Hotel / Motel Supplemental Questionnaire

In order to obtain a quote it is mandatory that all questions be answered and that loss runs or loss statement on the insured's
letterhead to be included with your application.
 
Applicant:
Broker:
Address:
Our reliance on this information makes the submitting broker assume full responsibility for the accuracy and legitimacy of these responses and any
resulting consequences thereof unless the Accord application and Supplemental questionnaires are signed by the insured.
Average Room Rate $
Average Occupancy
Number of ADA Compliant Rooms
Describe Type of Roof
Is Roof
FlatPitched
Manual Fire or Smoke Alarm Boxes on Premises?
YesNo
Central Station Alarm To Front Desk and Fire Department?
YesNo
Are Alarms Audible On Premises and Front Desk?
YesNo
Is Building Sprinklered?
YesNo
If yes what %
Are Smoke Detectors Hard Wired?
YesNo
If Not- Are Battery Inspections And Test Logs Maintained?
YesNo
Does insured have a min. of 3 yrs hotel mgmt experience?
YesNo
Does applicant have a liquor license?
YesNo
Does applicant have owned vehicles?
YesNo
Transportation of Passengers - Are Drivers over 25 years old?
YesNo
Service Vehicles - Are drivers over 21 years old?
YesNo
Does applicant hire or provide Valet Parking?
YesNo
Are shower/tub surfaces protected by non-skid surfaces?
YesNo
Are all shower/tub doors safety glass or curtain?
YesNo
(If No, Explain)
Does applicant have a closed season?
YesNo
(If Yes, When)
Are there any in-room 'gas' cooking units?
YesNo
(If Yes, Explain)
Does applicant provide health club facilities?
YesNo
Does applicant have a pool?
Yes No
If yes number of pools:
Is the pool fenced and secured by self locking gate?
YesNo
Does the pool have diving boards?
YesNo
Has applicant received any code violations in past 3 yrs?
YesNo
(If Yes, Explain)
Has applicant ever filed for bankruptcy protection?
YesNo
(If Yes, Explain)
Is there a child's playground or nursery on premises?
YesNo
(If Yes, Describe)
Does applicant employ/contract for security personnel?
YesNo
If yes, are security guards armed?
YesNo
(If Yes, Explain)
Do you comply with all applicable laws and codes concerning security?
YesNo
(If Yes, Explain)
Whether operated by the applicant or not, is there a restaurant or bar on premises where alcohol sales exceed 30% of total sales?
YesNo
Do you have formal written procedures regarding guest safety?
YesNo
Do those procedures include the following:
When room keys are provided to employees?
YesNo
Reprogramming of room door locks to upon departure of guests?
YesNo
Providing room keys only to registerd guests?
YesNo
Requiring proper identification of individual prior to giving room key?
Yes No
Prohibit the giving of 'master' keys?
YesNo
Prohibit giving room numbers verbally?
YesNo
Prohibit giving room numbers to guests over the phone?
YesNo
Prohibit the confirming or denying whether an individual is staying at the property?
YesNo
Require immediate call to police upon being notified a guest is in need of help or may be in danger?
YesNo
Require written documentation of any incident involving guest safety?
YesNo
Facility has CCTV for monitoring parking areas and entrances?
YesNo
Are any rooms rented for 30 consecutive days?
YesNo
(If Yes, Explain)
Is there a restaurant or bar on the premises?
YesNo
(If Yes,attach supplemental questionnaire)
Does applicant provide entertainment?
YesNo
(If Yes, Describe)
Does applicant have a written evacuation plan?
YesNo
Is there a manager on premises/duty 24hrs. daily?
YesNo
Is property ADA compliant?
YesNo
If yes, indicate # of rooms that meet ADA requirements
Is property owner operated?
YesNo
(If No, Explain)
Is emergency lighting available?
Yes No
Outside egress available on all floors?
YesNo
Indicate Number of Exits Per Floor
Hotel amenities: water sports, golf, tennis, horses, skiing?
YesNo
Is applicant within 500 feet of any river, lake or ocean?
YesNo
Any marina slips/boat docks?
YesNo
Do employees use their own vehicles for company purposes?
YesNo
How many employees drive own vehicles?
Do ee's provide Cert of Ins.?
YesNo
Any drivers under age of 21?
YesNo
Has the insured leased or rented vehicles in the last year?
YesNo
If Yes,provide cost of hire:
Date premises last visited?
Recommendations?
Other Comments:
 
NOTE:  Before transmitting this form via our website, please print a copy for your records and for the insured's signature.  We require that the insured sign this form and for the signed copy to be faxed to our office prior to binding.  Please note that coverage can't be bound or amended via this website.  You must receive a binder or written confirmation from our office for coverage to be bound.
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