Business Insurance Review Questionnaire
To assist us in protecting you against possible uninsured losses, and to keep our information current, please complete the following questionnaire and submit when finished!
Your Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Title
*
Date
*
-
Month
-
Day
Year
Date
Do you wish to make, or do circumstances require any changes to your current liability limits or coverage amounts?
*
Yes
No
Have you made any improvements or renovations to your buildings or added any structures since you last reviewed the coverage amounts on your policy?
*
Yes
No
Does your building/premises have Smoke Detectors?
*
Yes
No
Does your building/premises have Dead Bolt Locks?
*
Yes
No
Does your building/premises have Fire Extinguishers?
*
Yes
No
Does your building/premises have Alarm Systems?
*
Yes
No
Have you added, changed, or deleted any security systems, safes, or sprinkler system?
*
Yes
No
Any changes or additional equipment, signs, computer equipment,tools purchased?
*
Yes
No
Any changes or additional equipment, signs, computer equipment,tools purchased?
*
Yes
No
Has there been any change in your business; such as: New products sold or services provided?
*
Yes
No
Has there been any change in your business; such as: Changes to existing products or services offered?
*
Yes
No
Has there been any change in your business; such as: Changes in operations or types of work performed?
*
Yes
No
Are you regularly in possession of other people’s property? (i.e., for repair or maintenance)?
*
Yes
No
Do you or any employee carry company money off site?
*
Yes
No
Are all owned or leased vehicles listed on your policy?
*
Yes
No
Do you work, maintain or operate a business, or keep samples for your business at any other location not listed on your policy?
*
Yes
No
Would you like information on wind mitigation credits?
*
Yes
No
Your property coverage may not provide coverage for ordinance or law. Do you want a quote for this very valuable coverage?
*
Yes
No
If you do not have a workers’ compensation policy, would you like a quote?
*
Yes
No
Would you be interested in a quote for Employment Practices Liability Insurance? (Wrongful Termination, Discrimination,Sexual Harassment, etc.)
*
Yes
No
Have there been any changes in Payroll?
*
Yes
No
Have there been any changes in Sales Receipts?
*
Yes
No
Have there been any changes in Space Occupied?
*
Yes
No
Do you own any additional property, vacant land, or rent or sublet any portion of your building to others?
*
Yes
No
Does your office have any recreational facilities?
*
Yes
No
Do you obtain certificates of insurance from all subcontractors?
*
Yes
No
Your business policy DOES NOT provide flood insurance. Would you be interested in a flood insurance cost quotation?
*
Yes
No
Would you be interested in a quotation for Life, Retirement, Group Health or Disability insurance?
*
Yes
No
Please describe all your operations, products, or services
*
Thank you for taking the time to complete this questionnaire!
Submit
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