Commercial lines renewal questionnaire based on the Gartman PDF. "*" indicates required fields Contact InformationNamed Insured*Email Address* Completed By* First Last Is the Named Insured shown correct?* Yes No If no, please provide the correct Named InsuredBusiness Entity and Operations ChangesAre there any new corporations, partnerships, limited partnerships, or joint ventures?* Yes No If yes, please list the names of the new entitiesHas your company started, acquired, sold, or discontinued any operations during the past year?* Yes No If yes, please describe the operational changesHas your company had any building or location changes during the past year?* Yes No If yes, please describe the building or location changesNumber of employeesAnnual PayrollAnnual RevenuePlease always notify us of any changes as soon as possible.Property CoverageBuilder’s Risk Included: Occupancy Can Delete CoverageDo you own the building?* Yes No If yes, whose name owns the building?If the building is not insured with us, do you have building coverage elsewhere?* Yes No Not Applicable Do you have any of the following items? Fences Signs Antennas Awnings Glass Carports Do you feel your insurance amounts on your building and personal property are sufficient? Yes No What building and personal property limit would you like?Do you need coverage on personal property of others? If yes, what limit would you like? Yes No What personal property of others limit would you like?If you are a tenant, have you made improvements to the area you lease?* Yes No Not Applicable If yes, please describe the tenant improvementsHave you purchased, leased, or acquired any real property or locations, including vacant land, during the past year?* Yes No If yes, have those been added to your coverage? Yes No If yes, please describe the new property or locationsIf you have computer coverage, is your limit adequate?* Yes No Not Sure Not Applicable Are there any changes not already endorsed to the following business-owned items? Automobiles Trucks Boats / Yachts Aircraft Mobile Equipment & Tools Please describe any changes to the business-owned items selected aboveLiability CoverageAnnual Sales*Annual Payroll*Are you interested in higher limits of liability, if available?* Yes No Maybe Are you required to carry liquor liability coverage?* Yes No Not Sure Have there been any changes in operations during the past year?* Yes No If yes, please describe the changes in operationsDo employees use their own cars on company business?* Yes No Do you or any of your employees, family members, or officers use any company vehicle for ridesharing services such as Uber or Lyft?* Yes No If you answered yes to the ridesharing question above and have not discussed coverage for this exposure with your producer or account manager, please contact our office as soon as possible.Workers Compensation CoverageIf you do not have workers’ compensation coverage with us, do you have coverage elsewhere?* Yes No Not Applicable Do you have remote workers in other states?* Yes No Are you working in states other than your domiciled state?* Yes No Miscellaneous Coverage OptionsAre you interested in crime coverage, such as employee dishonesty, or in changing your current crime coverage?* Yes No Maybe Are you interested in discussing protection for allegations of discrimination, harassment, or similar claims against your company?* Yes No Maybe Would you like to discuss any of the following property coverages? Earthquake Flood Would you be interested in a life or health insurance quote?* Yes No Would you be interested in a personal home or auto quote?* Yes No Do you currently own and use drones in the operations of your business?* Yes No If you answered yes to the drone question above and have not discussed coverage for this exposure with your producer or account manager, please contact our office as soon as possible.Final ReviewUpload supporting documents (optional) Drop files here or Select files Max. file size: 100 MB, Max. files: 5. Signature*Date* MM slash DD slash YYYY
