Commercial Insurance Review Form

Overview

As your business grows and changes, we want to make sure that your insurance keeps up. Please complete the following checklist to help us ensure your policy continues to satisfy the needs of your business.

Company Name:

Policy Number:

Your Name: *

First

Last

Are you authorized by the business above to complete the following insurance review? *

Unauthorized

This form may only be completed by an authorized personnel. Please redirect this e-mail to the appropriate individual.

Information

Please confirm the following contact information:

Mailing Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Phone

Email *

1. Has there been any changes to your business's operating name, physical or mailing address, product or service offerings, business entities or partnerships?

Please Explain:

2. After reviewing your insurance renewal, can you confirm that the current coverage limits such as building limits, commercial equipment values, and contents limits are appropriate for your needs if you experience a major loss?

Please Explain:

3. In the event that your business is faced with a lawsuit, do the included liability limits seem appropriate for your business's level of assets as well as liability exposure?

Please explain:

4. Please confirm if you require either changes to the following coverages, or the addition of these coverages if you have not previously purchased them:

Business Contents (ex. computers and accessories, furniture, miscellaneous supplies)

Please explain:

Tools or Equipment (ex. hand held tools, power tools, specialized machinery etc.)

Please explain:

Cyber Breach (ex. liability and recovery expenses due to confidential data leaks)

Please explain:

Professional Error (ex. liability due to faulty advertisement or professional negligence)

Please explain:

5. Have there been any other recent changes to your business that may influence your insurance needs?

Please explain:

We also recommend completing an in-person policy review with our commercial insurance specialist every five years.

Would you like to request an in-person policy review?

Yes Please
No Thanks

Are you sure? Declining regular insurance reviews can impact the results of future claims if you are found to be incorrectly insured.

On second though, let's do it!
I'm sure.

Company Name:

Contact Name: *

First

Last

Contact Phone:

Preferred Date:

Preferred Time (select all that apply)

Morning
Afternoon

Location

HGA Insurance Office
Other

Where?

Are you in need of any other HGA Group services?

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