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Commercial Policy Check Up
Please take a few minutes to complete this survey for your upcoming policy renewal. Filling out this form will help us make sure you are properly insured and all of the information we have is correct.
19
Questions
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1
Company Name
*
This field is required.
first/last
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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
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3
Have you had an increase/decrease in payroll?
*
This field is required.
Yes
No
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4
If yes, what is the new annual payroll amount?
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5
Have you had an increase/decrease in gross sales/revenue?
*
This field is required.
Yes
No
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6
If yes, what are the new annual gross sales?
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7
Do you use subcontractors?
*
This field is required.
Yes
No
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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
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9
What is your annual payroll/cost for uninsured subcontractors?
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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
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11
In the last 12 months, have you increased your inventory or have you leased/purchased any additional equipment?
Yes
No
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12
Do you own any mobile equipment (equipment or tools that you move from location to location)?
Yes
No
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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
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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
No and I am not interested in this coverage
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15
Do you carry Cyber Liability insurance? Cyber liability addresses the risk associated with e-business, the internet, networks and personal information.
Yes
I am not sure but I would like more information
No and I am not interested in this coverage
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16
Do you have coverage for hired and non-owned autos? Hired/non-owned auto provides liability coverage for vehicles that are not owned by the business but may be used to conduct business.
Yes
I am not sure but I would like more information
No and I am not interested in this coverage
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17
Are you interested in adding Business Income (coverage designed to replace lost income following a covered loss) to your policy?
Yes
I am not sure but I would like more information
No and I am not interested in this coverage
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18
Are you interested in purchasing Workers Compensation Insurance?
I already have Workers Compensation coverage with Hanby
I have Workers Comp coverage through my payroll company
I would like a quote for Workers Comp
No and I am not interested in this coverage
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19
Is there anything NOT mentioned above that has changed or you think may affect your insurance policies?
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