Commercial Insurance Questionnaire

Our agency prides itself on properly managing our client's total risk, therefore we believe that being properly insured is just as important as cost: if we don't know your exposure, we can't make recommendations on coverage. These are very general questions - but the more detail we have, the more accurate a quote we can provide! Please fill out all applicable information and we will get back to you within 24 hours with additional questions.

Commercial Insurance Questionnaire

Business Name

Owner(s) Name

DBA's (if applicable)

Cell Phone

Who is your current insurance provider?

Year Business Established

Business EIN

Brief description of your business operations

Estimated gross sales or income for the current year

Estimated gross sales or income for prior year

Estimated gross sales or income for next year

Does the business own a building or need building coverage? If yes, please complete the below bulleted questions:

--- Square Footage

--- Construction Material of Building

--- Age & Material of Roof

--- Age of Building

--- Age of Improvements (i.e. wiring, plumbling, HVAC)

--- Amount of Building Coverage Desired

--- Current Market Value

--- Building security/fire systems

--- Any monitored alarms?

--- Sprinkler System?

How many employees does the business have?

For Worker's Comp:

Any equipment to insure?

Any specific construction equipment to schedule?

Any commercial auto coverage needed?

Attach commercial auto schedule:

Please attach your current declarations page.