Commercial Insurance Renewal Form

"*" indicates required fields

Full Name:*

First Last

Phone Number:*

Email Address:*

Mailing/Correspondence Address:*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Business Legal Name (and DBA, if applicable):*

Has your business name or entity changed?

Yes

What is new business name or entity change?

Has your business changed owners, partners or officers?

Yes

What is the change is owners, partners, or officers?

Has the nature of your business operations changed?

Yes

Merger/Acquisition/New products OR Services/New Locations or Territories/Etc

What is the change in the nature of your business operations?

Classification of business*

We ask specific renewal questions based off your business classification

How many W-2 employees does your team currently have?*

What is your projected total W-2 payroll for the upcoming 12 months?*

What is your projected gross revenue for the upcoming 12 months?*

What is your projected total paid to subcontractors or 1099 team members for the upcoming 12 months?

Do you have UL 300 or greater fire suppression system?

Yes

Do you have suppression system service contract in place?

Yes

What % of revenue is liquor or alcohol sales?

What % of revenue is delivery or catering?

Any major improvements or renovations on any properties we need to be aware of?

Yes

New roof, electrical, plumbing, kitchen remodel, bathroom remodel, structural changes,etc

What renovations or improvements have been done?

Please provide property address and explanation of improvement

Do your renewal policies need to be submitted to L&I?

Does your business have any of the below safety features? (May help with discounts)

Burglar Alarm

Fire Alarm

Interior Sprinkler System

Fire Extinguishers

Monitored Cameras

Employee Handbook

Drug Testing

Motor Vehicle Report monitoring

Select all that apply

Do we need to add any additional insured's to your policy?

(Bank/Landlord/New Contract holders/SBA)

If you have acquired any new property, added locations, or made other changes that effect your insurance needs, please detail them here.

Are you interested in getting a quote for any of the below coverages?

Cyber Liability

Employment Practice Liability

Employee Dishonesty

Earthquake Insurance

Other not listed

Cyber Liability- Protects you from data breach, ransomware, etc Employment Practice Liability - Protects your business against claims of discrimination, harassment, wrongful termination, etc Employee dishonesty- If an employee forges a check or steals money from you Earthquake- Provides coverage your business personal property or building in the event of an earthquake

Are there any certificate holders that need a copy of your renewal?

Yes

Is there anything else that we need to know now to make sure your insurance program is exactly what you need?

My business is built on referrals. What businessowners do you know that could benefit from my help?

Who do you work with on the PCRG Insurance Team?

hCaptcha*

Request Your Proposal Here

Are you ready to save time, aggravation, and money? The team at PCRG Insurance is here and ready to make the process as painless as possible. We look forward to meeting you!

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