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Philadelphia Insurance Companies
One Bala Plaza, Suite 100, Bala, Cynwyd, PA 19004
610-617-7900//Fax 610-617-7940//www.phly.com

Special Event - Liquor Liability Supplemental Application

1.
2. Is the Liquor License in your name?
If Yes, is it an annual license?
3. Have you ever been assessed a fine or violation of a law concerning the sale, serving or providing of alcohol?
4. Have you had any occurrences that have arisen out of the sale, serving or providing of any alcoholic beverage?
5. Has your liquor liability insurance been canceled or non-renewed in the last 3 years?
6. Are your employees or volunteers serving liquor?
Do you secure Certificate of Insurance from the contracting party?
7. Are servers, bartenders and parking valets required to participate in alcohol awareness programs? (TIPS, TAM, etc?)
8. Is there a Designated Driver Program or escort service provided for those unable to drive?
9. Is there a limit placed on the quantity of alcoholic beverages purchased at one time?
Applicant's Statement and Declarations
The applicant declares to the best of his / her knowledge the information contained in this application and all supplements attached to be true and that no material facts have been suppressed or misstated. The applicant further understands that any false or fraudulent statements or misrepresentations could result in termination or voidance of any insurance contract issued from the information stated herein.