ACORD 185 (2003/07) – Restaurant/Tavern Supplement
Use this form in conjunction with ACORD 125, Commercial Insurance Application – Applicant Information Section.
This form is intended to be used as a supplement to the following forms, when insurance is desired for restaurants, diners, banquet halls, taverns, night clubs, and other risks that provide food and/or beverage service:
ACORD 126, Commercial General Liability Section
ACORD 140ACORD 140, Property Section
ACORD 160, Business Owners Application
Month/day/year in which the form is completed.
Producer’s name, address, and telephone number.
Identification code assigned to the agency or brokerage firm by the insurance company receiving this form.
If the agency uses a sub-code identification system with this company, enter the appropriate code.
AGENCY CUSTOMER ID
Customer’s identification number assigned by the agency.
Full name of the applicant as it appears on ACORD 125.
LOCATION OF PROPERTY
Provide the street address as it appears on ACORD 125.
TYPE OF BUSINESS
Identify the type of business conducted. Also check the appropriate boxes to indicate if the business is franchised, not franchised, seasonal or year round.
HOURS OF OPERATION
Provide the hours of operation.
This section is designed to inform the underwriter about the past financial condition of the owner or corporation, the type of entertainment provided, if any, the original and subsequent use of the building, and the number of employees Also indicate if the building owner is to be named as an additional insured on the policy.
BED & BREAKFAST INN ONLY
Complete this section if the risk is a bed & breakfast inn.
KITCHEN FIRE PROTECTION
This section is intended to provide sufficient information about the cooking equipment fire protection maintenance, and installation to enable the underwriter to assess the risks involved. Use the Remarks section to explain “no” answers.
This section is intended to provide information related to the operation of this type of business that is not found in ACORD 126, General Liability.
Complete this section if liquor liability coverage is to be provided. Use the Remarks section if more space is needed to provide responses.
Use this section to provide information about the financial condition of the business during the most recent 12 month period.
It is not necessary to complete this section if adequate financial statements are attached.