Michael Keller Chief Brand Officer American Dairy Queen MarkED Conclave ‘06.
DAIRY QUEEN SHORT FORM APPLICATION - DQOA/DQOC · 2019. 12. 18. · Do you own any other businesses...
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DAIRY QUEEN SHORT FORM APPLICATION General Information: IDQ Franchise # Location # (provide separate applications for each location) Legal name of Franchise Entity Type Individual Partnership Corporation LLC Requested Effective Date Contact Name Years in Business Years of Experience Location Address Mailing Address (if different) Phone Fax Email Federal Tax Identification Number Workers Compensation: State Employer ID# (NJ, IN, MN) Annual Payroll $ Exp Mod No. of Employees Under 16/Over 70 Is owner’s salary included in payroll? Yes No Store Information Type of Franchise DQ Brazier Grill & Chill Orange Julius Soft Serve/Cakes/Treats Karmel Korn Construction Wood Frame Masonry/Wood Frame (JM) Masonry/Metal Frame (MNC) Hours of Operation Yr Built Date of Renovation & Type No. of Stories Sq Ft Seating Area Sq Ft Seating Capacity Alarm Central Station: Burglary Fire Sprinklered Playground Walk‐up Only Drive‐Thru Do you: Own or Lease the building? Does your lease require you to insure the building? Yes No Building Replacement Value $ Contents Replacement Value $ Signs on & off Premises $ Annual Sales $ % Hot Food % Soft Serve/Cakes/Soft Drinks Is your store a seasonal store? Yes No Precautions taken while closed Are you in a coastal state? Yes No Number of miles from ocean Has your insurance been cancelled/non‐renewed? Yes No Current Business Owners Premium Current Insurance Company No. of Claims Last 3 Years Amount Paid & Type of Claim Cooking Area Info Is the hood & duct system equipped with non‐combustible filters or a grease removal system? Yes No Are filters cleaned daily & hood & ducts cleaned twice yearly? Yes No Name of Automatic Extinguisher Serving Carrier Is there a service contract in place? Yes No Last Service Date Does the automatic extinguishing system meet the UL300 standard? Yes No Is the system Dry Chemical Wet Chemical Water Spray Gaseous or Clean Agent Is there an automatic fuel shut off? Yes No How many fire extinguishers do you have? How many are Class‐K? Options Available Do you own any other businesses in addition to Dairy Queen? Yes No Describe: Optional Coverages – Check to Add Employee Benefits Liability Earthquake Increased Liability $2,000,000/$4,000,000 Optional Policies – Check to Add Umbrella Liability Cyber Liability Flood Business Auto Employment Practices Liability Builders Risk – New Building or Renovation Please check here if you are interested in receiving information about our banking products * Please note that this is a short form application. Additional information may be requested in order to provide you with a quote for coverage. Fax To: 1.866.925.7116 or Email To: servicenow@mcgriffinsurance.com Questions: Call us at 1.888.780.8053
Transcript of DAIRY QUEEN SHORT FORM APPLICATION - DQOA/DQOC · 2019. 12. 18. · Do you own any other businesses...
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DAIRY QUEEN SHORT FORM APPLICATION General Information: IDQ Franchise # Location # (provide separate applications for each location) Legal name of Franchise Entity Type Individual Partnership Corporation LLC Requested Effective Date Contact Name Years in Business Years of Experience Location Address Mailing Address (if different) Phone Fax Email Federal Tax Identification Number
Workers Compensation: State Employer ID# (NJ, IN, MN) Annual Payroll $ Exp Mod No. of Employees Under 16/Over 70 Is owner’s salary included in payroll? Yes No
Store Information Type of Franchise DQ Brazier Grill & Chill Orange Julius Soft Serve/Cakes/Treats Karmel Korn Construction Wood Frame Masonry/Wood Frame (JM) Masonry/Metal Frame (MNC) Hours of Operation Yr Built Date of Renovation & Type No. of Stories Sq Ft Seating Area Sq Ft Seating Capacity
Alarm Central Station: Burglary Fire Sprinklered Playground Walk‐up Only Drive‐Thru Do you: Own or Lease the building? Does your lease require you to insure the building? Yes No Building Replacement Value $ Contents Replacement Value $ Signs on & off Premises $ Annual Sales $ % Hot Food % Soft Serve/Cakes/Soft Drinks Is your store a seasonal store? Yes No Precautions taken while closed Are you in a coastal state? Yes No Number of miles from ocean Has your insurance been cancelled/non‐renewed? Yes No Current Business Owners Premium Current Insurance Company
No. of Claims Last 3 Years Amount Paid & Type of Claim
Cooking Area Info Is the hood & duct system equipped with non‐combustible filters or a grease removal system? Yes No Are filters cleaned daily & hood & ducts cleaned twice yearly? Yes No Name of Automatic Extinguisher Serving Carrier
Is there a service contract in place? Yes No Last Service Date Does the automatic extinguishing system meet the UL300 standard? Yes No Is the system Dry Chemical Wet Chemical Water Spray Gaseous or Clean Agent
Is there an automatic fuel shut off? Yes No How many fire extinguishers do you have? How many are Class‐K?
Options Available Do you own any other businesses in addition to Dairy Queen? Yes No Describe: Optional Coverages – Check to Add Employee Benefits Liability
Earthquake Increased Liability $2,000,000/$4,000,000
Optional Policies – Check to Add Umbrella Liability Cyber Liability Flood Business Auto Employment Practices Liability Builders Risk – New Building or Renovation
Please check here if you are interested in receiving information about our banking products
* Please note that this is a short form application. Additional information may be requested in order to provide you with a quote for coverage.
Fax To: 1.866.925.7116 or Email To: [email protected] Questions: Call us at 1.888.780.8053
mailto:[email protected]
Legal name of Franchise: Individual: OffPartnership: OffCorporation: OffLLC: OffRequested Effective Date: Individual Partnership Corporation LLCContact Name: Years in Business: Years of Experience: Location Address: Mailing Address if different: Phone: Fax: Email: Federal Tax Identification Number: State Employer ID NJ IN MN: fill_38: Exp Mod: No of Employees: Under 16Over 70: undefined: Offundefined_2: OffDQ Brazier: OffGrill Chill: OffOrange Julius: OffSoft ServeCakesTreats: OffKarmel Korn: OffWood Frame: OffMasonryWood Frame JM: OffMasonryMetal Frame MNC: OffHours of Operation: Wood Frame MasonryWood Frame JM MasonryMetal Frame MNCYr Built: Date of Renovation Type: Wood Frame MasonryWood Frame JM MasonryMetal Frame MNCNo of Stories: Sq Ft: Seating Area Sq Ft: Seating Capacity: Alarm Central Station: OffBurglary: OffFire: OffSprinklered: OffPlayground: OffWalkup Only: OffDriveThru: OffOwn or: OffLease the building: Offfill_40: fill_41: Signs on off Premises: Offfill_43: Hot Food: Soft ServeCakesSoft Drinks: undefined_3: OffPrecautions taken while closed: Has your insurance been cancellednonrenewed: OffNumber of miles from ocean: OffNumber of miles from ocean_2: Current Business Owners Premium: Current Insurance Company: No of Claims Last 3 Years: Amount Paid Type of Claim: undefined_4: Offundefined_5: Offundefined_6: Offundefined_7: OffName of Automatic Extinguisher Serving Carrier: Does the automatic extinguishing system meet the UL300 standard: OffLast Service Date: undefined_8: Offundefined_9: Offundefined_10: Offundefined_11: Offundefined_12: Offundefined_13: Offundefined_14: OffHow many fire extinguishers do you have: How many are ClassK: undefined_15: OffDescribe: undefined_16: Offundefined_17: Offundefined_18: OffUmbrella Liability: OffCyber Liability: OffFlood: OffBusiness Auto: OffEmployment Practices Liability: OffBuilders Risk New Building or Renovation: OffPlease check here if you are interested in receiving information about our banking products: OffIDQ Franchise: location #: Submit Via Email:
