Renewal and Check-Up Worksheet

Business Coverage Check-Up and Pre-Renewal Worksheet
Business Clients
Please provide the formal name of your business*
What is your email address?*
example@example.com
Please provide your phone number*
Please provide your name*
First NameLast Name
Your company's coverage check-up or pre-renewal worksheet is vital to you receiving the lowest costs and the right coverage.
The entire process will take less than three minutes.
After completing the worksheet, please hit the SUBMIT button at the bottom.
Let's get started...
What do you project your company's sales or rental income will be for the next twelve months?*
Without including the owner's earnings, what do you estimate the company's total direct W2 payroll expense will be for the next twelve months by state?
State Payroll Expense $
1
2
3
How many employees does the company currently have by state?
State # Full Time # Part Time
1
2
3
Do your employees currently receive employer paid Health Insurance?
YesNo
Going into the approaching policy term, what limit should apply to cover all of your company's business office equipment, computer & phone systems, & inventory - if there were to be a total disaster*
This section requires that you mark one of the boxes for each kind of loss coverage
You can find examples of how these coverages work at our website, Click here.

Please mark each of the following rows as you see fit. A response is required on every line*

	I don't care about this	I care about this
Business Liability Protection
Owned or Non-Owned Autos
Business Property & Equipment
Business Interruption Coverage
Pandemic Related Coverage
Pollution Liability Protection
Product Recall Coverage
Errors & Omissions Liability
Workers' Compensation
Director's & Officers (Mismanagement) Protection
EPLI, Discrimination, Wrongful Termination Protection
Crime - Employee Theft - Embezzlement Protection
Cyber Crime - Cyber Security Data Breach Protection
International or Foreign Liability Protection
Flood Protection
Earthquake Protection
Wind Protection
Group Health, Group Benefits, Dental or Vision Plans
Key Person Life or Disability Protection

As a matter of practice, any time you expand or change your business, acquire equipment, vehicles, or locations, dispose of equipment, close a location, or enter into leases or other contracts, it's a good idea to have a conversation with us. We are consultative advisors, it does not cost you anything to ask us for feedback, we are your Service Team. (and for tax or legal matters, we encourage you to speak with your CPA and your Attorney).
Do you periodically review your coverage and limits with us and do you ask us to make adjustments when you believe they are needed?*
YesNo
Would you like us to give you a call to discuss other coverage adjustments or any of the items that you've marked above, before we start this year's shopping process for you?*
NoYes
Additional Comments
This worksheet contains a few general descriptions of a handful of coverage types that are most common, but it does not include all of the coverages, features, exclusions, and conditions that may apply in a specific case. In fact, coverages, features, and credits vary by state and may not be available to all policyholders.
We strive to engage openly with all of our policyholders. If you have questions, we strongly encourage you to reach out to us.
Your name here signifies that we have advised you that you may revise, adjust or modify any of your responses at any time by contacting anyone on the our team.*
(Unless you revise this name, we will presume it is you completing this worksheet)
Date*
MonthDayYear
Date
After you hit the SUBMIT button, we'll send you a copy of this worksheet for your records. Thank You from all of us here.
Please click the SUBMIT button now.
Should be Empty:

	State	Payroll Expense $
1
2
3

	State	# Full Time	# Part Time
1
2
3

Business Coverage Check-Up and Pre-Renewal Worksheet