Exposure Update Form

Exposure Update Form
Business Information:
Business Name*
DBA (If Applicable)
Submittor's Name*
Submittor's Email
Phone Number
Has the Business Physical Address changed?*

YesNo
Business Physical Address*
Has the Business Mailing Address changed?*

YesNo
Mailing Address
Key Company Personnel Changes:
Are there any new company personnel that you would like Added to your file and or insurlink?

YesNo
Full Name
Email
Phone Number
Title
Add Personnel
Full Name
Email
Phone Number
Title
Add Personnel
Full Name
Email
Phone Number
Title
Are there any new company personnel that you would like Removed to your file and or insurlink?

YesNo
Full Name
Email
Phone Number
Title
Remove Personnel
Full Name
Email
Phone Number
Title
Remove Personnel
Full Name
Email
Phone Number
Title
Brief Description of Operations:
Have your business operations changed?

YesNo
Tells us what your business does.
Business Insurance Quoting Information:
Has the company payroll changed?*

YesNo
Worker's Compensation Insurance
Payroll, Employees & Sub-contractors (1099's):
Payroll:
Total Company Payroll*
Total # of Employees*
Total Payroll Costs Including 1099
Please update the payroll for the Class Code(s) that changed.*
Subcontractor Compensation:
Does your company use Sub Contractors (1099's)?*

YesNo
Do the subcontractors have their own insurance?

YesNo
Total Sub-Contractor Payroll (1099)
Owners and Officers Inclusion / Exclusion:
Work Comp allows Owners and Officers to be excluded by choice.*
Have the company revenues changed?*

YesNo
General Liability Insurance
General Liability insurance is rated on payroll and or revenue. Please provide the total annual revenue for the company.*
Do you utilize Subcontractors?*

YesNo
Do Subcontractors provide Certificates of Insurance?*

YesNo
Has the auto and or driver schedule change?*

YesNo
Business Auto Insurance
ADD VEHICLES:
Vehicle List:
REMOVE VEHICLES:
Vehicle List:
ADD DRIVERS:
Driver List:
REMOVE DRIVERS:
Driver List:
Please upload the following Documents:
- Driver's list (excel format preferred) - Full name, Date of Birth, License number, State of Issue.
- Vehicle list (excel format preferred) - Year, Make, Model, Vin #, cost new or value of the vehicle, garage location (if different from physical business location).
- Copy of current business auto policy.
Secure File Upload:

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Best Safety & Risk Management Assessment?*

YesNo
Risk Management & Safety: Best Practices Assessment
Does your company have a dedicated Safety Director ?*

YesNo
Does your company have a written Safety policy?*

YesNo
Are employees allowed to take company vehicles home at night and/or utilize them for personal use?*

YesNo
Do you have an accident investigation process?*

YesNo
Do you maintain an accident register?*

YesNo
Does your company utilize telematic software for your fleet?*

YesNo
Does your company have a dedicated HR Director employed?*

YesNo
How often are Safety Meetings held?
Secure File Upload
Please upload the following Documents:
- Current Certificate of Insurance including any endorsements needed for contractual purposes.
- Driver's list (excel format preferred) - Full name, Date of Birth, License number, State of Issue.
- Vehicle list (excel format preferred) - Year, Make, Model, Vin #, cost new or value of the vehicle, garage location (if different from physical business location).
- Copies of current policies (all lines).
Accepted file types: .jpg, .pdf, .png, .xls, xlsx

Max file size: 1 GB.
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T. Hudson Risk Advisor
T. Hudson Risk Advisor EMAIL
Should be Empty:

Exposure Update Form

Business Insurance Quoting Information:

Worker's Compensation Insurance

General Liability Insurance

Business Auto Insurance

Risk Management & Safety: Best Practices Assessment

Secure File Upload