Commercial Insurance Renewal Form
Name of the business
*
Have there been any major changes in your operations?
*
Yes
No
Please list the changes as best as possible
*
Do you have any of the following as part of your business insurance?
General Liability
Building(s) Coverage
Auto Insurance
Workers Compensation Insurance
What is your estimated gross sales in the upcoming year?
*
What is your estimated payroll for the upcoming year?
*
Do you use subcontractors?
Yes
No
If yes, what percentage of your work is done by subcontractors?
*
What is your best guess of what the replacement cost of your building(s)?
*
What is the value of your business personal property?
*
If you rent your building out, what is the monthly rent amount?
*
When was the roof last updated?
*
When was the electrical wiring last updated?
*
When was the plumbing last updated?
*
When was the HVAC last updated?
*
Are there additional vehicles that should be on your policy that you do not see on your coverage outline?
*
No
Yes
If yes, please list year, make, and model of the vehicle(s)
*
Are all drivers listed on your policy correctly?
*
Yes
No
If no, please list the name, Driver's License #, and Date of Birth for each additional driver
*
What is your estimated payroll for the upcoming year?
*
Have you added any employees in the last year?
*
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