APRA Liquor Liability Questionnaire March 18, 2025 APRA Liquor Liability Questionnaire Step 1 of 2 50% This must be submitted for members requesting coverage for liquor liabilityMembers with more than one establishment selling or distributing alcohol must submit a separate questionnaire for each establishmentEntity Name:Questionnaire Completed By:Name: First Last Title:Phone:Email: If we have questions, who should we contact?Name: First Last Title:Phone:Email: Municipal Operations at which Liquor is Sold or Served (Select all that are relevant)Select all that apply Bar/ Tavern Package store Wholesale/Distributor Clubhouse or Restaurant Other Name and Address of Establishment where Liquor is Sold or Served (Fill out all that are relevant)Bar/Tavern:Package store:Wholesale/Distributor:Clubhouse or Restaurant:Other:Exposure Questions1.) Have you ever been assessed for a fine for violation of law concerning the sale of alcohol, or had your liquor license suspended? Yes No If yes, when?2.) Have all salespeople/servers and their supervisors been through Techniques in Alcohol Management (TAM) training? Yes No If yes, how often is the TAM training required?3.) Are procedures in place regulating the sale of alcohol to minors or those under the influence? Yes No If yes, describe:How is the age of the customer verified? 4.) How many years has the member operated this liquor business?5.) How many hours per week is the location open?6.) Are there procedures for handling violent or disruptive patrons? Yes No 7.) Estimated annual liquor receipts: ($)8.) Has applicant had any incidences or occurrences that may give rise to claims that have not already been reported to APRA, APEI, or AMLJIA? Yes No If yes, please give details:To the best of my knowledge, the information supplied is complete, correct, and reflects current practices.Signature – Member's RepresentativeTitle:Date: MM slash DD slash YYYY Δ