Commercial Renewal Fast App

Commercial Renewal Fast App
Name of Business
1st point of contact Email
example@example.com
1st point of contact Name

First NameLast Name
1st point of contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Coverage Requested
Website Address
Do you offer any new products or services
Describe any new products or services
Projected annual gross receipts
Projected annual payroll
Number of full-time employees
Number of part-time employees
Commercial General Liability
Commercial General Liability Coverage Information
Are there new operations
Define new products or services offered
Annual reciepts for new products or services offered
Annual payroll for new products or services offered
Do you use contractors
Insured sub costs
Uninsured sub costs
Commercial Property
Commercial Property Coverage Information
Commercial Property Coverage Information
Have any of your locations changed
Confirm the number of locations you own or lease
Location 1 Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Business value if owned
For Location 1 Address
Business personal property value
For Location 1 Address
Location 2 Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Business value if owned
For Location 2 Address
Business personal property value
For Location 2 Address
Location 3 Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Business value if owned
For Location 3 Address
Business personal property value
For Location 3 Address
Location 4 Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Business value if owned
For Location 4 Address
Business personal property value
For Location 4 Address
Location 5 Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Business value if owned
For Location 5 Address
Business personal property value
For Location 5 Address
Commercial Auto
Commercial Auto Current Policy Breakdown
Commercial Auto Current Policy Breakdown
Has your drivers list changed in the last year
Do you have a drivers list to upload
How many drivers do you have
Driver list

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Driver 1

First NameLast Name
Date of birth

MonthDayYear
Date
License number
Licensed state
Commercial driver's license
Driver 2

First NameLast Name
Date of birth

MonthDayYear
Date
License number
Licensed state
Commercial driver's license
Driver 3

First NameLast Name
Date of birth

MonthDayYear
Date
License number
Licensed state
Commercial driver's license
Driver 4

First NameLast Name
Date of birth

MonthDayYear
Date
License number
Licensed state
Commercial driver's license
Driver 5

First NameLast Name
Date of birth

MonthDayYear
Date
License number
Licensed state
Commercial driver's license
Vehicle/Trailer Details
Has your vehicle list changed in the last year
Do you have an updated vehicle list file available to upload
How many vehicles do you have
Vehicle List

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Vehicle 1
Year
Make
Model
VIN
Trailer length (if applicable)
Garaging zip code of vehicle
Value of vehicle
Permanently attached equipment value (if any)
Vehicle 2
Year
Make
Model
VIN
Trailer length (if applicable)
Garaging zip code of vehicle
Value of vehicle
Permanently attached equipment value (if any)
Vehicle 3
Year
Make
Model
VIN
Trailer length (if applicable)
Garaging zip code of vehicle
Value of vehicle
Permanently attached equipment value (if any)
Vehicle 4
Year
Make
Model
VIN
Trailer length (if applicable)
Garaging zip code of vehicle
Value of vehicle
Permanently attached equipment value (if any)
Vehicle 5
Year
Make
Model
VIN
Trailer length (if applicable)
Garaging zip code of vehicle
Value of vehicle
Permanently attached equipment value (if any)
Do you use any non-owned trailers
How many days a year are you using non-owned trailers
Workers Compensation
Workers Compensation Current Policy Breakdown
Workers Compensation Current Policy Breakdown
Has the ownership changed
Number of owners
Owner 1 Name

First NameLast Name
Date of birth

MonthDayYear
Date
Title
Duties
*Note: If you choose to exclude owners from Worker's Comp benefits they must be at least 25% owner.
Owner percentage
Exclude
Owner 2 Name

First NameLast Name
Date of birth

MonthDayYear
Date
Title
Duties
*Note: If you choose to exclude owners from Worker's Comp benefits they must be at least 25% owner.
Owner percentage
Exclude
Owner 3 Name

First NameLast Name
Date of birth

MonthDayYear
Date
Title
Duties
*Note: If you choose to exclude owners from Worker's Comp benefits they must be at least 25% owner.
Owner percentage
Exclude
Owner 4 Name

First NameLast Name
Date of birth

MonthDayYear
Date
Title
Duties
*Note: If you choose to exclude owners from Worker's Comp benefits they must be at least 25% owner.
Owner percentage
Exclude
Owner 5 Name

First NameLast Name
Date of birth

MonthDayYear
Date
Title
Duties
*Note: If you choose to exclude owners from Worker's Comp benefits they must be at least 25% owner.
Owner percentage
Exclude
Employee/Payroll Category

*Note: Employees Category Examples: Clerical, Driver, Technician, Retail, Electricians, HVAC, Plumbers, Artisan Contractor
Employee category 1
Number of employees
Payroll category total
Add another employee category (max. of 5 categories)
Employee category 2
Number of employees
Payroll category total
Add another employee category
Employee category 3
Number of employees
Payroll category total
Add another employee category
Employee category 4
Number of employees
Payroll category total
Add another employee category
Employee category 5
Number of employees
Payroll category total
Errors and Omissions
Errors and Omissions Policy Breakdown
Errors and Omissions Policy Breakdown
Do you wish to increase your current limits of liability
Cyber
Cyber Current Policy Breakdown
Cyber Current Policy Breakdown
Would you like us to increase your coverage limits
Directors and Offices
Directors and Offices Policy Breakdown
Directors and Offices Policy Breakdown
Would you like us to increase your coverage limits
Inland Marine
Inland Marine Policy Breakdown
Inland Marine Policy Breakdown
Inland Marine Schedule - Mobile Equipment
Have you sold/purchased any equipment in the last year
Do you have an updated equipment list to upload
Equipment List

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Number of equipment you want to list
Schedule any items at $500.00 or more
Item 1 description
Serial number
Make/Model
Item value
Item 2 description
Serial number
Make/Model
Item value
Item 3 description
Serial number
Make/Model
Item value
Item 4 description
Serial number
Make/Model
Item value
Item 5 description
Serial number
Make/Model
Item value
Total updated value of misc. tools/equipment ea. item under $500
Example: hammers, drills, bits combined equal $2k
Crime
Crime Current Policy Breakdown
Crime Current Policy Breakdown
Would you like us to increase your coverage limits
Umbrella
Umbrella Current Policy Breakdown
Umbrella Current Policy Breakdown
Would you like us to increase your liability coverages?
Builders Risk
Builders Risk Current Policy Breakdown
Builders Risk Current Policy Breakdown
Date Construction Started

MonthDayYear
Date
Expected Completion Date

MonthDayYear
Date
Cargo
Current Cargo Policy Breakdown
Current Cargo Policy Breakdown
Would you like us to increase your coverage limit
Any changes in cargo being hauled
Describe changes in cargo hauled
Bond
Current Bond Policy Breakdown
Current Bond Policy Breakdown
Would you like us to increase your coverage limit
Are you done preparing this form? (Only select "Yes" when you have selected all the coverages you want to request and have filled everything up above)
Any loose ends
Do you need any OTHER increases in coverage for your CURRENT policies
Describe the "other" coverage increase you're seeking
Would you like to get a quote on any of the below coverage OR do you have any of these policies managed elsewhere
Other coverage requested
Would you like a quote for personal auto insurance
Would you like a quote for personal home insurance
Would you like a quote for personal umbrella insurance
Would you like to see a quick indication of a quote for personal life insurance
Great! Thank you for filling up the form and we will be in touch shortly!
Should be Empty:

Commercial Renewal Fast App

Commercial General Liability

Commercial Property

Commercial Auto

Vehicle/Trailer Details

Vehicle 1

Vehicle 2

Vehicle 3

Vehicle 4

Vehicle 5

Workers Compensation

Employee/Payroll Category

Errors and Omissions

Cyber

Directors and Offices

Inland Marine

Crime

Umbrella

Builders Risk

Cargo

Bond

Any loose ends