Business Insurance

Business Name *

Do you wish to make, or do circumstances require any changes to your current liability limits or coverage amounts?YesNo

Have you made any improvements or renovations to your buildings or added any structures since you last reviewed the coverage amounts on your policy?YesNo

Does your building/premises have:Smoke DetectorsDead Bolt LocksFire ExtinguishersAlarm System

Have you added, changed, or deleted any security systems, safes, or sprinkler system?YesNo

Any changes or additional equipment, signs, computer equipment, tools purchased?YesNo

Has there been any change in your business; such as:New products sold or services provided?Changes to existing products or services offered?Changes in operations or types of work performed?

Are you regularly in possession of other people’s property? (i.e., for repair or maintenance)YesNo

Do you or any employee carry company money off site?YesNo

Are all owned or leased vehicles listed on your policy?YesNo

Do you work, maintain or operate a business, or keep samples for your business at any other location not listed on your policy?YesNo

Would you like information on wind mitigation credits?YesNo

Your property coverage may not provide coverage for ordinance or law. Do you want a quote for this very valuable coverage?YesNo

If you do not have a workers’ compensation policy, would you like a quote?YesNo

Would you be interested in a quote for Employment Practices Liability Insurance? (Wrongful Termination, Discrimination, Sexual Harassment, etc.)YesNo

Have there been any changes in:PayrollSales ReceiptsSpace Occupied

Do you own any additional property, vacant land, or rent or sublet any portion of your building to others?YesNo

Does your office have any recreational facilities?YesNo

Do you obtain certificates of insurance from all subcontractors?YesNo

Your business policy DOES NOT provide flood insurance. Would you be interested in a flood insurance cost quotation?YesNo

Would you be interested in a quotation for Life, Retirement, Group Health or Disability insurance?YesNo

Please describe all your operations, products, or services:

Insured’s Signature *

Date

Title

Phone Number

Email Address

Street Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

GET A HOME QUOTE

727-937-4291

info@capstoneinsurancegroup.com