CL Renewal Survey in San Antonio, TX

Business Insurance Renewal Survey

Thank you for allowing us to be of service over the last year!

In an effort to be proactive in ensuring that we are putting the most competitive renewal option in front of you, please complete the form below.

Depending on the type of policy(ies) you have with us, you will need to provide us with the following information so we can remarket your policies: estimated gross sales and payroll figures for the upcoming 12-months and answer questions about how your operations may have changed - if any.

If there is any other way that we can improve your insurance experience, please don't hesitate to let us know. We look forward to continue being of service!

CL Renewal Questionaire

Step 1 of 7

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Name(Required)

Please provide the contact information for the submitter of this form.

First Last

Email(Required)

Mobile Number(Required)

Policyholder Name(Required)

As shown on the policy paperwork

Policy Type(Required)

Please check the policy types you are completing the renewal survey for.

General Liability

Commercial Property

Commercial Auto

Worker's Comp

Professional Liability

Excess Liability/Umbrella

Employment Practice Liability

Equipment/Installation Floater

Directors & Office Liability

Other

Have there been any changes to your operations or ownership?(Required)

Yes

Have you filed any claims (paid or unpaid by the carrier) or are you aware of a situation that could lead to a claim during the last 12 months of coverage?(Required)

Yes

Claims details

Please provide claims/loss details for any claim in the last 5 years. You can multiple claims by clicking on "Add Entry" below.

Date of Loss	Type of Loss	Actions

There are no Entries.

Maximum number of entries reached.

Has your business moved?(Required)

Yes

Please enter your new business address:(Required)

Street Address City State ZIP Code

Please estimate your GROSS sales/revenue for the next 12 months:(Required)

PLEASE NOTE: This should be your estimated gross sales or revenue for the upcoming 12 month period BEFORE any anticipated expenses, including, but not limited to: payroll, subcontract cost, materials, labor, taxes, etc.

How many employees do you have?(Required)

Please provide the number of all employees, including: fulltime, part-time, W2 and UNINSURED subcontractors which you have direct supervision of their work, hours and job location. DO NOT include owners/partners payroll.

Please estimate your payroll total for all employees for the next 12 months:(Required)

PLEASE NOTE: This should be the estimated payroll amount for W2 employees not including owners. 1099 independent contractors that you DO NOT require to have their own insurance or have a subcontractor agreement with should also be included in this number.

Do you subcontract *any* work?(Required)

Yes

Please estimate the total cost of subcontractors for the next 12 months:(Required)

Estimate the cost of INSURED subcontractors including labor and materials

Do your subcontractors carry their own insurance with matching limits of liability, hold harmless clause and you as an additional insured on their policy?(Required)

Yes

Do you generally use the same subcontractors?(Required)

Yes

Have there been any changes to drivers on the policy?(Required)

Yes

Have there been any changes to the vehicles listed on the policy?(Required)

Yes

Are all vehicles listed on the policy titled in the business name?(Required)

Yes

Please identify the vehicles not titled to the business and how the vehicle is titled:(Required)

Example: 2022 GMC Sierra - titled to: John Smith, Owner

Please estimate the number of Certificates of Insurance you will require over the next 12 months.(Required)

Have there been any changes to tenants in the building?(Required)

Yes

Would you like to upload a copy of your new rent rolls or manually enter the information for each tenant on this application?(Required)

Upload new rent rolls

Manually enter the information for each new tenant in this application

List of Tenants

Suite Number	Occupancy	Tenant Name	Square Footage	Certificate of Insurance kept on file?	Actions

There are no Entries.

Maximum number of entries reached.

Have there been any improvements or updates to the building systems (Electrical, Plumbing, HVAC) and/or roof in the last 12 months?(Required)

Yes

Property Details

System updated in the last 12 months(Required)

Electrical

Plumbing

HVAC

Roofing

Alarm

Sprinkler system

Other

Describe update(Required)

Please provide details of the updates or improvements made to the property in the last 12 months. Please be specific with the updates so we can provide the carrier with as much information as we can to allow them to add any credits to the policy. Include the type of update, date completed, how the system was updated and who completed the update (contractor name).

Mechanical Updates Affirmation(Required)

I confirm that the property we are looking to insure does not contain any undesirable electrical elements (including but not limited to Federal Pacific (FPE) Stab-lock panel which has been found to be a fire hazard, fuse, knob and tube or aluminum wiring), and that plumbing and electrical elements are up to building code. I understand that a physical property inspection will be completed. If any undesirable elements are found to be present on the property, it will require remediation or coverage for the property may be set up to cancel.

Are you interested in rounding out your business's insurance protection with any additional lines of business?

If YES, please check any boxes to let us know which additional coverages you are interested in learning about.

General Liability

Commercial Auto

Worker's Comp

Professional Liability

Excess Liability/Umbrella

Cyber Liability

Employment Practice Liability

Equipment/Installation Floater

Directors & Office Liability

Other

Additional Information

Please provide us with any additional information that you feel will help us with your renewal application.

File Upload Section

Drop files here or

Max. file size: 5 MB, Max. files: 10.

Please upload any documentation that will help us expediate the quote for you: Rent Rolls, Loss Runs (claims experience for the last 5 years), Current policy copies, etc.

Consent(Required)

I understand and agree to the following:

In assisting you with your insurance needs we are dependent on the information provided to us by you. If any of these area or others that need to be evaluated, please bring them to our attention prior to renewing your policy.

Should any of your business operations or exposures change, it is your responsibility to let us know promptly so coverage can be adjusted accordingly.

Submitting this renewal survey DOES NOT constitute confirmation of coverage of a new or revised insurance coverage.

Please allow up to 1 business day for an agency representative to contact you.

My Insurance Group is committed to respecting your privacy and communication preferences. So that we may remain compliant with state and federal regulations, we need your expressed permission to communicate with you through phone, text and email as needed.

You may opt-out of all future communication at any time by making your preferences known to us.

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