First Name
Required
Input Required |
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Last Name
Required
Input Required |
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Street
Required
Input Required |
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City
Required
Input Required |
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State
Required
Input Required |
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ZIP / Postal Code
Required
Input Required
Please enter a valid Postal code. |
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E-Mail Address
Required
You must provide an e-mail address.
A valid e-mail address is required. |
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| Declaration Page |
| The part of your policy that includes your name and address; the property that is being insured, its location and description; the policy period; the amount of insurance coverage and the applicable premiums. |
| Since your last policy period: |
Has the name of your business changed?
Required
Has the name of your business changed? is required. |
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If yes, have you notified your insurance agent?
Optional |
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Has your mailing and or physical address changed?
Required
Has your mailing and or physical address changed? is required. |
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If yes, have you notified your insurance agent?
Optional |
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Has the nature of your operation changed?
Required
Has the nature of your operation changed? is required. |
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If yes, have you notified your insurance agent?
Optional |
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| Property Insurance |
| Since your last policy period: |
Have you reviewed the amount of insurance on your building?
Required
Have you reviewed the amount of insurance on your building? is required. |
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Have you conducted a through inventory of your business personal property, including inventory and stock? Keep in mind, inflation can and does impact personal property too.
Required
Have you conducted a though inventory of your business personal property, including inventory and stock? Keep in mind, inflation can and does impact personal property too. is required. |
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Have you added any security systems, including alarms, surveillance cameras, etc?
Required
Have you added any security systems, including alarms, surveillance cameras, etc? is required. |
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Have your revenues and costs of your business changed? If so you may not be adequately insured against your loss of business income and extra expense.
Required
Have your revenues and costs of your business changed? If so you may not be adequately insured against your loss of business income and extra expense. is required. |
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If you are a home based business without a commercial property or package insurance policy, Have you discussed with your insurance agent who provides your homeowner’s insurance policy of your home based business?
Optional |
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| General Liability Insurance |
| Insurance for what the policyholder is obligated to pay because of bodily injury or property damage caused to another person, except Auto & Professional Liability. Pricing is determined by gross sales, payroll, or area. |
| Since your last policy period: |
Has the rating base changed?
Required
Has the rating base changed? is required. |
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Have there been any signification changes in your business? For example have you started offering other products or services? Have you added staff (payroll)?
Required
Have there been any signification changes in your business? For example have you started offering other products or services? Have you added staff (payroll)? is required. |
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Have you reviewed the overall financial health of your company? Do you have enough liability insurance to protect you and your business against allegation which could lead to litigation?
Required
Have you reviewed the overall financial health of your company? Do you have enough liability insurance to protect you and your business against allegation which could lead to litigation? is required. |
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If you are a home based business without a commercial general liability or package insurance policy, Have you discussed with your insurance agent who provides your homeowner’s insurance policy of your home based business?
Optional |
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| Automobile Insurance |
| The insurance covers losses to the insured's property and losses for which the insured is liable as a result of owning or operating an auto. |
| Since your last policy period: |
Have you added or deleted any vehicle from your fleet?
Required
Have you added or deleted any vehicle from your fleet? |
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Have you reviewed the actual cash value of your vehicle to determine if comprehensive or collision coverage is worth the insurance expense to insure those exposures?
Required
Have you reviewed the actual cash value of your vehicle to determine if comprehensive or collision coverage is worth the insurance expense to insure those exposures? is required. |
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Has the use or radius of operation changed on any of your vehicles changed?
Required
Has the use or radius of operation changed on any of your vehicles changed? is required. |
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Are you considering or have you hired new drivers for your business?
Required
Are you considering or have you hired new drivers for your business? is required. |
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Have you reviewed the current limits of liability on your policy to see if you are carrying high enough limits should you be brought into litigation due to you or your employee’s legal liability?
Required
Have you reviewed the current limits of liability on your policy to see if you are carrying high enough limits should you be brought into litigation due to you or your employee’s legal liability? is required. |
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Have you reviewed your deductibles under the policy for both comprehensive and collision coverage parts?
Required
Have you reviewed your deductibles under the policy for both comprehensive and collision coverage parts? is required. |
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If you are a home based business without a commercial automobile or package insurance policy, Do you allow your employee’s to use your personal vehicle for business use?
Optional |
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| Workers Compensation Insurance |
| Insurance that pays for medical care and physical rehabilitation of injured workers and helps to replace lost wages while they are unable to work. |
| Since your last policy period: |
Has your payroll changed over the course of the last policy period?
Required
Has your payroll changed over the course of the last policy period? is required. |
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Has your operation or business changed?
Required
Has your operation or business changed? is required. |
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| Miscellaneous Insurance Coverage |
| The following coverage's are ones which you should discuss with your insurance agent to determine a) if you already have the coverage, or b) if you need to consider the coverage parts |
| Employment Practices Legal Liability (EPLI) |
| EPLI covers businesses against claims by workers that their legal rights as employees of the company have been violated. |
Do you have employees?
Required
Do you have employees? is required. |
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| Electronic Data Processing Coverage (EDP) |
| Specialized type of insurance designed to cover your computer equipment, data systems, information storage media and expenses or income loss related to the destruction of hardware or software. |
Do you have a computer system of network computers?
Required
Do you have a computer system of network computers? is required. |
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| Employee Dishonesty Coverage |
| Protects you if your employees steal from your business or customers. |
Do you have employees?
Required
Do you have employees? is required. |
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| Professional Liability or Errors and Omissions Coverage (E & O) |
| A professional liability policy covering the policyholder for negligent acts and omissions that may harm his or her clients. |
Do you provide a professional service?
Required
Do you provide a professional service? is required. |
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Enter Validation Code Required |
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