Commercial (BOP) Renewal Questionnaire

Commercial (BOP) Renewal Questionnaire
Page Insurance, Ltd

102 Boston Street

Guilford, CT 06437

(203) 453-5258

info@pageins.com
To assist us in protecting you against possible uninsured losses, and to keep our information current, please complete the following questionnaire.
Name

First NameLast Name
Company
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Name of individual completing this form

First NameLast Name
Today's Date

MonthDayYear
Day Phone Number

Area CodePhone Number
Evening Phone Number

Area CodePhone Number
E-mail Address
GENERAL QUESTIONS

Rows	Yes	No
New products sold or services provided?
Changes to existing products or services offered?
Changes in operations or types of work performed?

Does your building/premises have?

Alarm System?

YesNoOther
Has there been any change in the space occupied by the business?

YesNo
If 'Yes', please explain
Have you made any improvements or renovations to your buildings or added any structures since you last reviewed the coverage amounts on your policy?

YesNo

Rows	Yes	No
Have you added, changed, or deleted any security systems, safes, or sprinkler system?
Any changes or additional equipment, signs, computer equipment, or tools purchased?
Are you regularly in possession of other people’s property? (i.e., for repair or maintenance)?
Do you or any employee carry company money off site?
Do you own any additional property, vacant land, or rent or sublet any portion of your building to others?

Rows	Yes	No
Are all owned or leased vehicles listed on your policy?
Are there any changes to drivers, vehicles or vehicle usage?
Do you work, maintain or operate a business, or keep samples for your business at any other location not listed on your policy?
Do you obtain certificates of insurance for all subcontractors?
Your business policy DOES NOT provide flood insurance. Would you be interested in a flood insurance cost quotation?
Would you be interested in a quotation for Life, Retirement, Group Health or Disability insurance?

EXTRA PROTECTION
Check off any of the following the extra coverages on which you would like information:

Business Income CoverageCommercial Umbrella Policy of $1,000,000 or moreCrime / Employee DishonestyCyber LiabilityEmployment Practices LiabilityEmployee Dishonesty CoverageGeneral Liability – Increased Limits of LiabilityFlood InsuranceGroup Health / Disability / Dental insuranceHired and Non-Owned Auto LiabilityIdentity-TheftProfessional LiabilityRetirement / Financial PlanningWorkers Compensation Insurance
I am interested in information on the above protection. Please contact me by:

EmailRegular MailCell PhoneHome PhoneWork Phone
Enter any additional comments concerning your insurance in the space below
THANK YOU FOR TAKING THE TIME TO COMPLETE THIS IMPORTANT FORM.

Mailing address: Page Insurance, Ltd | 102 Boston Street Guilford, CT 06437

Primary Phone: 203-453-5258 | Fax to: 203-433-7659 | Email to: info@pageins.com
Should be Empty:

GENERAL QUESTIONS