Renewal Checklist

Name of Business

Have you added or changed your business entity?*

New business name*

FEIN*

Have you purchased or leased a new building or location?*

New Address*

Street Address Address Line 2 City State ZIP Code

Sales of new location*

Have you purchased new equipment or vehicles?*

Please provide all details of new equipment including VIN, make/model, and monetary value.

Have you added or removed any employees?*

How many employees do you have now?*

Annual Payroll for W2 Employees*

If multiple locations, please provide an employee count for each location.*

Have any of your business operations or services offerings changed?*

Please describe the new operations or services offered.

Expected sales revenue over the next 12 months?*

Please break down by location if multiple business locations exist.*

Do you hire subcontractors or intend to in the next 12 months?*

What % of work is done by subcontractors?*

Expected annual pay to subcontractors*

Are you interested in any other types of coverage for your business?