Commercial Renewal Questionnaire Explore More Commercial Insurance Options BUSINESS INFORMATIONHiddenPrimary Contact First Last HiddenApplicant Name (Name of Business) HiddenPrimary Email Who Is Completing This? First Last Best Contact Email Entity Type(Required)CorporationLLC | LLPPartnershipSole Proprietor (Personal)OtherTax | Federal ID(Required) Has There Been A Change In Corporate Structure In The Past Twelve Months? (Entity Change | Ownership Change | Etc)(Required)NoYesDescribe Corporate Structure Change(s)**Describe Change, If Ownership Change Please Describe**Have You Had A Material Change To Your Business Operations In The Last 12 Months?(Required)NANoYesDescribe How Your Business Has Changed?Last 12 Months Annual Revenue(Required)Next 12 Months Annual Revenue (Estimate)(Required)Do You Have Any Current Employees?(Required)NAYesNoNumber Of Full Time Employess**Full Time = 30+ Hours Per Week**Number Of Part Time Employees**Part Time = Less Than 30 Hours Per Week**Annual PayrollDo You Expect To Hire Any Employees?NAYesNoDo You Plan On Hiring Any Employees In The Next 12 Months?Number Of Full Time Employees (Next 12 Months)**Full Time = 30+ Hours Per Week**Number Of Part Time Employees (Next 12 Months)**Part Time = Less Than30 Hours Per Week**Annual Payroll (Next 12 Months)Do You Use Subcontractors As Part Of Your Workforce?(Required)NAYesNoTotal Cost Of Subcontractors? Do You Expect To Use Subcontractors In The Next 12 Months?NAYesNoTotal Cost Of Subcontractors (Next 12 Months)? Do You Have More Than One Business Location?(Required)NAYesNoList All Location AddressesPlease Include Street Address | City, State Postal CodeTYPE OF COVERAGE TO BE RENEWEDPlease Check The Boxes Below That Correspond With The Following Current Renewal Current Coverage(s) To Be Renewed(Required) Business Owners Landlord Or Lessors Risk Coverage (Including Habitational & Commercial) Business Auto Coverage Workers Compensation Business Umbrella Liability Cyber Liability Coverage Employment Practices Liability Professional | E&O Liability Coverage Bonds | Surety Coverage Select All That ApplyBusiness Owners | Commercial Package CoverageDoes (Should) Your Policy Include: Building Coverage Business Personal Property Coverage Tool Coverage Mobile Equipment And Inland Marine Coverage Employment Practices Liability Coverage Check All That ApplyBuilding UpdateLoc 1 Bldg 1 (Please Add As Many Loc's & Bldg's As Needed) 1. Year Of Plumbing Update: 2. Year Of Electrical Update: 3. Year Of Roof Update: 4. Any Additions (Yes Or No): 5. Is Building Vacant (Yes Or No):If Update Years Aren't Know - Please write "UNKNOWN"How Much Business Personal Property Do You Need? Business Personal Property Includes Things Such As: Inventory, Office Equipment, Computer Equipment, Furniture, Etc.How Much Tool Coverage Do You Need? Tools Are Not Part Of "Building" or "Equipment" Coverage. These items are typically handheld type toolsMobile Equipment UpdateMobile Equipment Includes Items Like: Forklifts, Bobcats, Tractors, EtcUpload Mobile Equipment ListingMax. file size: 60 MB.If you have a file that lists the information for your Mobile Equipment, please upload hereLandlord | Lessors Risk CoverageLessors Risk Building UpdateLoc 1 Bldg 1 (Please Add As Many Loc's & Bldg's As Needed) 1. Year Of Plumbing Update: 2. Year Of Electrical Update: 3. Year Of Roof Update: 4. Any Additions (Yes Or No): 5. Is Building Vacant (Yes Or No): 6. Annual Rent/Revenue For Building: 7. Number Of Units/Tenants: 8. Building Occupancy:If Update Years Aren't Know - Please write "UNKNOWN"Business Auto CoverageVerify Vehicle & Driver List**If You Have A Listing Of Drivers & Vehicles Please Attach | If You Don't Please Give The Following Information** DRIVER INFORMATION (PLEASE LIST) Driver Name | Date Of Birth | Driver's License Number VEHICLE INFORMATION (PLEASE LIST) Year | Make | Model | VIN | Radius Of OperationAttach Vehicle & Driver List(s) If You AvailableMax. file size: 60 MB.Workers Compensation CoverageDo You Have Any Out Of State ExposuresNAYesNoSelect YES if you have any employees that travel out of state, or live out of stateOther States Information**List All States With Exposure & Approx Payroll For That State**Owner | Officer InformationPlease List All Owners & Officers (Include Ownership %)Owner/Officer Coverage Selection Or RejectionReject CoverageSelect CoverageDo Owners/Officers Wish To INCLUDE or EXCLUDED For Workers Compensation Coverage Δ
