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HOTEL/MOTEL INSURANCE APPLICATION

This application will be used to derive a quote for your property. It is necessary that all questions be answered accurately and completely. If any questions are left blank it will delay the quoting process.

SECTION I: GENERAL INFORMATION

What date does your insurance policy expire? If this is for a closing what is the tentative closing date? _____/_____/_____

Type of business: o Individual o Partnership o Corporation

Individual, Partnership or Corp Name:
Name of Hotel or Motel:
Mailing Address:
Location Address:
City:
County:
State:
Zip Code:
Contact Person:
Telephone Number:
Cellular Phone Number:
Fax Number:
Email Address:

SECTION II: COVERAGE

(If you have multiple buildings you must separate each one below.)

	Building Limit	Contents Limit	Year Built	Number of Motel Rooms	Number of Stories	Square Footage
Building 1	$	$
Building 2	$	$
Building 3	$	$
Building 4	$	$
Building 5	$	$
Building 6	$	$
Building 7	$	$
Building 8	$	$
Building 9	$	$
Building 10	$	$

	Sign Value
Sign 1	$
Sign 2	$

SECTION III: PROPERTY DETAILS

A. STRUCTURE

What is the construction of your building? o Wood or Frame o Brick over Wood o Solid Concrete (no wood)

Does your building have EIFS (Exterior Insulation Finishing System)? o Yes o No

What is the construction of your roof? o Wood Trusses o Concrete Slab o Metal beams (not metal roof)

What is the shape of your roof? o Flat Roof o Pitched Roof (traditional triangle roof)

B. SWIMMING POOL

Is there a swimming pool at the property? o Yes o No

(Complete the following questions if you have a swimming pool)

How many swimming pools are there? __________

Is the swimming pool: o Indoor o Outdoor

Does the pool have a slide or a diving board? o Yes o No

Does the pool have a fence with a childproof latch? o Yes o No

Are pool depths clearly marked on top and sides of pool? o Yes o No

C. OCCUPANCY

What are the annual gross motel receipts? $_______________

What was your occupancy rate last year? __________%

What is your average room rate? $__________

Do you have any monthly or hourly rates? o Yes o No

Are there any apartment rentals? o Yes o No

D. RESTAURANT

Is there a restaurant on the property? o Yes o No

(Complete the following if you have a restaurant on your property)

(Complete Section E. Lounge if alcoholic beverages are sold at the restaurant)

Do you operate the restaurant? o Yes o No

If you operate the restaurant, what are the annual gross receipts? $_______________

Do you lease the restaurant out to a tenant? o Yes o No

What is the square footage of the restaurant? __________

What is the name of the restaurant? ____________________

What are the business hours of the restaurant? ____________________

What is the seating capacity of the restaurant? __________

Is there an ansul system in the kitchen? o Yes o No

Is there a U.L. approved automatic extinguishing system in the kitchen? o Yes o No

Are filters cleaned weekly? o Yes o No

Do you have your hoods and ducts cleaned professionally? o Yes o No

How often are the hoods and ducts cleaned? _______________

E. LOUNGE

Is there a lounge on the property? o Yes o No

(Complete the following if you have a lounge on your property)

Do you operate the lounge? o Yes o No

If you operate the lounge, what are the annual gross receipts? $_______________

Do you lease the lounge out to a tenant? o Yes o No

What is the square footage of the lounge? __________

What is the name of the lounge? ____________________

What are the business hours of the lounge? ____________________

What is the seating capacity of the lounge? __________

Are there bouncers or security guards? o Yes o No

Is there a dance floor? o Yes o No

Is there live entertainment provided? o Yes o No

Is there a happy hour? o Yes oNo

F. PROTECTION

Are the smoke detectors: o Hardwired o Battery

Is there a central station fire alarm? o Yes o No

Does the building have a sprinkler system? o Yes o No

Is premises covered by security cameras? o Yes o No

Are there dead bolts or chain locks on the doors? o Yes o No

Is there any armed security personnel at the property? o Yes o No

G. MISCELLANEOUS

How many years have you been in the hotel/motel business? __________

How many years have you owned this property? __________

Does Asian American Nations Insurance Group insure any other properties for you? o Yes o No

How many miles away is your property from the ocean or gulf? __________

How many employees work at your property? Full-Time __________ Part-Time __________

Approximately how many deposits do you make in a week? __________

(Please mark an “X” in the appropriate box)

	YES	NO		YES	NO
Is there a basement on the property?			Is there a fitness center?
Does the property have aluminum wiring?			Are there any meeting rooms?
Do tubs/showers have non-slip surfaces?			Are there any banquet facilities?
Do tubs/showers have grab bars?			Does the premise have a playground?
Do guest rooms have peepholes?			Are there any basketball or tennis courts?
Do you have electronic key cards?			Is there a manager’s quarter on premises?
Is there a night window for the front desk?			Are there any unusable/unrentable rooms?
Do guest rooms have self-closing doors?			Are there any vacant/unoccupied buildings?
Is there a hotel safe?			Is there any underground parking?
Are there any elevators?			Are there any rooms with kitchenettes?
Are parking lots and sidewalks free of holes?			Do you use surge protection on equipment?
Is there an evacuation plan in each room?			Do you have lightning rods on the building?
Do you presently own other hotels/motels?			Is the property interior corridor?

SECTION IV: UPDATES

When were the following updates completed?

	YEAR		YEAR
Roof		Plumbing
HVAC (Heating/Air condition)		Electrical

SECTION V: WORKERS COMPENSATION

(Complete the following if you need workers compensation insurance)

What is your federal/tax id number? ____________________ If you know your experience mod put it here: __________

What is your payroll for the following: Motel _______________ Clerical __________ Restaurant _______________

Officer/Partner #1 _______________________ Title ____________________ Shareholder Percentage _____ Incl or Excl _____

Officer/Partner #2 _______________________ Title ____________________ Shareholder Percentage _