Commercial Account Review Questionnaire

First Name

Last Name

Email Address

Business Name

Phone Number

Address

City

State

Zip Code

General Liability | Business liability insurance is coverage that can protect you from a variety of claims including bodily injury, property damage, personal injury and others that can arise from your business operations. Do you have or need it? General Liability | Business liability insurance is coverage that can protect you from a variety of claims including bodily injury, property damage, personal injury and others that can arise from your business operations. Do you have or need it? Yes No

What is your Estimated Gross Annual Revenue for the upcoming term?

How many employees do you have? How many employees do you have?01-155-1010+

What are your estimated subcontracting costs for the upcoming term, if any?

Have there been any changes in your business operations? Have there been any changes in your business operations? Yes No

Please provide a description of the work that you do

Business Property - Have you acquired new property of any kind? Buildings, Equipment, Tools, Furnishings, etc. Business Property - Have you acquired new property of any kind? Buildings, Equipment, Tools, Furnishings, etc. Yes No

Estimated value of business property

Commercial Auto | Covers injuries that you or your employees may cause to other people and their property while driving. A typical commercial auto policy may include: Liability coverage, Medical payments coverage, Comprehensive coverage, Collision coverage, Uninsured and underinsured motorist coverage, Coverage for vehicles you rent or borrow,Coverage for employees who use their cars for business. Do you need or have it? Commercial Auto | Covers injuries that you or your employees may cause to other people and their property while driving. A typical commercial auto policy may include: Liability coverage, Medical payments coverage, Comprehensive coverage, Collision coverage, Uninsured and underinsured motorist coverage, Coverage for vehicles you rent or borrow,Coverage for employees who use their cars for business. Do you need or have it? Yes No

Is anyone who regularly drives one of your vehicles listed as a driver on the policy? Is anyone who regularly drives one of your vehicles listed as a driver on the policy? Yes No Need to Add Driver(s) Need to Remove Driver(s)

Are all vehicles you own listed on your policy? Are all vehicles you own listed on your policy? Yes No Request Review with Agent

Are all vehicles garaged at your primary business address? Are all vehicles garaged at your primary business address? Yes No

Are all vehicles title in the name of the business? Are all vehicles title in the name of the business? Yes No

Do we need to make any other changes or updates to your commercial auto policy including limits of liability or deductibles? Do we need to make any other changes or updates to your commercial auto policy including limits of liability or deductibles? Yes No

Workers Comp | All public and private employers, with limited exceptions, must provide workers' compensation coverage for their employees if one or more full-time or part-time persons are employed. A person hired to perform services for pay is presumed by law to be an employee. This includes all persons elected or appointed to public sector service and all persons appointed or hired by private employers for remuneration. There are a few exemptions to this definition. Do you need a quote for Worker's Compensation Insurance? Workers Comp | All public and private employers, with limited exceptions, must provide workers' compensation coverage for their employees if one or more full-time or part-time persons are employed. A person hired to perform services for pay is presumed by law to be an employee. This includes all persons elected or appointed to public sector service and all persons appointed or hired by private employers for remuneration. There are a few exemptions to this definition. Do you need a quote for Worker's Compensation Insurance? Yes No

What is your expected Annual Payroll?

How many employees do you currently have?

If you have 1099 contractors do you require proof of their workers compensation insurance and/or the signed Declaration of Independent Contractor Status Form? If you have 1099 contractors do you require proof of their workers compensation insurance and/or the signed Declaration of Independent Contractor Status Form? Yes No

Inland Marine Insurance | Generally covers property that is movable or transportable in nature. It is often used to cover property that needs broader protection than what may be provided by the typical Business Owners Policy. Whether you are working off-site, shipping or transporting goods, or need coverage on contracting equipment. Commercial Inland Marine Insurance should be part of your overall plan. Do you want a quote for Inland Marine Insurance or need to update your current coverage? Inland Marine Insurance | Generally covers property that is movable or transportable in nature. It is often used to cover property that needs broader protection than what may be provided by the typical Business Owners Policy. Whether you are working off-site, shipping or transporting goods, or need coverage on contracting equipment. Commercial Inland Marine Insurance should be part of your overall plan. Do you want a quote for Inland Marine Insurance or need to update your current coverage? Yes No

Do we need to do any changes to the value or limits for any of your tools and equipment for the upcoming year? Do we need to do any changes to the value or limits for any of your tools and equipment for the upcoming year? Yes No

Cyber Liability Insurance | cover a business' liability for a data breach in which the firm's customers' personal information, such as Social Security or credit card numbers, is exposed or stolen by a hacker or other criminal who has gained access to the firm's electronic network. Do you have a need for Cyber Liability Insurance? Cyber Liability Insurance | cover a business' liability for a data breach in which the firm's customers' personal information, such as Social Security or credit card numbers, is exposed or stolen by a hacker or other criminal who has gained access to the firm's electronic network. Do you have a need for Cyber Liability Insurance? Yes No

Bonds | Also known as business and commercial surety bonds, commercial bonds are agreements that protect businesses. They're generally required by state laws for various industries, and guarantee some aspect of a principal's occupation. Does your business require a Commercial Bond? Bonds | Also known as business and commercial surety bonds, commercial bonds are agreements that protect businesses. They're generally required by state laws for various industries, and guarantee some aspect of a principal's occupation. Does your business require a Commercial Bond? Yes No

If you currently have a bond, has there been any changes to bond requirements? If you currently have a bond, has there been any changes to bond requirements? Yes No

Professional Liability | more commonly known as errors and omissions (E&O insurance), is a special type of coverage that protects your company against claims that a professional service you provided caused your client to suffer financial harm due to mistakes on your part (errors) or because you failed to perform some service (omissions). Do you have a need or require updating your current policy? Virtually any business that performs a service or provides advice in exchange for a fee may have a professional liability exposure Professional Liability | more commonly known as errors and omissions (E&O insurance), is a special type of coverage that protects your company against claims that a professional service you provided caused your client to suffer financial harm due to mistakes on your part (errors) or because you failed to perform some service (omissions). Do you have a need or require updating your current policy? Virtually any business that performs a service or provides advice in exchange for a fee may have a professional liability exposure Yes - Need to renew current policy No Need for coverage Request a consultation with licensed agent

Would you be interested in bundling your Auto and/or Homeowners Insurance? Would you be interested in bundling your Auto and/or Homeowners Insurance? Yes No

Questions and/or Comments