Commercial Insurance Annual Review Update/Confirm Contact InformationName* First Last Business Name* Phone*Email* Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Tax ID | Federal ID Business Auto Insurance Review - In The Past 9-12 MonthsHas there been a change of drivers on your policy? No Yes Has there been a change of vehicles listed on your policy? No Yes Has there been a change in the radius of operations? No Yes Have any insured vehicles been customized or altered? No Yes Have you paid off a vehicle loan? No Yes Have you discussed Comprehensive Coverage with your Agent? No Yes Have you discussed Collision Coverage with your Agent? No Yes Have you considered raising you Liability Limits? No Yes Would you like and Advisor to contact you? No Yes Business Owners Insurance Review - In The Past 9-12 MonthsHas there been a change in operations (or added additional operations)? Yes No Have you done work outside of NC? No Yes Have your sales increased? No Yes Has your payroll increased? No Yes Have you added any new locations? Removed Locations? No Yes Have you added any new equipment? No Yes Have you increased Business Personal Property | Inventory? No Yes Do you have a central station security and/or fire alarm system Yes No Have you paid off or refinanced any loans? Yes No Have you made any significant home improvements (additions, updates to plumbing, HVAC, roof, electrical) Yes No Floods are not a covered cause of loss, would you like more information Yes No Workers Compensation Insurance Review - In The Past 9-12 MonthsShould Owner/Officers Be Included or Excluded From Coverage? Excluded Included Have you added any additional employment job types (i.e. new operations)? No Yes Have you added any new locations? Removed Locations? No Yes Additional Questions Δ
