:

Name of disaster coordinator: ____________________________________________________

Disaster coordinator phone number: ______________________________________________

Disaster coordinator email address: ________________________________________________

Attach a copy of the disaster plan.

LIABILITY – LIQUOR

Describe the applicant’s liquor license.

Type of license	License No.	Date issued	Next renewal date, if any
________________________________________	_________________	_______	___________
________________________________________	_________________	_______	___________
________________________________________	_________________	_______	___________

Has the applicant’s liquor license ever been revoked? ___ Yes ___ No

If yes, explain all circumstances and include the dates it was revoked and reinstated.

____________________________________________________________________________________

Describe the applicant’s liquor-related business operations.

____________________________________________________________________________________

What is the breakdown of the applicant’s annual receipts?

	Estimate Next 12 mos.	Actual Past 12 mos.
On-premises consumption - liquor	$_________	$_________
Off-premises consumption - liquor	$_________	$_________
Food	$_________	$_________
Cover charge	$_________	$_________
Other sales	$_________	$_________
Total sales	$_________	$_________

Describe other.

____________________________________________________________________________________

What are the applicant’s standard hours of operation? (show a.m. or p.m. after time)

	Sun.	Mon.	Tue.	Wed.	Thu.	Fri.	Sat.
Open:	_____	_____	_____	_____	_____	_____	_____
Close:	_____	_____	_____	_____	_____	_____	_____

What is the establishment’s capacity?

_____ Dining room seating _____ Bar seating _____ Maximum legal occupancy

How many employees can serve alcoholic beverages during peak periods? _____

How many employees who serve are in each of the following categories?

____ Bartenders _____ Owners _____ Waiters/waitresses

How many security personnel are on site during peak periods (include bouncers)? _____

Does the applicant provide servers with training or guidance in how to handle minors or intoxicated customers?
___ Yes ___ No

If yes, describe.

____________________________________________________________________________________

Does a professional training organization certify this training? ___ Yes ___ No

If yes, attach a copy of the certificate.

Are all employees who serve alcoholic beverages required to take such training? ___ Yes ___ No

If no, what percentage of servers have received such training? ______%

Describe the applicant’s policy on serving intoxicated customers.

____________________________________________________________________________________

Are customers ever served alcoholic beverages before they produce age-documenting identification?
___ Yes ___ No

If yes, explain.

____________________________________________________________________________________

What amusement devices and how many are located on the applicant’s premises?

___ Gambling machines # _____	___ Video games # _____
___ Pool tables # _____	___ Dart boards # _____
___ Pinball machines # _____	___ Other # _____

Describe other.

____________________________________________________________________________________

What entertainment does the applicant provide?

___ Juke box ___ Individual musician ___ Live band

___ Piano/organ ___ Comedian/comedienne ___ Dancers

___ Other

Describe other.

Does the applicant permit dancing? ___ Yes ___ No

If yes, answer the following:

How many days per week? ______

What is the size of the dance floor? ______ sq.ft.

Does the applicant offer special alcoholic consumption promotions? ___ Yes ___ No

If yes, describe the promotion(s).

____________________________________________________________________________________

Does the applicant dispense or provide alcoholic beverages for off-premises events? ___ Yes ___ No

If yes, provide the following information for each event.

Event name	Event location	Start date	Number of days	Expected attendance

Has the applicant or its owners ever been fined or cited for violation(s) of a law or ordinance related to selling alcoholic beverages? ___ Yes ___ No

If yes, explain.

____________________________________________________________________________________

Has the applicant or its owners incurred any claim for liquor liability in the past five years? ___ Yes ___ No

If yes, explain and include the dates of the incident and the claim, the description, its current status, and the amount paid, if any.

____________________________________________________________________________________

Does the applicant know about any incident not described above that may become a liquor liability claim?
___ Yes ___ No

If yes, describe the incident(s).

____________________________________________________________________________________

Have fights between patrons occurred within the applicant’s establishment or in its parking area in the last five years? ___ Yes ___ No

If yes, describe the fight(s).

____________________________________________________________________________________

Does a contract or agreement require that the applicant provide insurance protection for its landlord?
___ Yes ___ No

If yes, provide the landlord’s name and address.

____________________________________________________________________________________

Does the applicant sell alcohol on the Internet? ___ Yes ___ No

If yes, describe the procedures in place to prevent sales to underage consumers.

____________________________________________________________________________________