BUSINESS INSURANCE QUESTIONNAIRE

First & Last Name ✶

Do you have any employees? ✶

If yes, consider Workers’ Comp and Employment Practices Liability.

Yes

Do you provide professional advice or services? ✶

If yes, consider Professional Liability (E&O)

Yes

Does your business have directors and officers? ✶

If yes, consider Directors and Officers (D&O) insurance.

Yes

Does your business need to be bonded? ✶

Yes

Do you need to meet vendor certificate of insurance requirements? ✶

Yes

Where does your business operate?

I lease space from others

I work at a job site

I own a property & lease to others

I run my business from property I own

Does your business own or lease any of the following assets?

Vehicles (Company owned or leased cars, trucks, vans or specialty vehicles used for business operations)

Inventory/Stock (Goods held for sale, raw materials or finished products stored onsite/in warehouses)

Buildings (Any commercial property your business owns or leases, including offices, warehouses or retail)

Furniture (Office furniture – desks, chairs, cabinets or other furnishings used in your business premises)

Tools or Equipment (Machinery, tools or specialized equipment used in production or daily operations)

Other

What kind of equipment and assets are essential to your business operations? ✶

Do you transport business property off-site, to client locations or other storage? ✶

Yes

If your business property were damaged or destroyed, would it interrupt your operations and result in lost income? ✶

Yes

What kind of accidents, natural disasters, or lawsuits could potentially damage your business property? ✶

Does your business store or process sensitive information (e.g., customer names, SSNs, medical or financial data)? ✶

If yes, consider Cyber Liability Insurance

Yes

Would you like to explore quotes for higher liability limits through umbrella coverage or excess liability? ✶

Yes

Does your business own, lease, or rent any vehicles? ✶

Yes

Is the vehicle registered or titled to the business name? ✶

Yes

Are you or your employees driving the vehicle(s) for business purposes? ✶

Yes

Do you haul heavy tools or equipment for your business? ✶

Yes

When traveling, do you cross state lines or need state/federal filings? ✶

Yes

I understand that coverage cannot be bound or altered until the information has been confirmed by one of our representatives by phone or email. ✶

Subject

Please leave this field blank. This field is here to help us protect against automated submissions. If you put something into this field, your entire submission will be ignored.

BUSINESS INSURANCE QUESTIONNAIRE

Business Operations

Property and Equipment

Cyber and Excess Liability

Vehicles