CRAFT BEVERAGES SUPPLEMENTAL QUESTIONNAIRE - BREWERIES

Transcription

1 CRAFT BEVERAGES SUPPLEMENTAL QUESTIONNAIRE - BREWERIES A - General Information Applicant Name: Mailing Address: Website: B - Operations 1. Year established: 2. List the number of years of experience of the Head Brew Master: 3. List qualifications of Head Brew Master or attach résumé: Date: 4. Classification of your operation: Microbrewery (<15,000 barrels/year) Regional Brewery (15,000-2,000,000 bbls/year) Large Brewery (over 2,000,000 bbls/year) Brewpub (25% or more of production is consumed on premises) Other - Please explain: 5. Annual Revenue - Total of all operations: Current year (projected year-end) $ / # barrels Previous year $ / # barrels 2 nd prior year $ / # barrels Projected next 12 months $ / # barrels 6. Revenue Sources: (current year) Beer manufacturing receipts $ % bottles % % cans % % kegged / bulk % Restaurant Food: $ Alcohol: $ Total: $ Gift Shop $ Tasting room $ Other (specify): $ 7. Do you manufacture, package or sell any other beverages (either alcoholic or non-alcoholic)? Yes No If "Yes", please explain: 8. What is your distribution area? IA Page 1 of 5

2 9. Do you distribute any of your products yourself? Yes No If "Yes", number of vehicles used for distribution: Furthest distance traveled: 10. Do you export any products? Yes No If "Yes", what percent of sales are exported: % To what countries: 11. Are you a member of any national, state or local associations or organizations? Yes No Please list: C - Policies and Procedures 1. Is there a formal quality control program in place? Yes No 2. Do you batch code all of your beer? Yes No If "Yes", how long do you retain the records? 3. Do you have a written product recall plan in place? Yes No 4. Are your refrigeration units covered under a service agreement? Yes No If "Yes", provide the name of the service company: 5. What is the age of your brewing equipment? 6. Did you purchase your brewing equipment New Used 7. What is the size (barrel capacity) of your brewing system? 8. Please explain your sanitation procedures: 9. Do you perform quality checks on all incoming raw ingredients? Yes No 10. Do you perform trademark investigations prior to finalizing new beer labels and / or names? Yes No 11. Do you have a contract with a professional pest control firm at all brewing locations? Yes No 12. Do you obtain certificates of insurance from all of your contractors and vendors? Yes No D - Premises and Property Information 1. Is the property you own / occupy listed on any historic registry? Yes No 2. Do other businesses occupy your same building? Yes No If "Yes", please list: 3. Do you mill your own grain? Yes No Is the milling performed in a separate room / area / building? Yes No Is there proper ventilation in the milling area? Yes No How is dust controlled? Is grain handling equipment and electrical service in compliance with NFPA codes? Yes No 4. Do you provide tours of your facility? Yes No Are they always guided? Yes No Are samples given? Yes No Are ID s checked? Yes No IA Page 2 of 5

3 5. Please describe entertainment provided (live music, pool tables, darts, DJ, etc.): 6. Is there a dance floor? Yes No 7. What is the maximum seating capacity of your establishment? 8. Do you permit smoking? Yes No If "Yes", is it permitted: Inside Outside only Both 9. Please list any special events that you either host or attend to promote your brand: E - Beverage and Food Service 1. Do you operate a tasting room? Yes No What are the hours of operation? Do you provide any special drink prices or "happy hours"? Yes No How are drinks served (Please select all that apply): By the pitcher By the glass - one at a time (16 oz. or less) By the glass (more than 16 oz.) By the glass - more than one at a time Explain procedures for serving high alcohol content beer (over 9% ABV): 2. Do you operate a restaurant? (If no restaurant, skip to F.) Yes No 3. What are the restaurant hours of operation? 4. Are all servers / bartenders trained and certified in a formal alcohol training course? Yes No If "Yes", which training course do you use? 5. Explain procedures for dealing with intoxicated patrons: 6. Indicate which types of cooking equipment is used on premises (check all that apply): Commercial ovens Deep fat fryers Broilers Open flame grills Pizza ovens No cooking present - cold sandwiches, snacks and/or soups only. Other - Please explain: 7. Construction of Hood: Are hoods equipped with filters? Yes No How often are they cleaned? Is wiring in grease tight conduit? Yes No Are electrical fixtures in grease tight fittings? Yes No IA Page 3 of 5

4 8. Construction of Exhaust Duct: Does duct pass through combustible building structure? Yes No Approximate diameter of the duct: Approximate length of the duct: Where is the termination point of the duct? Is a fan motor in the duct? Yes No 9. Is there a regular program in place for the cleaning of all hoods and ducts? Yes No Who provides the hood cleaning service? How frequently is service rendered? When was service last rendered? What is your procedure for cleaning removable filters and controlling grease accumulation? 10. Describe the type of any automatic or manually operated extinguishing system installed in the exhaust system: F - Liquor Liability 1. Liquor License Name: 2. Liquor License Number: Class of License: 3. Has your alcoholic beverage license ever been revoked or suspended? Yes No If "Yes", explain: 4. Has your liquor liability insurance been cancelled or nonrenewed in the last 3 years? Yes No If "Yes", explain: 5. Have you ever been fined by alcoholic beverage control or other governmental regulator? Yes No If "Yes", explain: 6. Have you ever filed for Bankruptcy? Yes No If "Yes", what year? 7. Number of servers / bartenders used: Number with 2 years bartending experience or more: Number with less than 2 years bartending experience: 8. Is there any type of designated driver program in effect? Yes No 9. Please describe any additional security measures in place: 10. Describe the area (check all that apply): Downtown Industrial Residential Shopping / Commercial Rural Resort / Seasonal College Campus IA Page 4 of 5

5 11. Current Liquor Liability Carrier: Current Limits: Current Premium: Limits of liquor liability being requested (Select only one option): Each common cause / Aggregate: $100,000 / $200,000 Each common cause / Aggregate: $300,000/ $600,000 Each common cause / Aggregate: $500,000 / $1,000,000 Each common cause / Aggregate: $1,000,000 / $2,000,000 Other: Applicant's Signature Agent's Signature Date Date Agency and Code Number Agent's Name and License Number (Florida only) Refer to the following page for the current version of ACORD 63 FRAUD STATEMENTS. IA Page 5 of 5

6 AGENCY AGENCY CUSTOMER ID: FRAUD STATEMENTS CARRIER NAIC CODE POLICY NUMBER EFFECTIVE DATE APPLICANT / NAMED INSURED Applicable in AL, AR, DC, LA, MD, NM, RI and WV Any person who knowingly (or willfully)* presents a false or fraudulent claim for payment of a loss or benefit or knowingly (or willfully)* presents false information in an application for insurance is guilty of a crime and may be subject to fines and confinement in prison. *Applies in MD Only. Applicable in CO It is unlawful to knowingly provide false, incomplete, or misleading facts or information to an insurance company for the purpose of defrauding or attempting to defraud the company. Penalties may include imprisonment, fines, denial of insurance and civil damages. Any insurance company or agent of an insurance company who knowingly provides false, incomplete, or misleading facts or information to a policyholder or claimant for the purpose of defrauding or attempting to defraud the policyholder or claimant with regard to a settlement or award payable from insurance proceeds shall be reported to the Colorado Division of Insurance within the Department of Regulatory Agencies. Applicable in FL and OK Any person who knowingly and with intent to injure, defraud, or deceive any insurer files a statement of claim or an application containing any false, incomplete, or misleading information is guilty of a felony (of the third degree)*. *Applies in FL Only. Applicable in KS Any person who, knowingly and with intent to defraud, presents, causes to be presented or prepares with knowledge or belief that it will be presented to or by an insurer, purported insurer, broker or any agent thereof, any written statement as part of, or in support of, an application for the issuance of, or the rating of an insurance policy for personal or commercial insurance, or a claim for payment or other benefit pursuant to an insurance policy for commercial or personal insurance which such person knows to contain materially false information concerning any fact material thereto; or conceals, for the purpose of misleading, information concerning any fact material thereto commits a fraudulent insurance act. Applicable in KY, NY, OH and PA Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any materially false information or conceals for the purpose of misleading, information concerning any fact material thereto commits a fraudulent insurance act, which is a crime and subjects such person to criminal and civil penalties* (not to exceed five thousand dollars and the stated value of the claim for each such violation)*. *Applies in NY Only. Applicable in ME, TN, VA and WA It is a crime to knowingly provide false, incomplete or misleading information to an insurance company for the purpose of defrauding the company. Penalties (may)* include imprisonment, fines and denial of insurance benefits. *Applies in ME Only. Applicable in NJ Any person who includes any false or misleading information on an application for an insurance policy is subject to criminal and civil penalties. Applicable in OR Any person who knowingly and with intent to defraud or solicit another to defraud the insurer by submitting an application containing a false statement as to any material fact may be violating state law. Applicable in PR Any person who knowingly and with the intention of defrauding presents false information in an insurance application, or presents, helps, or causes the presentation of a fraudulent claim for the payment of a loss or any other benefit, or presents more than one claim for the same damage or loss, shall incur a felony and, upon conviction, shall be sanctioned for each violation by a fine of not less than five thousand dollars ($5,000) and not more than ten thousand dollars ($10,000), or a fixed term of imprisonment for three (3) years, or both penalties. Should aggravating circumstances [be] present, the penalty thus established may be increased to a maximum of five (5) years, if extenuating circumstances are present, it may be reduced to a minimum of two (2) years. APPLICANT'S SIGNATURE DATE (MM/DD/YYYY) ACORD 63 (2013/09) ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD