Please fill out the form as completely as possible in order to get an accurate brewery or pub insurance quote.

Applicant Information

Your Name (required)

Your Email (required)

Phone Number (required)

Company Name

Federal ID #

Year Business Established

Liquor License Number

Risk Management Contact

Risk Manager Phone

Risk Manager Email

Website Address

Association Memberships Held

Section I Production & Revenue Information

Barrels Produced Prior Year

Barrels Projected Current Year

Revenue Prior Year

Projected Revenue Current Year

Size of Brewing/Distilling System

Manufacturing Operations Per Location (wholesale to others only)

Bottles $

Cans $

Kegs/Other $

Tap Room / Restaurant Per Location

On Premises Consumption

Bottles $

Cans $

Draft $

Wine/Spirits $

Food & Non-Alcoholic Beverage $

Merchandise $

Off Premises Consumption

Bottles $

Cans $

Kegs/Other $

Does the Applicant manufacture, package or sell any other beverages?  Yes No

If yes please explain

Applicant's Distribution Area

Does the Applicant distribute any product themselves?  Yes No

If yes, number of vehicles used

If yes, radius of travel

Does the Applicant export any product?  Yes No

If yes, what % of sales

If yes, to what countries

Section II - Policies & Procedures

Does the Applicant have a formal product recall plan in place?  Yes No

If yes, please attache a copy:

Has the Applicant ever had to recall a product?  Yes No

If yes, provide details, including cost of the recall

Does the Applicant currently have Product Recall coverage?  Yes No

If yes, what limits $

If yes, who is the carrier

How are the applicant's products identified as an item that you have produced?

How long are production records kept

Is this longer than life expectancy of the product?  Yes No

Does the Applicant maintain product records on the following:

Raw materials:  Yes No

Quality controls records:  Yes No

Raw material suppliers information:  Yes No

Purchasers information  Yes No

Is a batch code system utilized?  Yes No

If yes, is this system able to trace back to raw materials?  Yes No

Does the applicant have a formal Quality Assurance Program?  Yes No

Does the applicant have a formal supply assessment program of its supplies?  Yes No

Does the applicant perform audits on it's suppliers' Quality Assurance procedures?  Yes No

Is the applicant accredited with good manufacturing practices which include HACCP
principals such as SQF, FSSA 22000, or ISO?  Yes No

If yes, please explain

Are trademark investigations done prior to finalization of new products/labels?  Yes No

Is a Certificate and Additional Insured status required from all vendors?  Yes No

Are tours of the brewing facility provided?  Yes No

Is there an employee tour guid?  Yes No

Are samples provided and ID's checked for samples?  Yes No

Section III - Brewing / Distilling & Refrigeration Equipment

Was the equipment purchased new?  Yes No

What is the barrel capacity of the equipment

Please provide details of the sanitation procedure:

What country(ies) was the brewing equipment manufactured in

Is there a regular service plain in place for all brewing and refrigeration equipment?  Yes No

How many boilers are used at each location to provide process steam?

Who is the manufacturer and what is the construction type of each boiler?

What is the expiration date of each boiler's state / local certificate of operation?

How old is the boiler and brewing equipment at each facility?

How old is the boiler and brewing equipment at each facility?

Number of losses/claims made for equipment breakdown over the past five years and details of each:

Section IV - Property Information

Is the building on any historical registry(Local, State, or Federal)?  Yes No

Is the building over 100 years old?  Yes No

Are there any other businesses in the building?  Yes No

If yes, list the other businesses

Does the applicant mill its own grain?  Yes No

If yes, provide details of ventilation, dust control and room details:

Section V - Liquor Liability

Are all employees and volunteers who serve alcohol L.E.A.D. and / or T.I.P.S trained?  Yes No

Has the liquor license ever been revoked or suspended?  Yes No

If yes, when and explain:

Have there ever been citations by a liquor control board  Yes No

If yes, when and explain:

What controls are there to prevent over serving?

What are the procedures for handling an intoxicated patron?

Current Liquor liability carrier

Current liquor liability premium $

After going over your application, one of our brewery insurance representatives will get back to you as soon as possible with a custom plan to best fit your needs.