Commercial Renewal Check-Up

1

Company Name* This field is required.

first/last

2

Your Name* This field is required.This form should be completed by a person authorized to make changes to the insurance policy for your company.

first/last

3

Have you had an increase/decrease in payroll?* This field is required.

Yes

No

4

If yes, what is the new annual payroll amount?

5

Have you had an increase/decrease in gross sales/revenue?* This field is required.

Yes

No

6

If yes, what are the new annual gross sales?

7

Do you use subcontractors?* This field is required.

Yes

No

8

If you use subcontractors are they insured? (You should get current certificates of insurance for all subcontractors and keep them on file)

Yes

No

9

What is your annual payroll/cost for uninsured subcontractors?

10

Do you need to add, increase, or modify coverage for your building? Have you added any additional structures on your property in the last 12 months? Have you made any exterior or interior improvements?

Yes

No

11

In the last 12 months, have you increased your inventory or have you leased/purchased any additional equipment?

Yes

No

12

Do you own any mobile equipment (equipment or tools that you move from location to location)?

Yes

No

13

Are you interested in purchasing an excess liability policy? This policy would provide additional liability limits over and above the limits of your underlying policies.

Yes

No

I already have an excess liability policy

14

Do you carry Professional Liability insurance? Professional liability provides coverage for individuals and organizations for liability exposures that may arise from the practice of their profession.

Yes

I am not sure but I would like more information