BUSINESS OWNERS RISK MANAGEMENT QUESTIONNAIRE

In order for us to update our Risk Management Review of your business insurance coverages, we ask for your assistance with completing the questionnaire below. Upon receipt, we will review the responses and contact you if additional underwriting information is needed:

Has your business changed its operating name, business entities or partnerships?*

Yes
No

Please explain*

Has your business changed its location, products or services offered?*

Yes
No

Please explain*

In the past 12 months:

Has there been any change in ownership, management or key employees?*

Yes
No

Please explain*

Have you purchased any new equipment or business personal property?*

Yes
No

Please explain*

Have you completed any renovations or additions to your building?*

Yes
No

Please explain*

Please provide your Estimated Gross Sales (Revenue) for the next 12 months:*

Please provide your Estimated Payroll for the next 12 months:*

How many employees do you currently have?*

Has anything changed with your business vehicle usage?*

Yes
No

Please explain*

Data & Privacy - Do you have access to confidential data or personal information for your employees or customers?*

Yes
No

What percentage of your gross sales are:

Business to Business %

Business to Customer %

Website Derived %

What type of client & Employee Confidential information do you have? We will then have a list of items with check box next to them so clients can check off all the ones that apply:

Select All
Credit/Debit Cards
Bank Account Numbers
Protected Health Information
Social Security Numbers
Driver’s License/Passport Numbers
Educational Records

Professional Liability/Errors & Omissions - Do you offer a professional service to your clients that in the event of an error or omission on your behalf, could cause financial harm to your clients or others?*

Yes
No

Please explain*

Employment Practices Liability - Coverage is available to protect your business from lawsuits brought against you by your employees such as wrongful termination, discrimination or harassment. Would you be interested in a proposal?*

Yes
No

Do you have a human resources manual/Employee handbook?

Do you anticipate any changes in the number of employees over the next 12 months?

What is your average employee turnover rate in a year?

Thank you for taking the time to complete our risk management questionnaire.

Please enter your email address below and click Submit*