Commercial Insurance Client Intake

Commercial Insurance Risk Review

By completing this intake it will allow us to review your business, property, fleet, risk priorities, and any transparency items needed for the proposal process.
Your Business Snapshot
Business Name
Contact Name
Contact Email
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Years in Business
Legal Structure
Approximate Annual Revenue
Total Employees (Full/Part-Time)
Top growth priorities over the next 12–24 months
(Examples: adding vehicles, acquiring property, hiring, expanding territory, increasing revenue, etc.)
- Primary location status
  
  Other
- Property address(es)
  
  Street Address
  
  Street Address Line 2
  CityState / ProvincePostal / Zip Code
- Year built
- Total square footage
- Year of major renovations
  (roof, electrical, HVAC, plumbing)
- Construction type
- Fire protection systems
- Monitored security system?
  
  Other
- Describe operations inside this building
- Hazardous materials stored?
  
  Other
- Current insurance carrier
- Estimated building replacement value (if owned)
- Estimated business personal property value (if tenant)
- Property claims in past 5 years
- What concerns you most about your property exposure today?
  (Fire? Storm? Equipment downtime? Tenant risk? Something else?)
- Total Commercial Vehicles
- Vehicle List
  (Year, Make, Model, VIN, Primary Use)
- Garaging Locations (ZIP codes)
- Radius of Operation
- Primary Use
- Are vehicles branded with your company logo?
  
  Other
- Do employees take vehicles home?
  
  Other
- Driver List (Name / DOB / License State)
- Do you run annual MVR checks?
  
  Other
- Any leased or financed vehicles?
  
  Other
- Auto claims in past 5 years?
- Current Auto Carrier & Liability Limits
- What systems do you use to reduce driver risk and prevent accidents?
  (Examples: telematics, driver training, written safety program, dash cams, none yet)
- Areas to strengthen this year
  
  Other
- If you could improve one thing about your current insurance program, what would it be?
  (Limit clarity? Claims service? Pricing stability? Risk control? Communication?)
- Any prior cancellations or non-renewals?
- Any open or pending lawsuits?
- Seasonal operations?
- International exposure?
- Is the business heavily cash-based?
- Existing written safety protocols
- Anything else we should understand about your risk?
Should be Empty:

Commercial Insurance Risk Review

Your Business Snapshot