"A Tradition of Service Since 1965"
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Personal Information:


Your Full Name:                                                    
Corporate Legal Business Name:                                                 
 
Street Address:   
City:                                     State:                    Zip:   

Phone number:                                        Best time to reach you?     

Email address to send information:   

Years in Business:     Effective Date of Renewel:

Current Insurance Company:    
Current Premium (approx):
Hours of Operation:                         Total Gross Receipts:
Liquor Receipts:                         Delivery Percentage of Sales:
Total Square Footage:                         Building Construction:
Year Built (estimate):                         Building Coverage Limit:
Contents Coverage Limit:                      Tenant Improvement Limit:
Current Property Deductible:                        Sprinklers Installed?
Central Burglar / Fire Alarm?                 Seating Capacity
Seperate Bar?                 Live Entertainment ?

If Live Entertainment (Explain)




Average Dinner Price:  General Liaibility Limit:

Number of Claims in the Past 3 Years: 

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License# 0586791
Loomis Insurance Services
8175 Limonite Ave. Suite B
Jurupa Valley CA 92509
(Formally Riverside,Ca)

Office: 951-685-7478
Fax: 951-685-0665
Email Us
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