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EXECUTIVE SUMMARY
TIME OUT is unlike a typical restaurant it will provide a unique combination of excellent food at value pricing with a fun and entertaining atmosphere Time Out is the answer to an increasing demand The public wants value for everything that it purchases it will not accept anything that does not meet its expectation and wants entertaining with its dining experience
In todays highly competitive environment it is becoming increasingly more difficult to differentiate one restaurant concept from another Time Out does this by being the only restaurant in the area with a mesquite grill Our grill will be in view so that our guest can see their entree prepared to taste
This plan is prepared to obtain financing for the initial launch of this concept The financing is required to begin work on site selection kitchen design equipment purchases ledger manuals and marketing events In addition capital will allow Time Out to successfully ope and provide its guests with a value driven entertaining and dining experience A unique mid-scale innovative ~nvironment is required to provide the guest with an atmosphere that will entice the local community to bring family and friends to dine and socialize Successful operation through year two will provide adequate cash flow to be financially solvent in year three
The owner Mr Columbus Williams was a supply supervisor on board USS Dwight D Eisenhower Aircraft Carrier UN-69 Mr Williams was successful in purchasing receiving inventory and auditing food for over 5000 Navy personnel to consume daily Columbus was a member of the Advance Supply Base 209 unit for over 6 years
3
TIME OUT SPORTS CAFE RESTURANT amp DINER
A PROPRIETORSHIP
Business Plan
Nature ofBusiness
Time Out Sports Cafe 1 has been in the planning stage for the past 8 years Time Outs primary focus is to provide families with kids a four star restaurant in the Clarkston Stone Mountain area Time Out Sports Cafe is not just another restaurant It will have TVs and smooth jazz music free meal programs for kids all u can eat seafood on select days and a Sunday Breakfast Brunch Time Out Sports Cafe 1 is currently looking for space or land As soon as a location is determined it will be under immediate development Time Out Sports Cafe is the first of 4 restaurants and a motel planned Listed below are businesses planned for the near future
Location 1 Time Out Sports Cafe 1 Lawrenceville Hwy 2 Freedom Inn Motel (no pool) Greenbriar-Cascade 3 Eggs International (24 hours) Greenbriar- Cascade 4 Time Out Sports Cafe 2 To be determined 5 Eggs International (24 hours)To be determined
Time Out Sports Cafe 1 plans to open for business on Oct 1 2011
Management Team
OwnerOperator ofTime Out Sports Cafe will be Columbus Williams Jr Columbus has over 18 years of management experience He is certified in running a profitable small business
Vice President of Operation will be Antonio Wilkerson He has been a Master Chef in the Atlanta area for over 16 years Some of his experiences include The Mansion The Abby and Beasleys of Buckhead
4
MENU
LUNCH BASKETS
Monday thru Saturday from Ilam to 3pm Served with Fries and Coleslaw
Fish Nuggets $495 Chkken Tenders S495 Popcorn Shrimp S495 Grilled Hot Dog(beef) SJ95 Wings(8) Crawfish $495
KIDS MENU For kids to and under Served with chips Kids Eat Free Monday-Wednesday 4pm-8pm
Peanut Butteramp Jelly Sandwich St95 Fried Popcorn Shrimp St95 Hamburger SI95 Chicken Tenders St95 Grilled Cheese Sandwich SI95
Limit 2 kids plates with an adult order
SOUPS AND SALAD Cup SI95 Bowl S295 French Onion Potato Clam Chowder Bowl of Soup with Garden Salad $495
SANDWICHES Served with lettuce tomato onions on a Hoagie Roll with side order of fries
Basic Burger $495 Cajun Burger S495 Hickory Burger $495 Turkey Burger $455 Ham amp Cheese SJ95 Fish Sandwich $495 Grilled Chicken Breast $495 Pro Club Sandwich (ham turkey amp bacon) $495
PROS STARTING LINE UP
Potato Skins $495 Chicken Tenders $495 Cajun Shrimp S495 Burrato Shrimp $495 Snow Crab legs S595 Crawfish $495 Wings(12) $495 Nachos amp Dip SJ95 Cheese Sticks SJ95 French Fries S195
ENTREES Available after 500pm Each entree comes with a choice of Baked Potato French Fries or Rice served with a Garden Salad
Sturred Flounder $895 Fried Flounder $895 Trout Almondene $895 Fried Trout S895 Fried Catfish $895 Snow Crab Legs St 195 Grilled Chicken Teriyaki S795 Chicken Cordon Bleu $795 Fried or Boiled Shrimp $895 Hall of Fame Sampler Platter S1495 (Fish Shrimp and Crab legs)
BENCH WARMERS (side items) Corn on the Cob $99 Medley of Veales S99 Cole Slaw $99 Baked Potato S99 Steamed Rice S99 Garlic Biscuits S99 French Fries $99
I I
__________________-J--__________________ ~~______
AVERAGE CHECK WITH ESTIMATED SALES
Low Estimated Medium Estimated High Estimated Sales Sales Sales Based Oil 200 people Based Oil 200 people Based on 200 people served per day served per day served per day
bull Weekday Moo-Fri 160000 $210000 280000 X22DAYS= Sl520000 $4620000 $6160000
Weekday Sat amp Sun $275000 SlJ5000 SJ80000 X 8 days = 2200000 S2680000 53040000
Month End S5720000 7300000 9200000 ~
~ V I Year End f $68640000 ) $87600000 110400000 1
( Ji-
-
L Average Check ( $800 ) SIO50 I SI400
~ L
12
i
PROJECTED ESTIMATED SALES
1ST year $57800000 sales volume
2nd year $95000000 sales volume
3rd year $1600 00000 sales volume
4th year $180000000 sales volume
14
MrJ ~5+-IrLfMfDI fCf tJtfl4Wl -+- ltrrfPKFsI 5()NceA~ M (JiM-MMFJ1
M R MIDfL- lilT Yf( Wlaquo ( I ~TR(Jf2 4~j bull GJ)M -a3) 97 xa~ O~11 31pound($ rm 11Wro
cit ~TRUf MFG) (j)M -t5] 51 X~rh) ~jI ~~~ ~ I~OO
3( SoP~tPfI ~Jawflttr14o ltAAoI) Cff-757IJM~lt[tJlgt ~~~ _I C-S33 r~ f~ CeCLIJJMe ~gt FRyER) r5-rji fA III 1poundtb~ dp~I~ItlAa
rll 5~i(Nf vreX fllJltmy u-afampa~-ftwX~1)DXS~) 33poundIBgtJ1JQJf1~
[ ) FCM~SRM(JJIJJ AD Ifamplftf I DeeP ~ d~ f lWt~erlj ~ 7~Fr F~~~2-poundRSJ J4D 1--75 J) D-eep FftlaquozftJIXJB5 ~f7~41J
( ~ 5--~O ~flJJ ~J--$~~ 7 ~ MlteIi1~IAt((1eli 5LClte~ 5a-~ltt3-777 7 rLbs ~L ~ 7~-ltcc
V-fl ~1fIN) RJif IO(AJIIIQ ~ ~ ltf7~ ltlr IVqLCltN ~r~ k~~ V-7~ fcPdA~ P-Y ~xlr-J6f) (QSJ1 ~
4 ~ TlIIP y1 Jf y 7-Gr -(1amp GL~ UOiflRk7ABjA7 5iNJJ~9 (7 tJyElrac1fJ~ qaJay
Iamp ) fP~ PIZZA- rR~ m8k) TPP~7 ~7)~Jl-XlI~ SGths ~~ 2r7Sdc
------ --- ----___- ---shy
_La~ bull UPJ 1$1 -shy
----shy~--~-
Southern Insurance Underwriters From the desk of PATRICIA BROWNE PBROWNESIUINSCOM 678-498-4581
Agency 023039 ACCOUNT CURRENT
AgencyPEACHSTATE INSURANCE AGENCY (TUCKER) Phone (770) 938-4311
ContactBOB FLOR Fax (770) 938-9318
Named InsuredCOLUMBUS WILLIAMS Zip Code 30084
DBA TIMEOUT GRILL
Address 4349 LAWRENCEVILLE HWY CityrUCKER State GA
Operations BARRESTAURANT (16930) 875000 X 707 =6186 LIQUOR LlABLITY (58161) 570000 X 903 = 5147 TOTAL $11333
Prior Carrier NEW Losses NONE
Commercial QUOTE __-gt----4 Thank you for the opportunity on the above riskl Please review all coverage listed It may differ from that requested
D Commercial Property Properly Underwriting Information
Construction of Protection Age of Sprinklered Central Station of Smoke Building Class Building (YIN) Area Alarm Stories Detectors
Coverage Value Cause of Loss Valuation Comiddotlns Comments
Deductibles
Property Flat Premium Premium
Rate 1100
Exclusions and Endorsements
COLUMBUS WILLIAMS 023039
00 Commercial Liability Payroll Receipts Liquor Receipts Cost of Subs Area Units Other
875000 570000
Form of Coverage ISO OCCURRENCE FORM Occurrence Limit $500000 LIQUOR LIABILITY
General Aggregate $500000 ASSAULT AND BATTERY ProdSCompo Ops Agg $500000 PersonallAdv Inj Limit $500000
DamagePremises Rented $50000 Medical Payments Cvg $5000
$500000 $25000 I $50000
Liability Deductible 500 PER CLAIMANT
Liability Exclusions and Endorsements
ALL POLICIES ARE SUBJECT TO AUDIT Liability Premium $11333 Premium is MINIMUM amp DEPOSIT upon inception
All quotes are subject to a favorable inspection and any subsequent recommendations
Minimum Earned Premium 25 Carrier SCOTTSDALE INSURANCE CO (A+XV) Commission 10 WE MUST HAVE A SIGNED APPLICATION
Pure Premium $1133300 Terrorism Premium $113300 + Tax $4532 Policy Fee (100 Earned) $25000 cent (Premium above Is in addition to that shown at left)
Surplus Lines Tax 004 $46332 (Terrorism Premium is not included in Premium Financing)
Total Premium Due $1204632 Please note that we must have a signed Terrorism Option form when binding
Above is valid for 30 days Please call or advise in writing prior to effective date if coverage is to be considered bound If coverage is bound per your request a charge of 10 of the annual premium may be made if the policy is not issued Thanks for thinking of SIU
Sincerely PATRICIA BROWNE Our Fax 678-498-4604
e cial Property amp Casualty
DESIGNATED PREMISES L1MrrATION (CG2144) GL CVG FORM (CGOOO1)
RECORDINGDISTRIBUTION OF MATERIAUINFO (CGOO68)
TOTAL POLLUTION EXCL (CG2149) WAR OR TERRORISM EXCL(REJECTlNG) (CG2173)
AMEND OF INSD CONTRACT(NlA CG2139 ATtACH) (CG2426)
GL COVERAGE DEC (CLS-8D-1L) GL SCHEDULE OF CLASSES (CLS-SP-1L) KNOWN INJURYDAMG EXCL PERS ADV (GLS-289S) GA CANCELLATION CHANGES (IL0262) COMMON CONDrrlONS(ILOO17) (INCL-UTS182S1246S-1)
FUNGUBACTERIA EXCL(CG2167) (INCL-UTS182S246S-10)
AMENDMENT TO OTHER INS CONDS (GLS152S) (INCL-UTS182S1246S-11 )
LEAD CONTAM EXCL(GLS58S) (INCL-UTS182St246S-2) CONDITJONS(GLS74S) (INCL-UTS182St246S-3) ASBESTOS EXCL(UTS266G) (INCL-UTS182St246S-4) SUB WARRANTY(GLS30S) (lNCLmiddotUTS182S1246Smiddot5) EPLI EXCL(CG2147) (INCL-UTS182S1246S-6) NUCLEAR EXCL(ILOO21) (INCLmiddotUTS182St246S-7) PUNrrlVE EXC(UTS74G) (INCL-UTS182S1246S-8) WAR EXCL (CG0062) (INCL-UTS182St246S-9) - Continued on next page shy
Please include all pages of this form if requesting to bind We must have a completed application to consider binding coverage
DRiVERS UCENSE E)(PtlpoundS 06-01-2014
WILUAMS COLUMBUS JR 186 FlOIlA AVE NE ATLANTA GA 30307middot2714 SEX 1III111Ofl ~DAII COUNTY M ()601-1959 01-09-2OOIP 04A
HEIGHT WEIGHT esc m lUllCnONS 6middot02 200 9 50 00500
CLASS ENDOlISIMlN TY C OUfgt
~f+
bull ~~------------------------------------------------------------------------------------~----------------
TIME OUT SPORTS CAFE RESTURANT amp DINER
A PROPRIETORSHIP
Business Plan
Nature ofBusiness
Time Out Sports Cafe 1 has been in the planning stage for the past 8 years Time Outs primary focus is to provide families with kids a four star restaurant in the Clarkston Stone Mountain area Time Out Sports Cafe is not just another restaurant It will have TVs and smooth jazz music free meal programs for kids all u can eat seafood on select days and a Sunday Breakfast Brunch Time Out Sports Cafe 1 is currently looking for space or land As soon as a location is determined it will be under immediate development Time Out Sports Cafe is the first of 4 restaurants and a motel planned Listed below are businesses planned for the near future
Location 1 Time Out Sports Cafe 1 Lawrenceville Hwy 2 Freedom Inn Motel (no pool) Greenbriar-Cascade 3 Eggs International (24 hours) Greenbriar- Cascade 4 Time Out Sports Cafe 2 To be determined 5 Eggs International (24 hours)To be determined
Time Out Sports Cafe 1 plans to open for business on Oct 1 2011
Management Team
OwnerOperator ofTime Out Sports Cafe will be Columbus Williams Jr Columbus has over 18 years of management experience He is certified in running a profitable small business
Vice President of Operation will be Antonio Wilkerson He has been a Master Chef in the Atlanta area for over 16 years Some of his experiences include The Mansion The Abby and Beasleys of Buckhead
4
MENU
LUNCH BASKETS
Monday thru Saturday from Ilam to 3pm Served with Fries and Coleslaw
Fish Nuggets $495 Chkken Tenders S495 Popcorn Shrimp S495 Grilled Hot Dog(beef) SJ95 Wings(8) Crawfish $495
KIDS MENU For kids to and under Served with chips Kids Eat Free Monday-Wednesday 4pm-8pm
Peanut Butteramp Jelly Sandwich St95 Fried Popcorn Shrimp St95 Hamburger SI95 Chicken Tenders St95 Grilled Cheese Sandwich SI95
Limit 2 kids plates with an adult order
SOUPS AND SALAD Cup SI95 Bowl S295 French Onion Potato Clam Chowder Bowl of Soup with Garden Salad $495
SANDWICHES Served with lettuce tomato onions on a Hoagie Roll with side order of fries
Basic Burger $495 Cajun Burger S495 Hickory Burger $495 Turkey Burger $455 Ham amp Cheese SJ95 Fish Sandwich $495 Grilled Chicken Breast $495 Pro Club Sandwich (ham turkey amp bacon) $495
PROS STARTING LINE UP
Potato Skins $495 Chicken Tenders $495 Cajun Shrimp S495 Burrato Shrimp $495 Snow Crab legs S595 Crawfish $495 Wings(12) $495 Nachos amp Dip SJ95 Cheese Sticks SJ95 French Fries S195
ENTREES Available after 500pm Each entree comes with a choice of Baked Potato French Fries or Rice served with a Garden Salad
Sturred Flounder $895 Fried Flounder $895 Trout Almondene $895 Fried Trout S895 Fried Catfish $895 Snow Crab Legs St 195 Grilled Chicken Teriyaki S795 Chicken Cordon Bleu $795 Fried or Boiled Shrimp $895 Hall of Fame Sampler Platter S1495 (Fish Shrimp and Crab legs)
BENCH WARMERS (side items) Corn on the Cob $99 Medley of Veales S99 Cole Slaw $99 Baked Potato S99 Steamed Rice S99 Garlic Biscuits S99 French Fries $99
I I
__________________-J--__________________ ~~______
AVERAGE CHECK WITH ESTIMATED SALES
Low Estimated Medium Estimated High Estimated Sales Sales Sales Based Oil 200 people Based Oil 200 people Based on 200 people served per day served per day served per day
bull Weekday Moo-Fri 160000 $210000 280000 X22DAYS= Sl520000 $4620000 $6160000
Weekday Sat amp Sun $275000 SlJ5000 SJ80000 X 8 days = 2200000 S2680000 53040000
Month End S5720000 7300000 9200000 ~
~ V I Year End f $68640000 ) $87600000 110400000 1
( Ji-
-
L Average Check ( $800 ) SIO50 I SI400
~ L
12
i
PROJECTED ESTIMATED SALES
1ST year $57800000 sales volume
2nd year $95000000 sales volume
3rd year $1600 00000 sales volume
4th year $180000000 sales volume
14
MrJ ~5+-IrLfMfDI fCf tJtfl4Wl -+- ltrrfPKFsI 5()NceA~ M (JiM-MMFJ1
M R MIDfL- lilT Yf( Wlaquo ( I ~TR(Jf2 4~j bull GJ)M -a3) 97 xa~ O~11 31pound($ rm 11Wro
cit ~TRUf MFG) (j)M -t5] 51 X~rh) ~jI ~~~ ~ I~OO
3( SoP~tPfI ~Jawflttr14o ltAAoI) Cff-757IJM~lt[tJlgt ~~~ _I C-S33 r~ f~ CeCLIJJMe ~gt FRyER) r5-rji fA III 1poundtb~ dp~I~ItlAa
rll 5~i(Nf vreX fllJltmy u-afampa~-ftwX~1)DXS~) 33poundIBgtJ1JQJf1~
[ ) FCM~SRM(JJIJJ AD Ifamplftf I DeeP ~ d~ f lWt~erlj ~ 7~Fr F~~~2-poundRSJ J4D 1--75 J) D-eep FftlaquozftJIXJB5 ~f7~41J
( ~ 5--~O ~flJJ ~J--$~~ 7 ~ MlteIi1~IAt((1eli 5LClte~ 5a-~ltt3-777 7 rLbs ~L ~ 7~-ltcc
V-fl ~1fIN) RJif IO(AJIIIQ ~ ~ ltf7~ ltlr IVqLCltN ~r~ k~~ V-7~ fcPdA~ P-Y ~xlr-J6f) (QSJ1 ~
4 ~ TlIIP y1 Jf y 7-Gr -(1amp GL~ UOiflRk7ABjA7 5iNJJ~9 (7 tJyElrac1fJ~ qaJay
Iamp ) fP~ PIZZA- rR~ m8k) TPP~7 ~7)~Jl-XlI~ SGths ~~ 2r7Sdc
------ --- ----___- ---shy
_La~ bull UPJ 1$1 -shy
----shy~--~-
Southern Insurance Underwriters From the desk of PATRICIA BROWNE PBROWNESIUINSCOM 678-498-4581
Agency 023039 ACCOUNT CURRENT
AgencyPEACHSTATE INSURANCE AGENCY (TUCKER) Phone (770) 938-4311
ContactBOB FLOR Fax (770) 938-9318
Named InsuredCOLUMBUS WILLIAMS Zip Code 30084
DBA TIMEOUT GRILL
Address 4349 LAWRENCEVILLE HWY CityrUCKER State GA
Operations BARRESTAURANT (16930) 875000 X 707 =6186 LIQUOR LlABLITY (58161) 570000 X 903 = 5147 TOTAL $11333
Prior Carrier NEW Losses NONE
Commercial QUOTE __-gt----4 Thank you for the opportunity on the above riskl Please review all coverage listed It may differ from that requested
D Commercial Property Properly Underwriting Information
Construction of Protection Age of Sprinklered Central Station of Smoke Building Class Building (YIN) Area Alarm Stories Detectors
Coverage Value Cause of Loss Valuation Comiddotlns Comments
Deductibles
Property Flat Premium Premium
Rate 1100
Exclusions and Endorsements
COLUMBUS WILLIAMS 023039
00 Commercial Liability Payroll Receipts Liquor Receipts Cost of Subs Area Units Other
875000 570000
Form of Coverage ISO OCCURRENCE FORM Occurrence Limit $500000 LIQUOR LIABILITY
General Aggregate $500000 ASSAULT AND BATTERY ProdSCompo Ops Agg $500000 PersonallAdv Inj Limit $500000
DamagePremises Rented $50000 Medical Payments Cvg $5000
$500000 $25000 I $50000
Liability Deductible 500 PER CLAIMANT
Liability Exclusions and Endorsements
ALL POLICIES ARE SUBJECT TO AUDIT Liability Premium $11333 Premium is MINIMUM amp DEPOSIT upon inception
All quotes are subject to a favorable inspection and any subsequent recommendations
Minimum Earned Premium 25 Carrier SCOTTSDALE INSURANCE CO (A+XV) Commission 10 WE MUST HAVE A SIGNED APPLICATION
Pure Premium $1133300 Terrorism Premium $113300 + Tax $4532 Policy Fee (100 Earned) $25000 cent (Premium above Is in addition to that shown at left)
Surplus Lines Tax 004 $46332 (Terrorism Premium is not included in Premium Financing)
Total Premium Due $1204632 Please note that we must have a signed Terrorism Option form when binding
Above is valid for 30 days Please call or advise in writing prior to effective date if coverage is to be considered bound If coverage is bound per your request a charge of 10 of the annual premium may be made if the policy is not issued Thanks for thinking of SIU
Sincerely PATRICIA BROWNE Our Fax 678-498-4604
e cial Property amp Casualty
DESIGNATED PREMISES L1MrrATION (CG2144) GL CVG FORM (CGOOO1)
RECORDINGDISTRIBUTION OF MATERIAUINFO (CGOO68)
TOTAL POLLUTION EXCL (CG2149) WAR OR TERRORISM EXCL(REJECTlNG) (CG2173)
AMEND OF INSD CONTRACT(NlA CG2139 ATtACH) (CG2426)
GL COVERAGE DEC (CLS-8D-1L) GL SCHEDULE OF CLASSES (CLS-SP-1L) KNOWN INJURYDAMG EXCL PERS ADV (GLS-289S) GA CANCELLATION CHANGES (IL0262) COMMON CONDrrlONS(ILOO17) (INCL-UTS182S1246S-1)
FUNGUBACTERIA EXCL(CG2167) (INCL-UTS182S246S-10)
AMENDMENT TO OTHER INS CONDS (GLS152S) (INCL-UTS182S1246S-11 )
LEAD CONTAM EXCL(GLS58S) (INCL-UTS182St246S-2) CONDITJONS(GLS74S) (INCL-UTS182St246S-3) ASBESTOS EXCL(UTS266G) (INCL-UTS182St246S-4) SUB WARRANTY(GLS30S) (lNCLmiddotUTS182S1246Smiddot5) EPLI EXCL(CG2147) (INCL-UTS182S1246S-6) NUCLEAR EXCL(ILOO21) (INCLmiddotUTS182St246S-7) PUNrrlVE EXC(UTS74G) (INCL-UTS182S1246S-8) WAR EXCL (CG0062) (INCL-UTS182St246S-9) - Continued on next page shy
Please include all pages of this form if requesting to bind We must have a completed application to consider binding coverage
DRiVERS UCENSE E)(PtlpoundS 06-01-2014
WILUAMS COLUMBUS JR 186 FlOIlA AVE NE ATLANTA GA 30307middot2714 SEX 1III111Ofl ~DAII COUNTY M ()601-1959 01-09-2OOIP 04A
HEIGHT WEIGHT esc m lUllCnONS 6middot02 200 9 50 00500
CLASS ENDOlISIMlN TY C OUfgt
~f+
bull ~~------------------------------------------------------------------------------------~----------------
MENU
LUNCH BASKETS
Monday thru Saturday from Ilam to 3pm Served with Fries and Coleslaw
Fish Nuggets $495 Chkken Tenders S495 Popcorn Shrimp S495 Grilled Hot Dog(beef) SJ95 Wings(8) Crawfish $495
KIDS MENU For kids to and under Served with chips Kids Eat Free Monday-Wednesday 4pm-8pm
Peanut Butteramp Jelly Sandwich St95 Fried Popcorn Shrimp St95 Hamburger SI95 Chicken Tenders St95 Grilled Cheese Sandwich SI95
Limit 2 kids plates with an adult order
SOUPS AND SALAD Cup SI95 Bowl S295 French Onion Potato Clam Chowder Bowl of Soup with Garden Salad $495
SANDWICHES Served with lettuce tomato onions on a Hoagie Roll with side order of fries
Basic Burger $495 Cajun Burger S495 Hickory Burger $495 Turkey Burger $455 Ham amp Cheese SJ95 Fish Sandwich $495 Grilled Chicken Breast $495 Pro Club Sandwich (ham turkey amp bacon) $495
PROS STARTING LINE UP
Potato Skins $495 Chicken Tenders $495 Cajun Shrimp S495 Burrato Shrimp $495 Snow Crab legs S595 Crawfish $495 Wings(12) $495 Nachos amp Dip SJ95 Cheese Sticks SJ95 French Fries S195
ENTREES Available after 500pm Each entree comes with a choice of Baked Potato French Fries or Rice served with a Garden Salad
Sturred Flounder $895 Fried Flounder $895 Trout Almondene $895 Fried Trout S895 Fried Catfish $895 Snow Crab Legs St 195 Grilled Chicken Teriyaki S795 Chicken Cordon Bleu $795 Fried or Boiled Shrimp $895 Hall of Fame Sampler Platter S1495 (Fish Shrimp and Crab legs)
BENCH WARMERS (side items) Corn on the Cob $99 Medley of Veales S99 Cole Slaw $99 Baked Potato S99 Steamed Rice S99 Garlic Biscuits S99 French Fries $99
I I
__________________-J--__________________ ~~______
AVERAGE CHECK WITH ESTIMATED SALES
Low Estimated Medium Estimated High Estimated Sales Sales Sales Based Oil 200 people Based Oil 200 people Based on 200 people served per day served per day served per day
bull Weekday Moo-Fri 160000 $210000 280000 X22DAYS= Sl520000 $4620000 $6160000
Weekday Sat amp Sun $275000 SlJ5000 SJ80000 X 8 days = 2200000 S2680000 53040000
Month End S5720000 7300000 9200000 ~
~ V I Year End f $68640000 ) $87600000 110400000 1
( Ji-
-
L Average Check ( $800 ) SIO50 I SI400
~ L
12
i
PROJECTED ESTIMATED SALES
1ST year $57800000 sales volume
2nd year $95000000 sales volume
3rd year $1600 00000 sales volume
4th year $180000000 sales volume
14
MrJ ~5+-IrLfMfDI fCf tJtfl4Wl -+- ltrrfPKFsI 5()NceA~ M (JiM-MMFJ1
M R MIDfL- lilT Yf( Wlaquo ( I ~TR(Jf2 4~j bull GJ)M -a3) 97 xa~ O~11 31pound($ rm 11Wro
cit ~TRUf MFG) (j)M -t5] 51 X~rh) ~jI ~~~ ~ I~OO
3( SoP~tPfI ~Jawflttr14o ltAAoI) Cff-757IJM~lt[tJlgt ~~~ _I C-S33 r~ f~ CeCLIJJMe ~gt FRyER) r5-rji fA III 1poundtb~ dp~I~ItlAa
rll 5~i(Nf vreX fllJltmy u-afampa~-ftwX~1)DXS~) 33poundIBgtJ1JQJf1~
[ ) FCM~SRM(JJIJJ AD Ifamplftf I DeeP ~ d~ f lWt~erlj ~ 7~Fr F~~~2-poundRSJ J4D 1--75 J) D-eep FftlaquozftJIXJB5 ~f7~41J
( ~ 5--~O ~flJJ ~J--$~~ 7 ~ MlteIi1~IAt((1eli 5LClte~ 5a-~ltt3-777 7 rLbs ~L ~ 7~-ltcc
V-fl ~1fIN) RJif IO(AJIIIQ ~ ~ ltf7~ ltlr IVqLCltN ~r~ k~~ V-7~ fcPdA~ P-Y ~xlr-J6f) (QSJ1 ~
4 ~ TlIIP y1 Jf y 7-Gr -(1amp GL~ UOiflRk7ABjA7 5iNJJ~9 (7 tJyElrac1fJ~ qaJay
Iamp ) fP~ PIZZA- rR~ m8k) TPP~7 ~7)~Jl-XlI~ SGths ~~ 2r7Sdc
------ --- ----___- ---shy
_La~ bull UPJ 1$1 -shy
----shy~--~-
Southern Insurance Underwriters From the desk of PATRICIA BROWNE PBROWNESIUINSCOM 678-498-4581
Agency 023039 ACCOUNT CURRENT
AgencyPEACHSTATE INSURANCE AGENCY (TUCKER) Phone (770) 938-4311
ContactBOB FLOR Fax (770) 938-9318
Named InsuredCOLUMBUS WILLIAMS Zip Code 30084
DBA TIMEOUT GRILL
Address 4349 LAWRENCEVILLE HWY CityrUCKER State GA
Operations BARRESTAURANT (16930) 875000 X 707 =6186 LIQUOR LlABLITY (58161) 570000 X 903 = 5147 TOTAL $11333
Prior Carrier NEW Losses NONE
Commercial QUOTE __-gt----4 Thank you for the opportunity on the above riskl Please review all coverage listed It may differ from that requested
D Commercial Property Properly Underwriting Information
Construction of Protection Age of Sprinklered Central Station of Smoke Building Class Building (YIN) Area Alarm Stories Detectors
Coverage Value Cause of Loss Valuation Comiddotlns Comments
Deductibles
Property Flat Premium Premium
Rate 1100
Exclusions and Endorsements
COLUMBUS WILLIAMS 023039
00 Commercial Liability Payroll Receipts Liquor Receipts Cost of Subs Area Units Other
875000 570000
Form of Coverage ISO OCCURRENCE FORM Occurrence Limit $500000 LIQUOR LIABILITY
General Aggregate $500000 ASSAULT AND BATTERY ProdSCompo Ops Agg $500000 PersonallAdv Inj Limit $500000
DamagePremises Rented $50000 Medical Payments Cvg $5000
$500000 $25000 I $50000
Liability Deductible 500 PER CLAIMANT
Liability Exclusions and Endorsements
ALL POLICIES ARE SUBJECT TO AUDIT Liability Premium $11333 Premium is MINIMUM amp DEPOSIT upon inception
All quotes are subject to a favorable inspection and any subsequent recommendations
Minimum Earned Premium 25 Carrier SCOTTSDALE INSURANCE CO (A+XV) Commission 10 WE MUST HAVE A SIGNED APPLICATION
Pure Premium $1133300 Terrorism Premium $113300 + Tax $4532 Policy Fee (100 Earned) $25000 cent (Premium above Is in addition to that shown at left)
Surplus Lines Tax 004 $46332 (Terrorism Premium is not included in Premium Financing)
Total Premium Due $1204632 Please note that we must have a signed Terrorism Option form when binding
Above is valid for 30 days Please call or advise in writing prior to effective date if coverage is to be considered bound If coverage is bound per your request a charge of 10 of the annual premium may be made if the policy is not issued Thanks for thinking of SIU
Sincerely PATRICIA BROWNE Our Fax 678-498-4604
e cial Property amp Casualty
DESIGNATED PREMISES L1MrrATION (CG2144) GL CVG FORM (CGOOO1)
RECORDINGDISTRIBUTION OF MATERIAUINFO (CGOO68)
TOTAL POLLUTION EXCL (CG2149) WAR OR TERRORISM EXCL(REJECTlNG) (CG2173)
AMEND OF INSD CONTRACT(NlA CG2139 ATtACH) (CG2426)
GL COVERAGE DEC (CLS-8D-1L) GL SCHEDULE OF CLASSES (CLS-SP-1L) KNOWN INJURYDAMG EXCL PERS ADV (GLS-289S) GA CANCELLATION CHANGES (IL0262) COMMON CONDrrlONS(ILOO17) (INCL-UTS182S1246S-1)
FUNGUBACTERIA EXCL(CG2167) (INCL-UTS182S246S-10)
AMENDMENT TO OTHER INS CONDS (GLS152S) (INCL-UTS182S1246S-11 )
LEAD CONTAM EXCL(GLS58S) (INCL-UTS182St246S-2) CONDITJONS(GLS74S) (INCL-UTS182St246S-3) ASBESTOS EXCL(UTS266G) (INCL-UTS182St246S-4) SUB WARRANTY(GLS30S) (lNCLmiddotUTS182S1246Smiddot5) EPLI EXCL(CG2147) (INCL-UTS182S1246S-6) NUCLEAR EXCL(ILOO21) (INCLmiddotUTS182St246S-7) PUNrrlVE EXC(UTS74G) (INCL-UTS182S1246S-8) WAR EXCL (CG0062) (INCL-UTS182St246S-9) - Continued on next page shy
Please include all pages of this form if requesting to bind We must have a completed application to consider binding coverage
DRiVERS UCENSE E)(PtlpoundS 06-01-2014
WILUAMS COLUMBUS JR 186 FlOIlA AVE NE ATLANTA GA 30307middot2714 SEX 1III111Ofl ~DAII COUNTY M ()601-1959 01-09-2OOIP 04A
HEIGHT WEIGHT esc m lUllCnONS 6middot02 200 9 50 00500
CLASS ENDOlISIMlN TY C OUfgt
~f+
bull ~~------------------------------------------------------------------------------------~----------------
AVERAGE CHECK WITH ESTIMATED SALES
Low Estimated Medium Estimated High Estimated Sales Sales Sales Based Oil 200 people Based Oil 200 people Based on 200 people served per day served per day served per day
bull Weekday Moo-Fri 160000 $210000 280000 X22DAYS= Sl520000 $4620000 $6160000
Weekday Sat amp Sun $275000 SlJ5000 SJ80000 X 8 days = 2200000 S2680000 53040000
Month End S5720000 7300000 9200000 ~
~ V I Year End f $68640000 ) $87600000 110400000 1
( Ji-
-
L Average Check ( $800 ) SIO50 I SI400
~ L
12
i
PROJECTED ESTIMATED SALES
1ST year $57800000 sales volume
2nd year $95000000 sales volume
3rd year $1600 00000 sales volume
4th year $180000000 sales volume
14
MrJ ~5+-IrLfMfDI fCf tJtfl4Wl -+- ltrrfPKFsI 5()NceA~ M (JiM-MMFJ1
M R MIDfL- lilT Yf( Wlaquo ( I ~TR(Jf2 4~j bull GJ)M -a3) 97 xa~ O~11 31pound($ rm 11Wro
cit ~TRUf MFG) (j)M -t5] 51 X~rh) ~jI ~~~ ~ I~OO
3( SoP~tPfI ~Jawflttr14o ltAAoI) Cff-757IJM~lt[tJlgt ~~~ _I C-S33 r~ f~ CeCLIJJMe ~gt FRyER) r5-rji fA III 1poundtb~ dp~I~ItlAa
rll 5~i(Nf vreX fllJltmy u-afampa~-ftwX~1)DXS~) 33poundIBgtJ1JQJf1~
[ ) FCM~SRM(JJIJJ AD Ifamplftf I DeeP ~ d~ f lWt~erlj ~ 7~Fr F~~~2-poundRSJ J4D 1--75 J) D-eep FftlaquozftJIXJB5 ~f7~41J
( ~ 5--~O ~flJJ ~J--$~~ 7 ~ MlteIi1~IAt((1eli 5LClte~ 5a-~ltt3-777 7 rLbs ~L ~ 7~-ltcc
V-fl ~1fIN) RJif IO(AJIIIQ ~ ~ ltf7~ ltlr IVqLCltN ~r~ k~~ V-7~ fcPdA~ P-Y ~xlr-J6f) (QSJ1 ~
4 ~ TlIIP y1 Jf y 7-Gr -(1amp GL~ UOiflRk7ABjA7 5iNJJ~9 (7 tJyElrac1fJ~ qaJay
Iamp ) fP~ PIZZA- rR~ m8k) TPP~7 ~7)~Jl-XlI~ SGths ~~ 2r7Sdc
------ --- ----___- ---shy
_La~ bull UPJ 1$1 -shy
----shy~--~-
Southern Insurance Underwriters From the desk of PATRICIA BROWNE PBROWNESIUINSCOM 678-498-4581
Agency 023039 ACCOUNT CURRENT
AgencyPEACHSTATE INSURANCE AGENCY (TUCKER) Phone (770) 938-4311
ContactBOB FLOR Fax (770) 938-9318
Named InsuredCOLUMBUS WILLIAMS Zip Code 30084
DBA TIMEOUT GRILL
Address 4349 LAWRENCEVILLE HWY CityrUCKER State GA
Operations BARRESTAURANT (16930) 875000 X 707 =6186 LIQUOR LlABLITY (58161) 570000 X 903 = 5147 TOTAL $11333
Prior Carrier NEW Losses NONE
Commercial QUOTE __-gt----4 Thank you for the opportunity on the above riskl Please review all coverage listed It may differ from that requested
D Commercial Property Properly Underwriting Information
Construction of Protection Age of Sprinklered Central Station of Smoke Building Class Building (YIN) Area Alarm Stories Detectors
Coverage Value Cause of Loss Valuation Comiddotlns Comments
Deductibles
Property Flat Premium Premium
Rate 1100
Exclusions and Endorsements
COLUMBUS WILLIAMS 023039
00 Commercial Liability Payroll Receipts Liquor Receipts Cost of Subs Area Units Other
875000 570000
Form of Coverage ISO OCCURRENCE FORM Occurrence Limit $500000 LIQUOR LIABILITY
General Aggregate $500000 ASSAULT AND BATTERY ProdSCompo Ops Agg $500000 PersonallAdv Inj Limit $500000
DamagePremises Rented $50000 Medical Payments Cvg $5000
$500000 $25000 I $50000
Liability Deductible 500 PER CLAIMANT
Liability Exclusions and Endorsements
ALL POLICIES ARE SUBJECT TO AUDIT Liability Premium $11333 Premium is MINIMUM amp DEPOSIT upon inception
All quotes are subject to a favorable inspection and any subsequent recommendations
Minimum Earned Premium 25 Carrier SCOTTSDALE INSURANCE CO (A+XV) Commission 10 WE MUST HAVE A SIGNED APPLICATION
Pure Premium $1133300 Terrorism Premium $113300 + Tax $4532 Policy Fee (100 Earned) $25000 cent (Premium above Is in addition to that shown at left)
Surplus Lines Tax 004 $46332 (Terrorism Premium is not included in Premium Financing)
Total Premium Due $1204632 Please note that we must have a signed Terrorism Option form when binding
Above is valid for 30 days Please call or advise in writing prior to effective date if coverage is to be considered bound If coverage is bound per your request a charge of 10 of the annual premium may be made if the policy is not issued Thanks for thinking of SIU
Sincerely PATRICIA BROWNE Our Fax 678-498-4604
e cial Property amp Casualty
DESIGNATED PREMISES L1MrrATION (CG2144) GL CVG FORM (CGOOO1)
RECORDINGDISTRIBUTION OF MATERIAUINFO (CGOO68)
TOTAL POLLUTION EXCL (CG2149) WAR OR TERRORISM EXCL(REJECTlNG) (CG2173)
AMEND OF INSD CONTRACT(NlA CG2139 ATtACH) (CG2426)
GL COVERAGE DEC (CLS-8D-1L) GL SCHEDULE OF CLASSES (CLS-SP-1L) KNOWN INJURYDAMG EXCL PERS ADV (GLS-289S) GA CANCELLATION CHANGES (IL0262) COMMON CONDrrlONS(ILOO17) (INCL-UTS182S1246S-1)
FUNGUBACTERIA EXCL(CG2167) (INCL-UTS182S246S-10)
AMENDMENT TO OTHER INS CONDS (GLS152S) (INCL-UTS182S1246S-11 )
LEAD CONTAM EXCL(GLS58S) (INCL-UTS182St246S-2) CONDITJONS(GLS74S) (INCL-UTS182St246S-3) ASBESTOS EXCL(UTS266G) (INCL-UTS182St246S-4) SUB WARRANTY(GLS30S) (lNCLmiddotUTS182S1246Smiddot5) EPLI EXCL(CG2147) (INCL-UTS182S1246S-6) NUCLEAR EXCL(ILOO21) (INCLmiddotUTS182St246S-7) PUNrrlVE EXC(UTS74G) (INCL-UTS182S1246S-8) WAR EXCL (CG0062) (INCL-UTS182St246S-9) - Continued on next page shy
Please include all pages of this form if requesting to bind We must have a completed application to consider binding coverage
DRiVERS UCENSE E)(PtlpoundS 06-01-2014
WILUAMS COLUMBUS JR 186 FlOIlA AVE NE ATLANTA GA 30307middot2714 SEX 1III111Ofl ~DAII COUNTY M ()601-1959 01-09-2OOIP 04A
HEIGHT WEIGHT esc m lUllCnONS 6middot02 200 9 50 00500
CLASS ENDOlISIMlN TY C OUfgt
~f+
bull ~~------------------------------------------------------------------------------------~----------------
i
PROJECTED ESTIMATED SALES
1ST year $57800000 sales volume
2nd year $95000000 sales volume
3rd year $1600 00000 sales volume
4th year $180000000 sales volume
14
MrJ ~5+-IrLfMfDI fCf tJtfl4Wl -+- ltrrfPKFsI 5()NceA~ M (JiM-MMFJ1
M R MIDfL- lilT Yf( Wlaquo ( I ~TR(Jf2 4~j bull GJ)M -a3) 97 xa~ O~11 31pound($ rm 11Wro
cit ~TRUf MFG) (j)M -t5] 51 X~rh) ~jI ~~~ ~ I~OO
3( SoP~tPfI ~Jawflttr14o ltAAoI) Cff-757IJM~lt[tJlgt ~~~ _I C-S33 r~ f~ CeCLIJJMe ~gt FRyER) r5-rji fA III 1poundtb~ dp~I~ItlAa
rll 5~i(Nf vreX fllJltmy u-afampa~-ftwX~1)DXS~) 33poundIBgtJ1JQJf1~
[ ) FCM~SRM(JJIJJ AD Ifamplftf I DeeP ~ d~ f lWt~erlj ~ 7~Fr F~~~2-poundRSJ J4D 1--75 J) D-eep FftlaquozftJIXJB5 ~f7~41J
( ~ 5--~O ~flJJ ~J--$~~ 7 ~ MlteIi1~IAt((1eli 5LClte~ 5a-~ltt3-777 7 rLbs ~L ~ 7~-ltcc
V-fl ~1fIN) RJif IO(AJIIIQ ~ ~ ltf7~ ltlr IVqLCltN ~r~ k~~ V-7~ fcPdA~ P-Y ~xlr-J6f) (QSJ1 ~
4 ~ TlIIP y1 Jf y 7-Gr -(1amp GL~ UOiflRk7ABjA7 5iNJJ~9 (7 tJyElrac1fJ~ qaJay
Iamp ) fP~ PIZZA- rR~ m8k) TPP~7 ~7)~Jl-XlI~ SGths ~~ 2r7Sdc
------ --- ----___- ---shy
_La~ bull UPJ 1$1 -shy
----shy~--~-
Southern Insurance Underwriters From the desk of PATRICIA BROWNE PBROWNESIUINSCOM 678-498-4581
Agency 023039 ACCOUNT CURRENT
AgencyPEACHSTATE INSURANCE AGENCY (TUCKER) Phone (770) 938-4311
ContactBOB FLOR Fax (770) 938-9318
Named InsuredCOLUMBUS WILLIAMS Zip Code 30084
DBA TIMEOUT GRILL
Address 4349 LAWRENCEVILLE HWY CityrUCKER State GA
Operations BARRESTAURANT (16930) 875000 X 707 =6186 LIQUOR LlABLITY (58161) 570000 X 903 = 5147 TOTAL $11333
Prior Carrier NEW Losses NONE
Commercial QUOTE __-gt----4 Thank you for the opportunity on the above riskl Please review all coverage listed It may differ from that requested
D Commercial Property Properly Underwriting Information
Construction of Protection Age of Sprinklered Central Station of Smoke Building Class Building (YIN) Area Alarm Stories Detectors
Coverage Value Cause of Loss Valuation Comiddotlns Comments
Deductibles
Property Flat Premium Premium
Rate 1100
Exclusions and Endorsements
COLUMBUS WILLIAMS 023039
00 Commercial Liability Payroll Receipts Liquor Receipts Cost of Subs Area Units Other
875000 570000
Form of Coverage ISO OCCURRENCE FORM Occurrence Limit $500000 LIQUOR LIABILITY
General Aggregate $500000 ASSAULT AND BATTERY ProdSCompo Ops Agg $500000 PersonallAdv Inj Limit $500000
DamagePremises Rented $50000 Medical Payments Cvg $5000
$500000 $25000 I $50000
Liability Deductible 500 PER CLAIMANT
Liability Exclusions and Endorsements
ALL POLICIES ARE SUBJECT TO AUDIT Liability Premium $11333 Premium is MINIMUM amp DEPOSIT upon inception
All quotes are subject to a favorable inspection and any subsequent recommendations
Minimum Earned Premium 25 Carrier SCOTTSDALE INSURANCE CO (A+XV) Commission 10 WE MUST HAVE A SIGNED APPLICATION
Pure Premium $1133300 Terrorism Premium $113300 + Tax $4532 Policy Fee (100 Earned) $25000 cent (Premium above Is in addition to that shown at left)
Surplus Lines Tax 004 $46332 (Terrorism Premium is not included in Premium Financing)
Total Premium Due $1204632 Please note that we must have a signed Terrorism Option form when binding
Above is valid for 30 days Please call or advise in writing prior to effective date if coverage is to be considered bound If coverage is bound per your request a charge of 10 of the annual premium may be made if the policy is not issued Thanks for thinking of SIU
Sincerely PATRICIA BROWNE Our Fax 678-498-4604
e cial Property amp Casualty
DESIGNATED PREMISES L1MrrATION (CG2144) GL CVG FORM (CGOOO1)
RECORDINGDISTRIBUTION OF MATERIAUINFO (CGOO68)
TOTAL POLLUTION EXCL (CG2149) WAR OR TERRORISM EXCL(REJECTlNG) (CG2173)
AMEND OF INSD CONTRACT(NlA CG2139 ATtACH) (CG2426)
GL COVERAGE DEC (CLS-8D-1L) GL SCHEDULE OF CLASSES (CLS-SP-1L) KNOWN INJURYDAMG EXCL PERS ADV (GLS-289S) GA CANCELLATION CHANGES (IL0262) COMMON CONDrrlONS(ILOO17) (INCL-UTS182S1246S-1)
FUNGUBACTERIA EXCL(CG2167) (INCL-UTS182S246S-10)
AMENDMENT TO OTHER INS CONDS (GLS152S) (INCL-UTS182S1246S-11 )
LEAD CONTAM EXCL(GLS58S) (INCL-UTS182St246S-2) CONDITJONS(GLS74S) (INCL-UTS182St246S-3) ASBESTOS EXCL(UTS266G) (INCL-UTS182St246S-4) SUB WARRANTY(GLS30S) (lNCLmiddotUTS182S1246Smiddot5) EPLI EXCL(CG2147) (INCL-UTS182S1246S-6) NUCLEAR EXCL(ILOO21) (INCLmiddotUTS182St246S-7) PUNrrlVE EXC(UTS74G) (INCL-UTS182S1246S-8) WAR EXCL (CG0062) (INCL-UTS182St246S-9) - Continued on next page shy
Please include all pages of this form if requesting to bind We must have a completed application to consider binding coverage
DRiVERS UCENSE E)(PtlpoundS 06-01-2014
WILUAMS COLUMBUS JR 186 FlOIlA AVE NE ATLANTA GA 30307middot2714 SEX 1III111Ofl ~DAII COUNTY M ()601-1959 01-09-2OOIP 04A
HEIGHT WEIGHT esc m lUllCnONS 6middot02 200 9 50 00500
CLASS ENDOlISIMlN TY C OUfgt
~f+
bull ~~------------------------------------------------------------------------------------~----------------
MrJ ~5+-IrLfMfDI fCf tJtfl4Wl -+- ltrrfPKFsI 5()NceA~ M (JiM-MMFJ1
M R MIDfL- lilT Yf( Wlaquo ( I ~TR(Jf2 4~j bull GJ)M -a3) 97 xa~ O~11 31pound($ rm 11Wro
cit ~TRUf MFG) (j)M -t5] 51 X~rh) ~jI ~~~ ~ I~OO
3( SoP~tPfI ~Jawflttr14o ltAAoI) Cff-757IJM~lt[tJlgt ~~~ _I C-S33 r~ f~ CeCLIJJMe ~gt FRyER) r5-rji fA III 1poundtb~ dp~I~ItlAa
rll 5~i(Nf vreX fllJltmy u-afampa~-ftwX~1)DXS~) 33poundIBgtJ1JQJf1~
[ ) FCM~SRM(JJIJJ AD Ifamplftf I DeeP ~ d~ f lWt~erlj ~ 7~Fr F~~~2-poundRSJ J4D 1--75 J) D-eep FftlaquozftJIXJB5 ~f7~41J
( ~ 5--~O ~flJJ ~J--$~~ 7 ~ MlteIi1~IAt((1eli 5LClte~ 5a-~ltt3-777 7 rLbs ~L ~ 7~-ltcc
V-fl ~1fIN) RJif IO(AJIIIQ ~ ~ ltf7~ ltlr IVqLCltN ~r~ k~~ V-7~ fcPdA~ P-Y ~xlr-J6f) (QSJ1 ~
4 ~ TlIIP y1 Jf y 7-Gr -(1amp GL~ UOiflRk7ABjA7 5iNJJ~9 (7 tJyElrac1fJ~ qaJay
Iamp ) fP~ PIZZA- rR~ m8k) TPP~7 ~7)~Jl-XlI~ SGths ~~ 2r7Sdc
------ --- ----___- ---shy
_La~ bull UPJ 1$1 -shy
----shy~--~-
Southern Insurance Underwriters From the desk of PATRICIA BROWNE PBROWNESIUINSCOM 678-498-4581
Agency 023039 ACCOUNT CURRENT
AgencyPEACHSTATE INSURANCE AGENCY (TUCKER) Phone (770) 938-4311
ContactBOB FLOR Fax (770) 938-9318
Named InsuredCOLUMBUS WILLIAMS Zip Code 30084
DBA TIMEOUT GRILL
Address 4349 LAWRENCEVILLE HWY CityrUCKER State GA
Operations BARRESTAURANT (16930) 875000 X 707 =6186 LIQUOR LlABLITY (58161) 570000 X 903 = 5147 TOTAL $11333
Prior Carrier NEW Losses NONE
Commercial QUOTE __-gt----4 Thank you for the opportunity on the above riskl Please review all coverage listed It may differ from that requested
D Commercial Property Properly Underwriting Information
Construction of Protection Age of Sprinklered Central Station of Smoke Building Class Building (YIN) Area Alarm Stories Detectors
Coverage Value Cause of Loss Valuation Comiddotlns Comments
Deductibles
Property Flat Premium Premium
Rate 1100
Exclusions and Endorsements
COLUMBUS WILLIAMS 023039
00 Commercial Liability Payroll Receipts Liquor Receipts Cost of Subs Area Units Other
875000 570000
Form of Coverage ISO OCCURRENCE FORM Occurrence Limit $500000 LIQUOR LIABILITY
General Aggregate $500000 ASSAULT AND BATTERY ProdSCompo Ops Agg $500000 PersonallAdv Inj Limit $500000
DamagePremises Rented $50000 Medical Payments Cvg $5000
$500000 $25000 I $50000
Liability Deductible 500 PER CLAIMANT
Liability Exclusions and Endorsements
ALL POLICIES ARE SUBJECT TO AUDIT Liability Premium $11333 Premium is MINIMUM amp DEPOSIT upon inception
All quotes are subject to a favorable inspection and any subsequent recommendations
Minimum Earned Premium 25 Carrier SCOTTSDALE INSURANCE CO (A+XV) Commission 10 WE MUST HAVE A SIGNED APPLICATION
Pure Premium $1133300 Terrorism Premium $113300 + Tax $4532 Policy Fee (100 Earned) $25000 cent (Premium above Is in addition to that shown at left)
Surplus Lines Tax 004 $46332 (Terrorism Premium is not included in Premium Financing)
Total Premium Due $1204632 Please note that we must have a signed Terrorism Option form when binding
Above is valid for 30 days Please call or advise in writing prior to effective date if coverage is to be considered bound If coverage is bound per your request a charge of 10 of the annual premium may be made if the policy is not issued Thanks for thinking of SIU
Sincerely PATRICIA BROWNE Our Fax 678-498-4604
e cial Property amp Casualty
DESIGNATED PREMISES L1MrrATION (CG2144) GL CVG FORM (CGOOO1)
RECORDINGDISTRIBUTION OF MATERIAUINFO (CGOO68)
TOTAL POLLUTION EXCL (CG2149) WAR OR TERRORISM EXCL(REJECTlNG) (CG2173)
AMEND OF INSD CONTRACT(NlA CG2139 ATtACH) (CG2426)
GL COVERAGE DEC (CLS-8D-1L) GL SCHEDULE OF CLASSES (CLS-SP-1L) KNOWN INJURYDAMG EXCL PERS ADV (GLS-289S) GA CANCELLATION CHANGES (IL0262) COMMON CONDrrlONS(ILOO17) (INCL-UTS182S1246S-1)
FUNGUBACTERIA EXCL(CG2167) (INCL-UTS182S246S-10)
AMENDMENT TO OTHER INS CONDS (GLS152S) (INCL-UTS182S1246S-11 )
LEAD CONTAM EXCL(GLS58S) (INCL-UTS182St246S-2) CONDITJONS(GLS74S) (INCL-UTS182St246S-3) ASBESTOS EXCL(UTS266G) (INCL-UTS182St246S-4) SUB WARRANTY(GLS30S) (lNCLmiddotUTS182S1246Smiddot5) EPLI EXCL(CG2147) (INCL-UTS182S1246S-6) NUCLEAR EXCL(ILOO21) (INCLmiddotUTS182St246S-7) PUNrrlVE EXC(UTS74G) (INCL-UTS182S1246S-8) WAR EXCL (CG0062) (INCL-UTS182St246S-9) - Continued on next page shy
Please include all pages of this form if requesting to bind We must have a completed application to consider binding coverage
DRiVERS UCENSE E)(PtlpoundS 06-01-2014
WILUAMS COLUMBUS JR 186 FlOIlA AVE NE ATLANTA GA 30307middot2714 SEX 1III111Ofl ~DAII COUNTY M ()601-1959 01-09-2OOIP 04A
HEIGHT WEIGHT esc m lUllCnONS 6middot02 200 9 50 00500
CLASS ENDOlISIMlN TY C OUfgt
~f+
bull ~~------------------------------------------------------------------------------------~----------------
_La~ bull UPJ 1$1 -shy
----shy~--~-
Southern Insurance Underwriters From the desk of PATRICIA BROWNE PBROWNESIUINSCOM 678-498-4581
Agency 023039 ACCOUNT CURRENT
AgencyPEACHSTATE INSURANCE AGENCY (TUCKER) Phone (770) 938-4311
ContactBOB FLOR Fax (770) 938-9318
Named InsuredCOLUMBUS WILLIAMS Zip Code 30084
DBA TIMEOUT GRILL
Address 4349 LAWRENCEVILLE HWY CityrUCKER State GA
Operations BARRESTAURANT (16930) 875000 X 707 =6186 LIQUOR LlABLITY (58161) 570000 X 903 = 5147 TOTAL $11333
Prior Carrier NEW Losses NONE
Commercial QUOTE __-gt----4 Thank you for the opportunity on the above riskl Please review all coverage listed It may differ from that requested
D Commercial Property Properly Underwriting Information
Construction of Protection Age of Sprinklered Central Station of Smoke Building Class Building (YIN) Area Alarm Stories Detectors
Coverage Value Cause of Loss Valuation Comiddotlns Comments
Deductibles
Property Flat Premium Premium
Rate 1100
Exclusions and Endorsements
COLUMBUS WILLIAMS 023039
00 Commercial Liability Payroll Receipts Liquor Receipts Cost of Subs Area Units Other
875000 570000
Form of Coverage ISO OCCURRENCE FORM Occurrence Limit $500000 LIQUOR LIABILITY
General Aggregate $500000 ASSAULT AND BATTERY ProdSCompo Ops Agg $500000 PersonallAdv Inj Limit $500000
DamagePremises Rented $50000 Medical Payments Cvg $5000
$500000 $25000 I $50000
Liability Deductible 500 PER CLAIMANT
Liability Exclusions and Endorsements
ALL POLICIES ARE SUBJECT TO AUDIT Liability Premium $11333 Premium is MINIMUM amp DEPOSIT upon inception
All quotes are subject to a favorable inspection and any subsequent recommendations
Minimum Earned Premium 25 Carrier SCOTTSDALE INSURANCE CO (A+XV) Commission 10 WE MUST HAVE A SIGNED APPLICATION
Pure Premium $1133300 Terrorism Premium $113300 + Tax $4532 Policy Fee (100 Earned) $25000 cent (Premium above Is in addition to that shown at left)
Surplus Lines Tax 004 $46332 (Terrorism Premium is not included in Premium Financing)
Total Premium Due $1204632 Please note that we must have a signed Terrorism Option form when binding
Above is valid for 30 days Please call or advise in writing prior to effective date if coverage is to be considered bound If coverage is bound per your request a charge of 10 of the annual premium may be made if the policy is not issued Thanks for thinking of SIU
Sincerely PATRICIA BROWNE Our Fax 678-498-4604
e cial Property amp Casualty
DESIGNATED PREMISES L1MrrATION (CG2144) GL CVG FORM (CGOOO1)
RECORDINGDISTRIBUTION OF MATERIAUINFO (CGOO68)
TOTAL POLLUTION EXCL (CG2149) WAR OR TERRORISM EXCL(REJECTlNG) (CG2173)
AMEND OF INSD CONTRACT(NlA CG2139 ATtACH) (CG2426)
GL COVERAGE DEC (CLS-8D-1L) GL SCHEDULE OF CLASSES (CLS-SP-1L) KNOWN INJURYDAMG EXCL PERS ADV (GLS-289S) GA CANCELLATION CHANGES (IL0262) COMMON CONDrrlONS(ILOO17) (INCL-UTS182S1246S-1)
FUNGUBACTERIA EXCL(CG2167) (INCL-UTS182S246S-10)
AMENDMENT TO OTHER INS CONDS (GLS152S) (INCL-UTS182S1246S-11 )
LEAD CONTAM EXCL(GLS58S) (INCL-UTS182St246S-2) CONDITJONS(GLS74S) (INCL-UTS182St246S-3) ASBESTOS EXCL(UTS266G) (INCL-UTS182St246S-4) SUB WARRANTY(GLS30S) (lNCLmiddotUTS182S1246Smiddot5) EPLI EXCL(CG2147) (INCL-UTS182S1246S-6) NUCLEAR EXCL(ILOO21) (INCLmiddotUTS182St246S-7) PUNrrlVE EXC(UTS74G) (INCL-UTS182S1246S-8) WAR EXCL (CG0062) (INCL-UTS182St246S-9) - Continued on next page shy
Please include all pages of this form if requesting to bind We must have a completed application to consider binding coverage
DRiVERS UCENSE E)(PtlpoundS 06-01-2014
WILUAMS COLUMBUS JR 186 FlOIlA AVE NE ATLANTA GA 30307middot2714 SEX 1III111Ofl ~DAII COUNTY M ()601-1959 01-09-2OOIP 04A
HEIGHT WEIGHT esc m lUllCnONS 6middot02 200 9 50 00500
CLASS ENDOlISIMlN TY C OUfgt
~f+
bull ~~------------------------------------------------------------------------------------~----------------
Southern Insurance Underwriters From the desk of PATRICIA BROWNE PBROWNESIUINSCOM 678-498-4581
Agency 023039 ACCOUNT CURRENT
AgencyPEACHSTATE INSURANCE AGENCY (TUCKER) Phone (770) 938-4311
ContactBOB FLOR Fax (770) 938-9318
Named InsuredCOLUMBUS WILLIAMS Zip Code 30084
DBA TIMEOUT GRILL
Address 4349 LAWRENCEVILLE HWY CityrUCKER State GA
Operations BARRESTAURANT (16930) 875000 X 707 =6186 LIQUOR LlABLITY (58161) 570000 X 903 = 5147 TOTAL $11333
Prior Carrier NEW Losses NONE
Commercial QUOTE __-gt----4 Thank you for the opportunity on the above riskl Please review all coverage listed It may differ from that requested
D Commercial Property Properly Underwriting Information
Construction of Protection Age of Sprinklered Central Station of Smoke Building Class Building (YIN) Area Alarm Stories Detectors
Coverage Value Cause of Loss Valuation Comiddotlns Comments
Deductibles
Property Flat Premium Premium
Rate 1100
Exclusions and Endorsements
COLUMBUS WILLIAMS 023039
00 Commercial Liability Payroll Receipts Liquor Receipts Cost of Subs Area Units Other
875000 570000
Form of Coverage ISO OCCURRENCE FORM Occurrence Limit $500000 LIQUOR LIABILITY
General Aggregate $500000 ASSAULT AND BATTERY ProdSCompo Ops Agg $500000 PersonallAdv Inj Limit $500000
DamagePremises Rented $50000 Medical Payments Cvg $5000
$500000 $25000 I $50000
Liability Deductible 500 PER CLAIMANT
Liability Exclusions and Endorsements
ALL POLICIES ARE SUBJECT TO AUDIT Liability Premium $11333 Premium is MINIMUM amp DEPOSIT upon inception
All quotes are subject to a favorable inspection and any subsequent recommendations
Minimum Earned Premium 25 Carrier SCOTTSDALE INSURANCE CO (A+XV) Commission 10 WE MUST HAVE A SIGNED APPLICATION
Pure Premium $1133300 Terrorism Premium $113300 + Tax $4532 Policy Fee (100 Earned) $25000 cent (Premium above Is in addition to that shown at left)
Surplus Lines Tax 004 $46332 (Terrorism Premium is not included in Premium Financing)
Total Premium Due $1204632 Please note that we must have a signed Terrorism Option form when binding
Above is valid for 30 days Please call or advise in writing prior to effective date if coverage is to be considered bound If coverage is bound per your request a charge of 10 of the annual premium may be made if the policy is not issued Thanks for thinking of SIU
Sincerely PATRICIA BROWNE Our Fax 678-498-4604
e cial Property amp Casualty
DESIGNATED PREMISES L1MrrATION (CG2144) GL CVG FORM (CGOOO1)
RECORDINGDISTRIBUTION OF MATERIAUINFO (CGOO68)
TOTAL POLLUTION EXCL (CG2149) WAR OR TERRORISM EXCL(REJECTlNG) (CG2173)
AMEND OF INSD CONTRACT(NlA CG2139 ATtACH) (CG2426)
GL COVERAGE DEC (CLS-8D-1L) GL SCHEDULE OF CLASSES (CLS-SP-1L) KNOWN INJURYDAMG EXCL PERS ADV (GLS-289S) GA CANCELLATION CHANGES (IL0262) COMMON CONDrrlONS(ILOO17) (INCL-UTS182S1246S-1)
FUNGUBACTERIA EXCL(CG2167) (INCL-UTS182S246S-10)
AMENDMENT TO OTHER INS CONDS (GLS152S) (INCL-UTS182S1246S-11 )
LEAD CONTAM EXCL(GLS58S) (INCL-UTS182St246S-2) CONDITJONS(GLS74S) (INCL-UTS182St246S-3) ASBESTOS EXCL(UTS266G) (INCL-UTS182St246S-4) SUB WARRANTY(GLS30S) (lNCLmiddotUTS182S1246Smiddot5) EPLI EXCL(CG2147) (INCL-UTS182S1246S-6) NUCLEAR EXCL(ILOO21) (INCLmiddotUTS182St246S-7) PUNrrlVE EXC(UTS74G) (INCL-UTS182S1246S-8) WAR EXCL (CG0062) (INCL-UTS182St246S-9) - Continued on next page shy
Please include all pages of this form if requesting to bind We must have a completed application to consider binding coverage
DRiVERS UCENSE E)(PtlpoundS 06-01-2014
WILUAMS COLUMBUS JR 186 FlOIlA AVE NE ATLANTA GA 30307middot2714 SEX 1III111Ofl ~DAII COUNTY M ()601-1959 01-09-2OOIP 04A
HEIGHT WEIGHT esc m lUllCnONS 6middot02 200 9 50 00500
CLASS ENDOlISIMlN TY C OUfgt
~f+
bull ~~------------------------------------------------------------------------------------~----------------
COLUMBUS WILLIAMS 023039
00 Commercial Liability Payroll Receipts Liquor Receipts Cost of Subs Area Units Other
875000 570000
Form of Coverage ISO OCCURRENCE FORM Occurrence Limit $500000 LIQUOR LIABILITY
General Aggregate $500000 ASSAULT AND BATTERY ProdSCompo Ops Agg $500000 PersonallAdv Inj Limit $500000
DamagePremises Rented $50000 Medical Payments Cvg $5000
$500000 $25000 I $50000
Liability Deductible 500 PER CLAIMANT
Liability Exclusions and Endorsements
ALL POLICIES ARE SUBJECT TO AUDIT Liability Premium $11333 Premium is MINIMUM amp DEPOSIT upon inception
All quotes are subject to a favorable inspection and any subsequent recommendations
Minimum Earned Premium 25 Carrier SCOTTSDALE INSURANCE CO (A+XV) Commission 10 WE MUST HAVE A SIGNED APPLICATION
Pure Premium $1133300 Terrorism Premium $113300 + Tax $4532 Policy Fee (100 Earned) $25000 cent (Premium above Is in addition to that shown at left)
Surplus Lines Tax 004 $46332 (Terrorism Premium is not included in Premium Financing)
Total Premium Due $1204632 Please note that we must have a signed Terrorism Option form when binding
Above is valid for 30 days Please call or advise in writing prior to effective date if coverage is to be considered bound If coverage is bound per your request a charge of 10 of the annual premium may be made if the policy is not issued Thanks for thinking of SIU
Sincerely PATRICIA BROWNE Our Fax 678-498-4604
e cial Property amp Casualty
DESIGNATED PREMISES L1MrrATION (CG2144) GL CVG FORM (CGOOO1)
RECORDINGDISTRIBUTION OF MATERIAUINFO (CGOO68)
TOTAL POLLUTION EXCL (CG2149) WAR OR TERRORISM EXCL(REJECTlNG) (CG2173)
AMEND OF INSD CONTRACT(NlA CG2139 ATtACH) (CG2426)
GL COVERAGE DEC (CLS-8D-1L) GL SCHEDULE OF CLASSES (CLS-SP-1L) KNOWN INJURYDAMG EXCL PERS ADV (GLS-289S) GA CANCELLATION CHANGES (IL0262) COMMON CONDrrlONS(ILOO17) (INCL-UTS182S1246S-1)
FUNGUBACTERIA EXCL(CG2167) (INCL-UTS182S246S-10)
AMENDMENT TO OTHER INS CONDS (GLS152S) (INCL-UTS182S1246S-11 )
LEAD CONTAM EXCL(GLS58S) (INCL-UTS182St246S-2) CONDITJONS(GLS74S) (INCL-UTS182St246S-3) ASBESTOS EXCL(UTS266G) (INCL-UTS182St246S-4) SUB WARRANTY(GLS30S) (lNCLmiddotUTS182S1246Smiddot5) EPLI EXCL(CG2147) (INCL-UTS182S1246S-6) NUCLEAR EXCL(ILOO21) (INCLmiddotUTS182St246S-7) PUNrrlVE EXC(UTS74G) (INCL-UTS182S1246S-8) WAR EXCL (CG0062) (INCL-UTS182St246S-9) - Continued on next page shy
Please include all pages of this form if requesting to bind We must have a completed application to consider binding coverage
DRiVERS UCENSE E)(PtlpoundS 06-01-2014
WILUAMS COLUMBUS JR 186 FlOIlA AVE NE ATLANTA GA 30307middot2714 SEX 1III111Ofl ~DAII COUNTY M ()601-1959 01-09-2OOIP 04A
HEIGHT WEIGHT esc m lUllCnONS 6middot02 200 9 50 00500
CLASS ENDOlISIMlN TY C OUfgt
~f+
bull ~~------------------------------------------------------------------------------------~----------------
DRiVERS UCENSE E)(PtlpoundS 06-01-2014
WILUAMS COLUMBUS JR 186 FlOIlA AVE NE ATLANTA GA 30307middot2714 SEX 1III111Ofl ~DAII COUNTY M ()601-1959 01-09-2OOIP 04A
HEIGHT WEIGHT esc m lUllCnONS 6middot02 200 9 50 00500
CLASS ENDOlISIMlN TY C OUfgt
~f+
bull ~~------------------------------------------------------------------------------------~----------------