Insurance Checkup Form

Please make sure you have the following information available. Click the button to continue to the form.

• Company contact information including Federal ID Number.
• Current insurance information (property, liability, auto, worker's comp, bonds, etc) including
  Company Name, expiration date, limits, and length of time with carrier.
• Number of employees (full and part time) and revenue info.
• Property information including replacement cost of structure, contents, equipment, and signs, the
  amount of linear feet of glass on the building, the year constructed, and the year of any updates
  to sprinklers, roof, plumbing, heating, or electrical. (2 buildings)
• Vehicle information (up to six) including year, make, model, gross vehicle weight, cost new, and
  current lein holder.
• Driver information (up to six) including first and last name, date of birth, driver's license number,
  and the vehicle used.