Hospitality Insurance

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Corporate Name

DBA

Expiration Date of Current Policy: Workers Comp

Expiration Date of Current Policy: Property/Liability

Location Address

Contact Name

Contact Phone

Number of Employees

Restaurant Employees: Full Time

Restaurant Employees: Part Time

Clerical Employees: Part Time

Delivery Employees: Part Time

Other Employees (& Type): Part Time

Estimated Payroll

Total

Restaurant

Clerical

Delivery

Other (& Type)

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