Business Insurance Checklist

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Just as your health needs an annual checkup - so does your business insurance program. Although you may not be aware of it, your business's financial profile changed over the past year. To make sure you and your business are adequately insured for those changes, please complete the questionnaire and press the "Send Checklist" button at the end of the form. We will use the information in your response to evaluate the adequacy of your current insurance program.

Contact Information
Full Name:
Company:
Address:
City:
State:	Zip:
Daytime Phone:	Night Phone:
E-mail Address:

CHECKLIST QUESTIONS
Commercial Auto
1) Auto Leasing Exposure	Yes No
2) Drive Other Car Exposure	Yes No
3) Hired/Non-owned Auto	Yes No
4) Out-of-State Exposure	Yes No
5) Pollution	Yes No
6) Tapes, Records, & Discs Coverage	Yes No
7) Audio, Visual, & Data Electronic Equipment Coverage	Yes No
8) Any Loss Payees	Yes No
9) Foreign Exposure	Yes No
10) "1-800-How's My Driving" Program	Yes No
Crime Exposure
11) Employee Dishonesty	Yes No
12) Forgery or Alteration	Yes No
13) Theft, Disappearance and Destruction	Yes No
14) Computer Fraud	Yes No
15) Extortion	Yes No
Commercial General Liability
16) Bodily Injury and Property Damage Liability	Yes No
17) Personal and Advertising Injury Liability	Yes No
18) Medical Payments	Yes No
19) Tenants Fire Damage Liability	Yes No
20) Products/Completed Operations Liability	Yes No
21) Additional Insureds	Yes No
22) Contractual (Insured Contracts)	Yes No
23) Liquor Liability	Yes No
24) Leased Workers	Yes No
25) Independent Contractors	Yes No
26) Pollution/Asbestos Liability	Yes No
Commercial Property
27) Flood and/or Earthquake	Yes No
28) Boiler and Machinery	Yes No
29) Ordinance of Law Conditions	Yes No
30) Planned Renovation/New Construction	Yes No
31) Peak Season	Yes No
32) Personal Property Off Location	Yes No
33) Records/Valuable Papers at Location	Yes No
34) Contractors Equipment	Yes No
35) Off Premises Water/Power/Communication	Yes No
Workers Compensation
36) Operations Outside U.S.	Yes No
37) Second Injury Fund Exposures	Yes No
38) Deductible Per Claim	Yes No
39) Partners, Officers, Others Exclusion	Yes No
Miscellaneous
40) Employment Practices (ADA, Harrassment, Discrimination)	Yes No
41) Employee Benefit Plans (ERISA)	Yes No
42) Professional Liability/Errors and Omissions	Yes No
43) Kidnap and Ransom	Yes No
44) Credit Insurance	Yes No
45) Directors & Officers Employment Practices	Yes No
46) Umbrella/Excess Liability	Yes No

Additional Comments or Questions

Please click the "Send Checklist" button to send your Commercial Insurance Checklist.

Phone: 678.297.7977 Toll Free: 1.800.378.0766 Fax: 678.297.9575

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