Commercial Lines Insurance Checklist Full Name* How many locations do you have?* Do you own, rent or have a triple net lease for your location?* Own Rent Triple net lease Home based business I currently have insurance coverage for the following: General Liability / Business Owners Policy Business property Business auto Equipment Breakdown Business interruption Employment practices liability Professional Liability Workers compensation Director’s & Officer’s liability Pollution liability Intellectual Property Cyber Liability/Date Breach Protection Company sponsored retirement plan Group medical plan Product recall Earthquake Flood Are any vehicles used for or registered to your business name?* Yes No Does your business lease/rent vehicles under the business name?* Yes No Do any employees use their own vehicles for your business?* Yes No Please let us know if you would like a quote for any of the following: General Liability / Business Owners Policy Business property Business auto Equipment Breakdown Business interruption Employment practices liability Professional Liability Workers compensation Director’s & Officer’s liability Pollution liability Intellectual Property Cyber Liability/Date Breach Protection Company sponsored retirement plan Group medical plan Product recall Earthquake Flood Other Would you like us to contact you for a coverage review?* Yes No Please note that this list is not all inclusive. You may have other exposures not addressed by these questions. If so, please let us know if you would like us to contact you to discuss your insurance needs and address any concerns you might have.
