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Commercial Lines Survey
Commercial Lines Survey
Name
*
First
Last
Business Name
*
Phone
*
Email
*
Have you had a change in your business' entity? (such as a change to an Inc or LLC)
Yes
No
What are your annual Gross Receipts?
Annual payroll?
Have you added or lost any employees?
Yes
No
What is the number of FT Employees?
PT Employees?
Officers?
Worker’s compensation laws are being enforced. At the minimum you can be fined by the state if you fail to carry coverage. Do you need to discuss this with us?
Yes
No
Have you had any changes in the type of work you are doing?
Yes
No
Have you purchased or sold any property, vehicles or equipment?
Yes
No
Do you need to remove or add any vehicles or leinholders on your auto policy?
Yes
No
Do you need to remove or add any drivers?
Yes
No
Have you made any building updates- roof/ heat & air /plumbing and/or electrical?
Yes
No
Would you like a quote or more information on Employment Practices Liability?
Yes
No
Would you like a quote or more information on Utility Services Coverage?
Yes
No
Do you conduct business over the internet? (such as orders, pmts, etc)
Yes
No
Would you like a quote or more information on Data Breach Coverage or Cyber Liability?
Yes
No
Would you like an Umbrella quote? We recommend all business have this!!
Yes
No
Have there been any changes to your local building ordinances that require additional coverage?
Do you use drones in your business?
Yes
No
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