Transcription of LIQUOR LIABILITY SUPPLEMENTAL APPLICATION
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LIQUOR LIABILITY SUPPLEMENTAL APPLICATION
Kinsale Insurance Company P. O. Box 17008. Richmond, VA 23226. (804) 289-1300. LIQUOR LIABILITY SUPPLEMENTAL APPLICATION . COMPLETE IN ADDITION TO ACORD applications . ATTACH ADDITIONAL SHEETS AS NECESSARY. ANSWER ALL QUESTIONS. If not applicable, indicate N/A. APPLICANT'S INFORMATION. DATE: APPLICANT NAME: MAILING ADDRESS: STREET ADDRESS (if different): CITY, STATE, ZIP CODE: WEBSITE: www. GENERAL INFORMATION. 1) Receipts: Total Receipts: $ Food Receipts:$ LIQUOR Receipts:$. 2) Type of risk: Bar/Tavern Casino Catering Convenience/Grocery Store Gentleman's Club LIQUOR Manufacturer Night Club Restaurant 3) Is there a dance floor or an area for dancing?
page 1 of 4 . liquor liability supplemental application . complete in addition to acord applications . attach additional sheets as necessary . answer all questions.
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