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CRAFT BEVERAGES SUPPLEMENTAL QUESTIONNAIRE -BREWERIES

Date:

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:

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

• 2nd 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?

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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

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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

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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

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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 Date

Agent's Signature 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.