Commercial Insurance quote

Here is a quick form you can use if you are calling around for commercial insurance quotes.  You will not need eerything here but this will give you a guide of some of the information to have available.

Name:		Phone:
Mailing Address:		Contact:
Location Address:
Detailed description of business:
Corp. Individual Partnership Association Other:
How long in business?	Product brochures obtained? Yes No
How long with current carrier?	Happy with carrier/agent?
Reason for changing from current carrier/agent:
Any exposure in other states? Yes No If yes, name of states:
Average longevity of employees:
Personal Insurance with same company/agency:
Life/Health with same carrier/agency:
What is client looking for in agent?
Property – Photo Yes No Construction:       Alarms/Sprinklers:       PC:       Distance to Hydrant:       Date built:       Age of electrical/plumbing systems:       Square footage:       # of Stories:       Years at this location:       Safe:       Other Tenants:       Deductible:       Values: Bldg.:       Loss of Income:       Contents:       Signs:       Inland Marine:       EDP:       Glass:       System Protector:       Spoilage:       Carrier:       Date:       Annual Premium:       Copy of Policy: Yes No	Losses (by policy type) Property:       Auto:       Liability:       Crime:       Workers Comp:       Umbrella:       Note: 3 full years of hard loss runs are required for risks that generate $10,000 of more in premium or is to be experienced rated.
Liability # of Employees: Full-time       Part-time       Payroll:       Sales/Receipts:       Limits: Occurrence:       General Aggregate:       Products Aggregate:       Pers. & Adv.:       Fire Legal:       Medical:       Professional (limited classes eligible at NW):       Carrier:       Date:       Annual Premium:       Copy of Policy: Yes No

Umbrella Coverage Limit:       Retention:       Carrier:       Date:       Annual Premium:       Copy of Policy: Yes No						Auto Number of Autos:       (see chart below)Combined Single Limit:       MVR’s run? Uninsured Motorist:       Safety program? Medical Payments:       List of Drivers?Comprehensive Yes No Deductible:       Collision: Yes No Deductible:       Hired/Non-owned: Yes No Carrier:       Date:       Annual Premium:       Copy of Policy: Yes No
Workers Compensation Excluded parties? States:       FEIN #:       Carrier:       Date:       Annual Premium:       Mod:       Copy of Policy Yes No
Crime Employee Dishonesty (Form A):       Forgery or Alteration (Form B):       Money and Securities (Form C):       Computer Fraud (Form F):       Robbery and Safe Burglary (Form Q) (M&S):       Annual Premium:					Ratable Employees:       Deductible:       Ratable Employees:       Deductible:       Exposure:       Deductible:       Deductible:       Exposure:       Deductible:       Copy of Policy: Yes No
Miscellaneous
Directions to risk:
Additional Insured: Yes No
Auto Schedule
#	Make	Model	Year	Cost New			Weight	Use	Radius of Use
1
2
3
4
5
6
7
8
Notes
Property Comments:       Casualty Comments:       Other Comments:

Initial Client Review – Commercial Risk

Initial Client Review – Commercial Risk