Intake help for AI assistants

Help the applicant complete the questionnaire accurately. The applicant gives the final acknowledgment.

Never guess. Use only facts supplied or confirmed by the applicant. Answer every question the supplied facts answer. Use Not sure only when it accurately describes the applicant’s answer.
Public intake has no Leave this for the applicant control. Stop and ask the applicant when a required fact is missing. Do not continue past unanswered required questions, type a placeholder answer, or use Come back later as a bypass.
For credit authorization, stop and ask the applicant unless the applicant explicitly supplied their choice. Never infer authorization, decline, or Discuss with Lee first. Discuss with Lee first is an explicit applicant instruction, not an unanswered question.
Not sure records an unknown answer. Does not apply is different: use it only when the question does not apply.
Come back later bookmarks a question without answering it. Required unanswered questions still need a response before Continue, Review or submission.
Attach documents using the labelled file input on the relevant question. Check the displayed file status and Review for missing files. Use an offered send-later option only when appropriate.
Use the form save controls and keep the latest resume link private. Reopen that link to resume, check the restored answers, and reattach files if the form asks. Keep only one form tab open and do not overwrite newer answers from an older tab.
Only the applicant may use Answer this question to resolve an existing pending answer with a real response; never auto-accept a saved pending answer or clear its pending state automatically. Required pending answers must be resolved before Continue, Review and submission.
Stop at Review. The applicant must personally review all answers and give the required final acknowledgment. An AI assistant cannot attest for the applicant.
Submitting this questionnaire does not create, bind or change insurance coverage.
This reference lists every question-bank branch. Follow the full path shown in the live form; do not answer hidden branches or bypass the form with a submission API.

Return to your original questionnaire tab to continue. Machine-readable question reference

Question reference

Choose only the path that matches the applicant’s facts. Available lines: Business Insurance; Lessor's Risk / Property Insurance; Events, Sports & Recreation; Personal Insurance. Business classes: Contractor/Trades; Trucking/Transport; Food & Beverage; Beauty/Wellness; Healthcare/Care; Healthcare & Allied Health; Professional Services; Retail/E-commerce; Manufacturing & Products; Equipment & Event Rental; Real Estate / Property; Specialty/E&S.

Generated from bank f02d6f9be: 2322 question definitions across 237 branches. When shown, provide the applicant’s response or an available unknown answer that accurately reflects their choice. Required unanswered or pending questions must be resolved before Continue, Review and submission.

Home or Condo You Own: The home (6 questions)

Home address

What is the address of the home to be insured?

Control: address
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

How the home is used

Which best describes this home?

A primary home, a seasonal home, and a vacant one are written on different policy forms, so this shapes the rest of the questions.

Control: pills
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: My primary residence; A second or seasonal home; Currently vacant or unoccupied

Type of home

What kind of home is it?

Control: pills
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Site-built house; Condo or townhouse; Modular home; Log home; Adobe home; Metal home; Manufactured / mobile home; Other (dome, earth, or straw-bale)

Buying or already own

Are you buying this home now (under contract or closing soon), or do you already own it?

Control: pills
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Buying it now (under contract / closing soon); I already own it

Purchase date

When did you buy the home? An approximate date is fine.

Control: date
Response needed when shown: Optional
Shown when: Buying or already own is I already own it

Purchase price

What did you pay, or what are you paying, for the home?

A recent price is one input to sizing the dwelling coverage. The rebuild-cost estimate is done separately.

Control: money
Response needed when shown: Optional
Shown when: When this step is shown in the live form.

Home or Condo You Own: How it is occupied (7 questions)

Renting out part of the home

Do you rent out any part of the home, a room or the whole house, through Airbnb, VRBO, or a similar service, or to a longer-term tenant?

Paying guests and tenants change the liability picture, and some policy forms exclude them unless the coverage is added, subject to the policy wording.

Control: yesno
Response needed when shown: Optional
Shown when: How the home is used is one of: My primary residence; A second or seasonal home
Options: Yes; No

Smoking

Does anyone living in the home smoke?

Carriers ask this for fire rating. It does not decide eligibility on its own.

Control: yesno
Response needed when shown: Optional
Shown when: How the home is used is one of: My primary residence; A second or seasonal home
Options: Yes; No

Months occupied

Roughly how many months a year is someone living in the home?

Control: number
Response needed when shown: Optional
Shown when: How the home is used is A second or seasonal home

Why it is vacant

Why is the home vacant right now?

Control: pills
Response needed when shown: Yes when shown
Shown when: How the home is used is Currently vacant or unoccupied
Options: Estate, the owner passed away; Between tenants or up for rent; The owner moved to senior living or in with family; Recently bought or inherited; Under renovation; Up for sale; Other

Vacant since

About when did the home become vacant?

Control: date
Response needed when shown: Optional
Shown when: How the home is used is Currently vacant or unoccupied

Occupancy when coverage starts

On the day the policy would start, will anyone be living in the home?

A home that is empty on the day coverage starts is written on a different form than one that is lived in by then, so the plan matters more than the situation today.

Control: pills
Response needed when shown: Optional
Shown when: How the home is used is Currently vacant or unoccupied
Options: Still empty; Someone will be living in it by then; Not sure yet

Plans for the home

What is the plan for the home over the next year: sell it, rent it, move in, or keep it as is?

Control: textarea
Response needed when shown: Optional
Shown when: How the home is used is Currently vacant or unoccupied

Home or Condo You Own: About the house (6 questions)

Year built

What year was the home built? An approximate year is fine.

Age is a primary rating factor, and older homes may be asked about system updates.

Control: number
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Not sure

Square footage

What is the total living area, in square feet?

Control: number
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Not sure

Stories

How many stories does the home have?

Control: pills
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: 1; 1.5 (split-level or tri-level); 2 (including bi-level); 2.5; 3 or more

Living units

How many separate living units are in the building?

A duplex or larger is rated differently even when you live in one of the units.

Control: pills
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Just one (single-family); Duplex; Triplex; Fourplex; Five or more

Other dwellings on the property

Is there a second home, guest house, or casita on the same property?

Control: yesno
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes; No

Shared walls

Does the home share a wall with a neighbor, like a rowhouse or an attached townhouse?

Control: yesno
Response needed when shown: Optional
Shown when: Type of home is Site-built house
Options: Yes; No

Home or Condo You Own: Construction (11 questions)

Construction type

How are the outside walls built?

Frame and masonry homes are rated differently for fire and wind. Not sure is fine; public records usually have it.

Control: pills
Response needed when shown: Yes when shown
Shown when: Type of home is one of: Site-built house; Condo or townhouse; Modular home; Log home; Adobe home; Metal home; Other (dome, earth, or straw-bale)
Options: Wood frame; Solid brick or masonry (90% or more); Concrete block; Mixed: part masonry, part frame; Masonry veneer (brick or stone over a frame, 90% or more); Fiber-cement siding (HardiePlank, 90% or more); Fire resistive (concrete or steel, 90% or more); Other / not sure

Home masonry wall share

About how much of the outside walls is masonry or block?

Control: pills
Response needed when shown: Optional
Shown when: (Type of home is one of: Site-built house; Condo or townhouse; Modular home; Log home; Adobe home; Metal home; Other (dome, earth, or straw-bale) AND Construction type is Mixed: part masonry, part frame)
Options: Most of it; About half; Less than half; Not sure

Home roof and floor framing

What are the roof and upper floors built on?

Masonry walls with a wood-framed roof are rated differently from an all-masonry building.

Control: pills
Response needed when shown: Optional
Shown when: (Type of home is one of: Site-built house; Condo or townhouse; Modular home; Log home; Adobe home; Metal home; Other (dome, earth, or straw-bale) AND Construction type is one of: Solid brick or masonry (90% or more); Concrete block; Mixed: part masonry, part frame)
Options: Wood framing or rafters; Concrete or steel deck; Not sure

Foundation

What kind of foundation does the home sit on?

Control: pills
Response needed when shown: Yes when shown
Shown when: Type of home is one of: Site-built house; Condo or townhouse; Modular home; Log home; Adobe home; Metal home; Other (dome, earth, or straw-bale)
Options: Slab; Basement; Closed crawl space; Raised pier and beam, 2 feet or lower; Raised pier and beam, more than 2 feet; Wood; Other / not sure

Roof material

What is the roof made of?

Roof material and age are among the biggest factors on a home policy. Not sure is a fine answer.

Control: pills
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Asphalt or composition shingle; Tile (concrete or clay); Metal (steel, aluminum, or copper); Wood shake or shingle; A newer roof laid over wood shake; Slate; Other; Not sure

Roof replacement

Has the roof been replaced, and if so was it a full or partial job?

A full replacement generally means the complete roof was replaced; a partial job means repairs or replacement of only a portion of it. Pick whichever is closest. If a condo or townhouse association owns the roof, pick that instead.

Control: pills
Response needed when shown: Optional
Shown when: Buying or already own is I already own it
Options: Full replacement; Partial repair or replacement; Not replaced, or not sure; The HOA maintains it

Year of roof work

About what year was that roof work done?

Control: number
Response needed when shown: Optional
Shown when: Roof replacement is one of: Full replacement; Partial repair or replacement
Options: Not sure

Home type

Which best describes the home?

Control: pills
Response needed when shown: Optional
Shown when: Type of home is Manufactured / mobile home
Options: Single Wide; Double Wide; Triple Wide; Park Model; Fifth Wheel

Make / model

What is the make and model of the home?

Control: text
Response needed when shown: Optional
Shown when: Type of home is Manufactured / mobile home

Length x width

What are the home's outside length and width, in feet?

Control: dimensions
Response needed when shown: Optional
Shown when: Type of home is Manufactured / mobile home

How it's secured

How is the home installed or secured?

Control: pills
Response needed when shown: Optional
Shown when: Type of home is Manufactured / mobile home
Options: Permanent foundation; Tie-downs / anchored; Blocks & piers; Not sure

Home or Condo You Own: Heating and systems (11 questions)

Main heat source

What is the home's main source of heat?

Control: pills
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Furnace (forced air or central); Heat pump; Electric baseboard; Boiler (steam or hot-water radiators); Fireplace or wood stove as the main heat; Built-in space heater; Portable space heaters; None; Other

Heating fuel

What fuel does the main heating use?

Control: pills
Response needed when shown: Yes when shown
Shown when: Main heat source is one of: Furnace (forced air or central); Heat pump; Electric baseboard; Boiler (steam or hot-water radiators); Fireplace or wood stove as the main heat; Built-in space heater; Portable space heaters; Other
Options: Natural gas; Propane; Electricity from the utility; Solar, wind, or generator electricity; Oil; Wood or pellets; Other / not sure

Fireplace or wood stove

Is there a fireplace, wood or pellet stove, or other supplemental heating in the home?

Control: yesno
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes; No

Heater in a garage or outbuilding

Does a garage, workshop, or outbuilding have a wood, pellet, or kerosene heater?

Solid-fuel and kerosene heaters outside the living space are a common fire question on home applications.

Control: yesno
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes; No

Electrical / wiring update

Has the wiring been updated, and if so was it a full or partial update?

For a home over about 25 years old, carriers ask whether the wiring, plumbing and heating have been updated. A full update generally means replacing all wiring, outlets and the panel; partial means some of it. Not sure is fine.

Control: pills
Response needed when shown: Optional
Shown when: Year built is unknown or is at least 25 calendar years ago
Options: Full update; Partial update; Not updated, or not sure

Year of electrical work

About what year was the electrical work done?

Control: number
Response needed when shown: Optional
Shown when: Electrical / wiring update is one of: Full update; Partial update

Plumbing update

Has the plumbing been updated, and if so was it a full or partial update?

Control: pills
Response needed when shown: Optional
Shown when: Year built is unknown or is at least 25 calendar years ago
Options: Full update; Partial update; Not updated, or not sure

Year of plumbing work

About what year was the plumbing work done?

Control: number
Response needed when shown: Optional
Shown when: Plumbing update is one of: Full update; Partial update

Heating / cooling (HVAC) update

Has the heating or cooling system been updated, and if so was it a full or partial update?

Control: pills
Response needed when shown: Optional
Shown when: Year built is unknown or is at least 25 calendar years ago
Options: Full update; Partial update; Not updated, or not sure

Year of heating / cooling work

About what year was the heating or cooling work done?

Control: number
Response needed when shown: Optional
Shown when: Heating / cooling (HVAC) update is one of: Full update; Partial update

Other updates

Any other updates or renovations worth knowing about?

Control: textarea
Response needed when shown: Optional
Shown when: When this step is shown in the live form.

Home or Condo You Own: Condo or association (5 questions)

Condo / townhouse or HOA

Is this home a condo or townhouse, or otherwise part of an owners association (HOA)? You will see this question on each property you add, so properties in different associations, or in none, are all handled.

When an association is involved, its master insurance policy typically covers part of the building. Knowing that up front helps this property's coverage line up with the association's instead of insuring too much or too little.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Association / management company

What is the name of the association or its management company? A phone number or email is helpful if you have it.

If the documents aren't handy, the association or its management company is the quickest source for the master policy details.

Control: text
Response needed when shown: Optional
Shown when: Condo / townhouse or HOA is Yes

What the master policy covers

Associations carry a master insurance policy for the community. Do you know which parts of a unit it covers? Pick the closest match. Not sure is a perfectly normal answer.

The association's master policy may insure only the exterior structure, the unit as originally constructed, or most permanently installed parts of the unit. Your policy generally fills the gaps for what the master policy leaves out, along with personal property, liability, loss of use, and possible association deductibles or assessments, subject to the policy wording. A best guess here is fine. The association's documents are what actually spell this out, which is why we ask for a copy at the end.

Control: pills
Response needed when shown: Yes when shown
Shown when: Condo / townhouse or HOA is Yes
Options: Bare walls: structure and common areas only, not the unit interior; As originally built: the unit as first constructed, but not upgrades; All-in: most permanently installed parts of the unit; Not sure

Master policy deductible

If you know the master policy deductible, enter it here. Some associations can charge part of that deductible back to a unit owner after a loss; note that too if you know it. Not sure is fine.

A large master policy deductible, especially for water or wind, can sometimes be assessed back to unit owners. Knowing it helps with sizing loss assessment coverage. It also appears in the association documents, so leaving this blank just means the answer comes from there.

Control: text
Response needed when shown: Optional
Shown when: Condo / townhouse or HOA is Yes

Interior finishes and upgrades

Roughly what would it cost to redo the interior finishes of this unit: flooring, cabinets, counters, built-in fixtures, and any upgrades made since original construction? A rough estimate is fine.

Depending on what the master policy covers, some or all of the interior may be yours to insure. This estimate helps set the unit coverage limit. The association documents fill in the rest.

Control: money
Response needed when shown: Optional
Shown when: Condo / townhouse or HOA is Yes

Home or Condo You Own: Safety and liability (6 questions)

Safety and security devices

Which of these does the home have?

Several of these earn credits with most carriers. Pick everything that applies.

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Deadbolt locks; Smoke detectors; Carbon monoxide detector; Fire extinguisher; Monitored (central station) fire alarm; Burglar alarm, local or monitored; Fire sprinkler system; Smart home devices (leak sensor, cameras, smart locks); Bars on windows or doors; None of these

Existing damage or repairs needed

Is there any existing damage, or repairs that are needed, to the roof, structure, siding, chimney, foundation, walkways, or any other structure on the property?

Existing damage is usually excluded until it is fixed, so carriers ask about it up front. Describing it accurately avoids a surprise at inspection.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Construction or renovation

Is the home under construction or being renovated right now?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Swimming pool or hot tub

Is there a swimming pool deeper than about 2.5 feet, or a hot tub, on the property?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Pool fencing

How is the pool or hot tub secured?

A fence with a self-closing, self-latching gate is what most carriers look for. Note any diving board or slide in the comments at the end.

Control: pills
Response needed when shown: Yes when shown
Shown when: Swimming pool or hot tub is Yes
Options: Fully enclosed by a fence or barrier 4 feet or higher, with a self-latching gate; Fenced, but under 4 feet or without a self-latching gate; Not fenced, or not fully enclosed; It is a hot tub or spa with a locking cover

Trampoline

Is there a trampoline on the property?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Home or Condo You Own: Animals and business use (4 questions)

Dogs

Are there any dogs in the household?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Animal bite or injury history

Has any animal in the household ever bitten or injured someone?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Exotic or unusual animals

Any exotic or unusual animals, such as snakes, ferrets, large lizards, or livestock?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Business or farming on the property

Is any business run from the home or on the property, including farming or ranching, a home office with client visits, day care, or a salon?

A home-based business can generally be covered, but it has to be disclosed for the coverage to respond, subject to the policy wording.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Home or Condo You Own: Insurance history (4 questions)

Current insurance

Is the home insured right now?

Control: pills
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes, it is insured now; No, this is a new purchase; No, the policy lapsed or was cancelled; No, it has never been insured

Current insurer

Which company is the current policy with?

Control: text
Response needed when shown: Optional
Shown when: Current insurance is Yes, it is insured now
Options: AAA (Auto Club); Allstate; American Family; American Modern; American Reliable; Amica; ASI; Assurant; Auto-Owners; Chubb; COUNTRY Financial; Encompass; Farm Bureau; Farmers; Foremost; Homesite; Liberty Mutual; MetLife; National General; Nationwide; Progressive; Safeco; State Farm; Stillwater; The Hartford; Travelers; USAA

Cancellations or non-renewals

In the past five years, has any insurer cancelled, declined, or non-renewed a home policy of yours, including for non-payment?

Carriers ask this on every application. A yes rarely stops a quote; it just needs the reason.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Other policies to consider

Would you like a quote on anything else at the same time, such as a rental property, a boat, RV, or motorcycle, or an umbrella?

Control: textarea
Response needed when shown: Optional
Shown when: When this step is shown in the live form.

Home or Condo You Own: Claims history (2 questions)

Prior claims

Any current, ongoing, or past claims or losses at this home in the past 5 years?

Control: yesno
Response needed when shown: Optional
Shown when: Buying or already own is I already own it
Options: Yes; No

Known claims or damage

Are you aware of any past damage or insurance claims at this home, for example anything the seller disclosed or an inspection found?

Control: yesno
Response needed when shown: Optional
Shown when: Buying or already own is Buying it now (under contract / closing soon)
Options: Yes; No

Home or Condo You Own: Loan and other parties (7 questions)

Loan or mortgage

Is there a loan or mortgage on this home?

A lender named on the policy generally asks to receive the coverage documents directly. If there is no loan on this home, the next few questions are skipped.

Control: yesno
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes; No

Mortgagee / lender

Who is the lender or mortgagee on this home? The name as it appears on your loan paperwork is what we need.

A lender named on the policy is generally sent the coverage documents directly, which can help avoid force placed insurance.

Control: text
Response needed when shown: Optional
Shown when: Loan or mortgage is Yes

Clause wording

Lenders usually ask for a stock phrase after their name on the policy. Pick whichever ones your lender asked for. If they did not say, or you are not sure, choose the last option.

ISAOA and ATIMA are the two phrases nearly every lender asks to have added after its name. Picking them here means the mortgagee clause can be assembled from your answers instead of being typed out a second time.

Control: multichips
Response needed when shown: Optional
Shown when: Loan or mortgage is Yes
Options: ISAOA (its successors and/or assigns); ATIMA (as their interests may appear); Not sure, or my lender did not specify

Loan number

What is the loan number, if you have it handy? Lenders use it to match the insurance to your loan.

Control: text
Response needed when shown: Optional
Shown when: Loan or mortgage is Yes

Lender mailing address

What mailing address does the lender want listed on the policy? It is usually on your mortgage statement, and it is often a payment processing address rather than a branch.

This is generally where the lender's copy of the policy documents is sent. With the name and the wording above, it completes the mortgagee clause, so there is nothing left to paste in.

Control: address
Response needed when shown: Optional
Shown when: Loan or mortgage is Yes

Billing

How do you expect the insurance on this home to be paid: billed to the mortgage company through escrow, or paid by you directly?

Escrow billing runs through the loan servicer, so knowing which way you expect to pay tells us where the billing paperwork should go.

Control: pills
Response needed when shown: Optional
Shown when: Loan or mortgage is Yes
Options: Mortgagee billed (escrow); I'll pay directly; Not sure yet

Additional insureds

Besides the owner and any lender above, does anyone else need to be listed on the policy for this home, such as a property manager, a member or holding LLC, or a master tenant? Choose No if the named insured above is the only party. You will see the same question on each additional property you add.

An additional insured or loss payee is a party you've agreed to protect or name on the policy. Listing them with the property they belong to helps keep each policy's parties straight and can save a mid term policy change and a re issued certificate later.

Control: yesno
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes; No

Home or Condo You Own: Who is on the policy (6 questions)

Your date of birth

What is your date of birth?

Date of birth is a standard rating and identity factor on a home policy.

Control: date
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Spouse or co-applicant

Should a spouse or co-applicant be listed on the policy?

Control: yesno
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes; No

Who holds title

Who is on the title or deed?

The policy names whoever holds title. If the deed is in a trust or an LLC but the policy names only you, a claim can be disputed.

Control: pills
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Me, or me and my spouse or partner; A trust; An LLC, corporation, or other business; Someone else

Name on the title

What is the exact name on the title or deed?

Control: text
Response needed when shown: Optional
Shown when: Who holds title is one of: A trust; An LLC, corporation, or other business; Someone else

Mailing address same as the home

Is your mailing address the same as the home's address?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Mailing address

What is the best mailing address for your policy documents?

Control: address
Response needed when shown: Optional
Shown when: Mailing address same as the home is No

Home or Condo You Own: Coverage & policy details (5 questions)

Start / closing date

What date would you like the policy to begin? If you already have coverage, this is usually your current policy's renewal or cancellation date. If you are buying, it is your closing date. A near-term placeholder date is fine.

Control: date
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Detached structures

Are there detached structures to cover, such as a garage, workshop, casita, barn, or pool house?

Control: yesno
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes; No

High-value items

Do you have jewelry, art, firearms, collectibles, or other high-value items you would want specifically listed?

Standard policies cap certain categories. Listing items individually is how they are generally covered for full value, subject to the policy wording.

Control: yesno
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes; No

Current policy

Optional: attach your current declarations page or renewal notice.

Control: upload
Response needed when shown: Optional
Shown when: Current insurance is Yes, it is insured now
Options: I'll send it later

Anything else

Is there anything else Lee should know about the home?

Control: textarea
Response needed when shown: Optional
Shown when: When this step is shown in the live form.

Personal Auto: Household and garaging (5 questions)

Auto applicant date of birth

What is your date of birth?

Date of birth is a standard rating and identity factor on a personal auto policy.

Control: date
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Auto applicant marital status

What is your marital status?

Control: pills
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Single; Married; Divorced; Separated; Widowed

Garaging address

What is the main address where the vehicles are kept overnight?

Control: address
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Mailing address same as garaging address

Is your mailing address the same as the garaging address?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Different mailing address

What mailing address should be used for policy documents?

Control: address
Response needed when shown: Optional
Shown when: Mailing address same as garaging address is No

Personal Auto: Drivers (1 questions)

Drivers on the auto policy

Add every household member and other regular driver who may operate any of the vehicles, starting with yourself.

Carriers generally rate every household member and regular driver. Listing someone here does not add or change coverage.

Control: property_repeater
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Personal Auto: Vehicles (1 questions)

Vehicles on this auto policy

Add each vehicle. Enter the VIN if you have it, or enter the year, make, and model instead.

Control: property_repeater
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Personal Auto: Current insurance (6 questions)

Current personal auto insurance

Which best describes your personal auto insurance today?

Control: pills
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes, I have personal auto insurance now; No, this will be my first personal auto policy; No, my prior policy lapsed or was cancelled; No, I do not currently own a vehicle

Current auto insurer

Which company is the current policy with?

Control: text
Response needed when shown: Optional
Shown when: Current personal auto insurance is Yes, I have personal auto insurance now
Options: AAA (Auto Club); Allstate; American Family; American Modern; American Reliable; Amica; ASI; Assurant; Auto-Owners; Chubb; COUNTRY Financial; Encompass; Farm Bureau; Farmers; Foremost; Homesite; Liberty Mutual; MetLife; National General; Nationwide; Progressive; Safeco; State Farm; Stillwater; The Hartford; Travelers; USAA

Current policy renewal date

When does the current policy renew or expire?

Control: date
Response needed when shown: Optional
Shown when: Current personal auto insurance is Yes, I have personal auto insurance now

Continuous insurance history

How long have you had personal auto insurance without a break?

Control: pills
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: No prior personal auto insurance; Less than 6 months; 6 to 11 months; 1 to 2 years; 3 to 5 years; More than 5 years; Not sure

Coverage lapse

In the past three years, has there been any break in your personal auto insurance?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Cancellation or decline

In the past three years, has an insurer cancelled, declined, or non-renewed your personal auto insurance?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Personal Auto: Excluded household drivers (2 questions)

Excluded household drivers

Is any household member or regular driver excluded from the current policy or expected to be excluded from the quote?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Drivers to exclude

Add each driver and the reason for the exclusion.

An exclusion generally removes coverage for that person's driving, subject to the policy wording and carrier rules. This answer only records the requested application fact.

Control: property_repeater
Response needed when shown: Yes when shown
Shown when: Excluded household drivers is Yes

Personal Auto: Policy details (4 questions)

Requested auto policy start date

What date should the quote use as the requested policy start date? For an existing policy, this is often the renewal date. For a new vehicle, it may be the delivery date. A near-term placeholder date is fine.

Control: date
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Current auto policy document

Optional: attach your current declarations page or renewal notice.

Control: upload
Response needed when shown: Optional
Shown when: Current personal auto insurance is Yes, I have personal auto insurance now
Options: I'll send it later

Other personal policies to consider

Would you like us to consider anything else at the same time, such as home, rental property, boat, RV, motorcycle, or umbrella?

Control: textarea
Response needed when shown: Optional
Shown when: When this step is shown in the live form.

Anything else about the auto policy

Is there anything else Lee should know about the drivers, vehicles, or insurance history?

Control: textarea
Response needed when shown: Optional
Shown when: When this step is shown in the live form.

Personal Umbrella: Household (4 questions)

Umbrella applicant date of birth

What is your date of birth?

Date of birth is a standard rating and identity factor on a personal umbrella application.

Control: date
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Umbrella applicant home address

What is your primary home address?

Control: address
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Umbrella applicant marital status

What is your marital status?

Control: pills
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Single; Married; Divorced; Separated; Widowed

Household members

Add each person who lives in your household, including yourself.

Control: property_repeater
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Personal Umbrella: Drivers (4 questions)

Drivers in the household

Add each household member or other regular operator who drives. If no one drives, leave this empty.

Control: property_repeater
Response needed when shown: Optional
Shown when: When this step is shown in the live form.

Household vehicles

Add each car, pickup, SUV, van, or other private passenger vehicle owned, leased, or regularly used by the household. If there are none, leave this empty.

Control: property_repeater
Response needed when shown: Optional
Shown when: When this step is shown in the live form.

Drivers under age 25

Is any household member or regular driver under age 25?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Younger driver details

Add each driver under age 25.

Control: property_repeater
Response needed when shown: Yes when shown
Shown when: Drivers under age 25 is Yes

Personal Umbrella: Underlying policies (2 questions)

Policies beneath the umbrella

Add each current auto, home, watercraft, rental dwelling, or other liability policy that would sit beneath the umbrella.

Umbrella carriers generally require specified underlying policies and liability limits, subject to carrier guidelines. This schedule records what you currently carry; it does not select new limits or change any policy.

Control: property_repeater
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Underlying policy documents

Optional: attach the declarations pages for the policies you listed.

Control: upload
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: I'll send it later

Personal Umbrella: Rental properties (1 questions)

Rental properties you own

Add every rental dwelling you own. If you do not own any, leave this empty.

Control: property_repeater
Response needed when shown: Optional
Shown when: When this step is shown in the live form.

Personal Umbrella: Watercraft and recreational vehicles (1 questions)

Watercraft and recreational vehicles

Add every boat, personal watercraft, motorcycle, motor home, trailer, ATV, golf cart, or similar unit you own. If you do not own any, leave this empty.

Control: property_repeater
Response needed when shown: Optional
Shown when: When this step is shown in the live form.

Personal Umbrella: Liability exposures (5 questions)

Pools and hot tubs

Does any home or rental property you own have a swimming pool or hot tub?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Trampolines

Does any home or rental property you own have a trampoline?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Dogs in the household

Do you or any household member own a dog?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Household employees

Do you employ anyone in or around the home, such as a nanny, housekeeper, caretaker, or grounds worker?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Business or professional activity

Do you or any household member own a business, serve on a board, or have a professional activity that could create personal liability?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Personal Umbrella: Umbrella and claim history (5 questions)

Current umbrella policy

Do you currently have a personal umbrella policy?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Prior umbrella decline

In the past five years, has an insurer declined, cancelled, or non-renewed a personal umbrella policy for you?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Liability claims or incidents

In the past five years, have you or any household member had a liability claim, lawsuit, or incident that could lead to one?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Requested umbrella start date

What date should the umbrella quote use as the requested policy start date? A near-term placeholder date is fine.

Control: date
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Anything else about the umbrella

Is there anything else Lee should know about the household, underlying policies, or liability exposures?

Control: textarea
Response needed when shown: Optional
Shown when: When this step is shown in the live form.

Manufactured / Mobile Home: About you (2 questions)

Your date of birth

What is your date of birth?

Date of birth is a standard rating and identity factor on a home policy.

Control: date
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Spouse or co-applicant

Will a spouse or co-applicant be listed on the policy?

Control: yesno
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes; No

Manufactured / Mobile Home: The home (7 questions)

New purchase or existing home

Is this for a home you're buying, or one you already own?

Control: pills
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: New purchase; Existing home

Home address

What is the address of the manufactured or mobile home to be insured?

Control: address
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

How the home is used

Will this home be your primary residence, or a secondary / seasonal home?

Carriers use different policy forms for a primary home versus a seasonal or secondary one; getting this right keeps the coverage valid.

Control: pills
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Primary residence; Secondary / seasonal

Park or private land

Is the home in a mobile-home park, or on land?

Whether you own the land changes what lot and liability coverage you need.

Control: pills
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: In a mobile-home park (lot rent); On land I own; On land I rent

Years in the home

How long have you lived in the home?

Control: number
Response needed when shown: Optional
Shown when: New purchase or existing home is Existing home

Reason for shopping

What's prompting you to get a quote now?

Control: pills
Response needed when shown: Optional
Shown when: New purchase or existing home is Existing home
Options: Non-renewed by my current insurer; Shopping for better rates; New mortgage or refinance; Other

Your current address

What is your current residential address?

Control: address
Response needed when shown: Optional
Shown when: New purchase or existing home is New purchase

Manufactured / Mobile Home: About the home (18 questions)

Home type

Which best describes the home?

Control: pills
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Single Wide; Double Wide; Triple Wide; Park Model; Fifth Wheel

Year built

What year was the home built?

Age drives eligibility and rate; older homes may need updated systems to qualify.

Control: number
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Not sure

Make / model

What is the make and model of the home?

Control: text
Response needed when shown: Optional
Shown when: When this step is shown in the live form.

Serial / HUD number

What is the serial number or HUD tag number? (Leave blank if you don't have it handy.)

Carriers and the HUD registry identify a manufactured home by its serial / HUD number.

Control: text
Response needed when shown: Optional
Shown when: When this step is shown in the live form.

Square footage

Approximately how many square feet is the home?

Control: number
Response needed when shown: Optional
Shown when: When this step is shown in the live form.

Length x width

What are the home's outside length and width, in feet?

Control: dimensions
Response needed when shown: Optional
Shown when: When this step is shown in the live form.

How it's secured

How is the home installed or secured?

Anchoring / tie-downs affect wind eligibility and pricing.

Control: pills
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Permanent foundation; Tie-downs / anchored; Blocks & piers; Not sure

Insured value

About what amount would you like the home insured for (purchase price or replacement cost)?

This sets the dwelling limit used to rebuild or replace the home after a covered loss.

Control: money
Response needed when shown: Optional
Shown when: When this step is shown in the live form.

Roof replacement

Has the roof been replaced, and if so was it a full or partial job?

This just helps us describe the roof accurately. A full replacement generally means the complete roof was replaced; a partial job generally means repairs or replacement of only a portion of it. Pick whichever is closest. It's fine if it predates your purchase or you're not sure.

Control: pills
Response needed when shown: Optional
Shown when: New purchase or existing home is Existing home
Options: Full replacement; Partial repair or replacement; Not replaced, or not sure

Year of roof work

About what year was that roof work done? An approximate year is fine.

Control: number
Response needed when shown: Optional
Shown when: Roof replacement is one of: Full replacement; Partial repair or replacement
Options: Not sure

Electrical / wiring update

Has the wiring been updated, and if so was it a full or partial update?

This just helps us describe the wiring accurately. A full update generally means replacing all wiring, outlets, and the panel; a partial update generally means updates to some outlets or panel components only. Pick whichever is closest.

Control: pills
Response needed when shown: Optional
Shown when: New purchase or existing home is Existing home
Options: Full update; Partial update; Not updated, or not sure

Year of electrical work

About what year was the electrical work done? An approximate year is fine.

Control: number
Response needed when shown: Optional
Shown when: Electrical / wiring update is one of: Full update; Partial update

Plumbing update

Has the plumbing been updated, and if so was it a full or partial update?

This just helps us describe the plumbing accurately. A full update generally means replacing the plumbing in the kitchen and bathrooms; a partial update generally means replacing faucets, hoses, or smaller components. Pick whichever is closest.

Control: pills
Response needed when shown: Optional
Shown when: New purchase or existing home is Existing home
Options: Full update; Partial update; Not updated, or not sure

Year of plumbing work

About what year was the plumbing work done? An approximate year is fine.

Control: number
Response needed when shown: Optional
Shown when: Plumbing update is one of: Full update; Partial update

Heating / cooling (HVAC) update

Has the heating or cooling (HVAC) been updated, and if so was it a full or partial update?

This just helps us describe the HVAC accurately. A full update generally means replacing the furnace, water heater, or HVAC units; a partial update generally means some new equipment but not a full system replacement. Pick whichever is closest.

Control: pills
Response needed when shown: Optional
Shown when: New purchase or existing home is Existing home
Options: Full update; Partial update; Not updated, or not sure

Year of heating / cooling work

About what year was the heating or cooling work done? An approximate year is fine.

Control: number
Response needed when shown: Optional
Shown when: Heating / cooling (HVAC) update is one of: Full update; Partial update

Other updates

Any other updates or renovations we should know about?

Control: textarea
Response needed when shown: Optional
Shown when: New purchase or existing home is Existing home

Prior claims

Any current, ongoing, or past insurance claims or losses on this home in the past 5 years that you're aware of?

Control: yesno
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes; No

Manufactured / Mobile Home: Home eligibility (10 questions)

On stilts

Is the home raised up on stilts, posts, or open pilings?

A home elevated on stilts or open pilings is rated differently, and not every carrier will write one.

Control: yesno
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes; No

Condemned

Has the home been condemned, or is it currently condemned?

Carriers ask this to confirm the home is safe and legal to occupy.

Control: yesno
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes; No

Utilities connected

Is the home currently without utilities, meaning no electricity, water, or gas connected?

A home with the utilities shut off is treated differently from one that is lived in day to day.

Control: yesno
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes; No

Under renovation

Is the home currently under renovation or construction?

Active construction changes the policy form and who is on the hook while the work is underway.

Control: yesno
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes; No

Business use

Is any business run out of the home or conducted on the premises, meaning it's used as a commercial risk rather than just a place to live?

A home used for business, even a small home-based one, adds liability and can be quoted on a different program than an owner-occupied residence.

Control: yesno
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes; No

Titled to a business

Is the home titled in the name of a business or corporation?

Who holds title affects which program fits and who is named on the policy.

Control: yesno
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes; No

Unrepaired damage

Does the home or any attached structure have any damage that has not been repaired?

Existing unrepaired damage is usually excluded until it is fixed, so carriers ask about it up front.

Control: yesno
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes; No

Liability hazards

Are there any hazardous liability exposures on the premises or in the home, such as a dog with a bite history, a trampoline, or a similar hazard?

These are the exposures carriers most often ask about before quoting the liability coverage.

Control: yesno
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes; No

Community pool

Does the mobile-home park or community have a swimming pool or hot tub?

Carriers rating a home inside a park ask which shared amenities the community has, so we note a park pool or hot tub either way. This one is about the park's own amenity, not anything on your lot.

Control: yesno
Response needed when shown: Optional
Shown when: Park or private land is In a mobile-home park (lot rent)
Options: Yes; No

Swimming pool

Is there a swimming pool or hot tub on the premises?

A pool or hot tub adds liability exposure. A fence with a self-closing, self-latching gate is a requirement for most of the carriers we work with; without one, we may be unable to find a market willing to offer a policy.

Control: yesno
Response needed when shown: Optional
Shown when: Park or private land is one of: On land I own; On land I rent
Options: Yes; No

Manufactured / Mobile Home: Heating, protection and insurance history (6 questions)

Heating type

What is the home's main source of heat?

A wood stove or portable space heater is rated differently from central heat, and carriers ask on every application.

Control: pills
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Forced air / central; Heat pump; Electric baseboard; Wall or floor furnace; Wood or pellet stove; Portable space heaters; None; Other

Safety and security devices

Which of these does the home have?

Smoke detectors and monitored alarms generally earn credits.

Control: multichips
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Smoke detectors; Central fire or smoke monitoring; Burglar alarm (monitored); Deadbolt locks; None of these

Smoking

Does anyone living in the home smoke?

Carriers ask this for fire rating. It does not decide eligibility on its own.

Control: yesno
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes; No

Current insurance

Is the home insured right now?

Control: pills
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes, it is insured now; No, this is a new purchase; No, the policy lapsed or was cancelled; No, it has never been insured

Current insurer

Which company is the current policy with?

Control: text
Response needed when shown: Optional
Shown when: Current insurance is Yes, it is insured now
Options: AAA (Auto Club); Allstate; American Family; American Modern; American Reliable; Amica; ASI; Assurant; Auto-Owners; Chubb; COUNTRY Financial; Encompass; Farm Bureau; Farmers; Foremost; Homesite; Liberty Mutual; MetLife; National General; Nationwide; Progressive; Safeco; State Farm; Stillwater; The Hartford; Travelers; USAA

Cancellations or non-renewals

In the past five years, has any insurer cancelled, declined, or non-renewed a home policy of yours, including for non-payment?

Control: yesno
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes; No

Manufactured / Mobile Home: Coverage & policy details (6 questions)

Effective / closing date

What date would you like the policy to begin? If you already have coverage, this is usually your current policy's renewal or cancellation date. If you're buying, it's the date you'll take ownership. You can also enter any other date, for example if you're switching mid-term. A near-term placeholder date is fine.

Control: date
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Billing

Will the policy be billed to you directly, or paid through escrow by your lender?

Control: pills
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: I'll pay directly; Escrow (lender pays); No lender

Mortgagee / lender

Who is the lender or mortgagee on this home? Give the name, mailing address and loan number to list on the policy.

A lender named on the policy receives proof of coverage directly, which helps avoid force-placed insurance.

Control: textarea
Response needed when shown: Optional
Shown when: Billing is one of: I'll pay directly; Escrow (lender pays)

Registration / title

Optional: attach a copy of your manufactured-home registration or title.

Control: upload
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: I'll send it later

Current / renewal policy

Optional: attach your current policy declarations or renewal documents.

Control: upload
Response needed when shown: Optional
Shown when: Reason for shopping is one of: Non-renewed by my current insurer; Shopping for better rates
Options: I'll send it later

Anything else

Is there anything else I should know or be aware of?

Control: textarea
Response needed when shown: Optional
Shown when: When this step is shown in the live form.

Renters Insurance: Your rental (1 questions)

Rental address

What is the address of the home or apartment you rent?

Control: address
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Motorcycle, ATV, Golf Cart, or Snowmobile: About you (5 questions)

Your date of birth

What is your date of birth?

Date of birth is a standard rating and identity factor on a vehicle policy.

Control: date
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Marital status

What is your marital status?

Carriers rate on it. Any answer is fine.

Control: pills
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Single; Married; Divorced; Separated; Widowed

Mailing address

What is your home mailing address?

Where the policy documents are sent. If any of your vehicles are kept somewhere else, you can say so on each one.

Control: address
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Anyone else on the title

Are any of the vehicles titled to a second person, a business, or a trust as well as you?

Everyone on the title is generally named on the policy so a claim payment reaches the right owner.

Control: pills
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Just me; A second person (spouse, partner, or family member); A business; A trust

Co-owner name

What is the full name of the other person, business, or trust on the title? Add a date of birth for a person.

Control: text
Response needed when shown: Optional
Shown when: Anyone else on the title is one of: A second person (spouse, partner, or family member); A business; A trust

Motorcycle, ATV, Golf Cart, or Snowmobile: Riders and drivers (1 questions)

Who rides or drives

Add everyone in the household who rides or drives any of these vehicles, starting with yourself.

Every regular operator is rated and listed on the policy. Someone who never operates them does not need to be added.

Control: property_repeater
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Motorcycle, ATV, Golf Cart, or Snowmobile: Your vehicles (1 questions)

Vehicles to insure

Add each vehicle to insure.

Control: property_repeater
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Motorcycle, ATV, Golf Cart, or Snowmobile: Insurance history (3 questions)

Current insurance

Are the vehicles insured right now?

Control: pills
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes, with another company; No, this is a new purchase; No, coverage lapsed or was cancelled; No, it has never been insured

Current insurer

Which company is the current policy with?

Control: text
Response needed when shown: Optional
Shown when: Current insurance is Yes, with another company
Options: AAA (Auto Club); Allstate; American Family; American Modern; American Reliable; Amica; ASI; Assurant; Auto-Owners; Chubb; COUNTRY Financial; Encompass; Farm Bureau; Farmers; Foremost; Homesite; Liberty Mutual; MetLife; National General; Nationwide; Progressive; Safeco; State Farm; Stillwater; The Hartford; Travelers; USAA

Claims and losses

In the past 3 years, have you or anyone who operates the vehicles had a claim, accident, or loss involving any of them?

Every carrier asks this. A past claim rarely stops a quote, it just needs to be described accurately up front.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Motorcycle, ATV, Golf Cart, or Snowmobile: Continuous coverage (1 questions)

Prior coverage

Have you carried insurance on a motorcycle or off-road vehicle continuously for the past six months?

Continuous prior coverage earns a credit with many carriers. No is a normal answer for a first bike.

Control: yesno
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes; No

Motorcycle, ATV, Golf Cart, or Snowmobile: Coverage & policy details (4 questions)

Start date

What date would you like the policy to begin? If you already have coverage, this is usually your renewal or cancellation date. If you are buying, it is the day you take delivery. A near-term placeholder date is fine.

Control: date
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Level of coverage

For the vehicles, are you looking for liability only, or full coverage that also pays for damage to your own unit?

Liability only covers injury or damage you cause to others. Full coverage generally adds comprehensive and collision for the unit itself, subject to the policy wording. A lender usually asks for full coverage on a financed unit.

Control: pills
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Liability only; Full coverage (comprehensive and collision too); Not sure, please advise

Current policy

Optional: attach your current declarations page or renewal notice.

Control: upload
Response needed when shown: Optional
Shown when: Current insurance is Yes, with another company
Options: I'll send it later

Anything else

Is there anything else Lee should know?

Control: textarea
Response needed when shown: Optional
Shown when: When this step is shown in the live form.

Motor Home or Travel Trailer: What you are insuring (1 questions)

Motor home or trailer

Is this a motor home you drive, a trailer you tow, or both?

A motor home is rated on its drivers like a car. A towed trailer has no driver questions of its own.

Control: pills
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Motor home (you drive it); Travel trailer, fifth wheel, or camper (you tow it); Both

Motor Home or Travel Trailer: About you (5 questions)

Your date of birth

What is your date of birth?

Date of birth is a standard rating and identity factor on a vehicle policy.

Control: date
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Marital status

What is your marital status?

Carriers rate on it. Any answer is fine.

Control: pills
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Single; Married; Divorced; Separated; Widowed

Mailing address

What is your home mailing address?

Where the policy documents are sent. If any of your RVs are kept somewhere else, you can say so on each one.

Control: address
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Anyone else on the title

Are any of the RVs titled to a second person, a business, or a trust as well as you?

Everyone on the title is generally named on the policy so a claim payment reaches the right owner.

Control: pills
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Just me; A second person (spouse, partner, or family member); A business; A trust

Co-owner name

What is the full name of the other person, business, or trust on the title? Add a date of birth for a person.

Control: text
Response needed when shown: Optional
Shown when: Anyone else on the title is one of: A second person (spouse, partner, or family member); A business; A trust

Motor Home or Travel Trailer: Drivers (1 questions)

Who drives the motor home

Add everyone who drives the motor home, starting with yourself.

Control: property_repeater
Response needed when shown: Yes when shown
Shown when: Motor home or trailer is one of: Motor home (you drive it); Both

Motor Home or Travel Trailer: Your RVs (1 questions)

RVs and trailers to insure

Add each motor home or trailer to insure.

Control: property_repeater
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Motor Home or Travel Trailer: Insurance history (3 questions)

Current insurance

Are the RVs insured right now?

Control: pills
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes, with another company; No, this is a new purchase; No, coverage lapsed or was cancelled; No, it has never been insured

Current insurer

Which company is the current policy with?

Control: text
Response needed when shown: Optional
Shown when: Current insurance is Yes, with another company
Options: AAA (Auto Club); Allstate; American Family; American Modern; American Reliable; Amica; ASI; Assurant; Auto-Owners; Chubb; COUNTRY Financial; Encompass; Farm Bureau; Farmers; Foremost; Homesite; Liberty Mutual; MetLife; National General; Nationwide; Progressive; Safeco; State Farm; Stillwater; The Hartford; Travelers; USAA

Claims and losses

In the past 3 years, have you or anyone who operates the RVs had a claim, accident, or loss involving any of them?

Every carrier asks this. A past claim rarely stops a quote, it just needs to be described accurately up front.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Motor Home or Travel Trailer: Coverage & policy details (5 questions)

Start date

Control: date
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Level of coverage

For the RVs, are you looking for liability only, or full coverage that also pays for damage to your own unit?

Control: pills
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Liability only; Full coverage (comprehensive and collision too); Not sure, please advise

Belongings inside

Roughly what are the personal belongings kept in the RV worth?

Clothing, electronics, camping gear and kitchen items are generally covered separately from the unit itself, up to the amount chosen, subject to the policy wording.

Control: money
Response needed when shown: Optional
Shown when: When this step is shown in the live form.

Current policy

Optional: attach your current declarations page or renewal notice.

Control: upload
Response needed when shown: Optional
Shown when: Current insurance is Yes, with another company
Options: I'll send it later

Anything else

Is there anything else Lee should know?

Control: textarea
Response needed when shown: Optional
Shown when: When this step is shown in the live form.

Boat or Watercraft: About you (6 questions)

Your date of birth

What is your date of birth?

Date of birth is a standard rating and identity factor on a vehicle policy.

Control: date
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Marital status

What is your marital status?

Carriers rate on it. Any answer is fine.

Control: pills
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Single; Married; Divorced; Separated; Widowed

Mailing address

What is your home mailing address?

Where the policy documents are sent. If any of your boats are kept somewhere else, you can say so on each one.

Control: address
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Anyone else on the title

Are any of the boats titled to a second person, a business, or a trust as well as you?

Everyone on the title is generally named on the policy so a claim payment reaches the right owner.

Control: pills
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Just me; A second person (spouse, partner, or family member); A business; A trust

Co-owner name

What is the full name of the other person, business, or trust on the title? Add a date of birth for a person.

Control: text
Response needed when shown: Optional
Shown when: Anyone else on the title is one of: A second person (spouse, partner, or family member); A business; A trust

Corporate ownership

Is a boat owned in a corporation's name for tax purposes only, while you use it personally?

Control: yesno
Response needed when shown: Optional
Shown when: Anyone else on the title is A business
Options: Yes; No

Boat or Watercraft: Operators (1 questions)

Who operates the boat

Add everyone who operates any of the boats, starting with yourself.

Control: property_repeater
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Boat or Watercraft: Your boats (1 questions)

Boats to insure

Add each boat or watercraft to insure.

Control: property_repeater
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Boat or Watercraft: Insurance history (3 questions)

Current insurance

Are the boats insured right now?

Control: pills
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes, with another company; No, this is a new purchase; No, coverage lapsed or was cancelled; No, it has never been insured

Current insurer

Which company is the current policy with?

Control: text
Response needed when shown: Optional
Shown when: Current insurance is Yes, with another company
Options: AAA (Auto Club); Allstate; American Family; American Modern; American Reliable; Amica; ASI; Assurant; Auto-Owners; Chubb; COUNTRY Financial; Encompass; Farm Bureau; Farmers; Foremost; Homesite; Liberty Mutual; MetLife; National General; Nationwide; Progressive; Safeco; State Farm; Stillwater; The Hartford; Travelers; USAA

Claims and losses

In the past 3 years, have you or anyone who operates the boats had a claim, accident, or loss involving any of them?

Every carrier asks this. A past claim rarely stops a quote, it just needs to be described accurately up front.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Boat or Watercraft: Prior coverage (2 questions)

Prior boat insurance

Have you had boat insurance continuously for the past 12 months?

Prior coverage earns a credit with many carriers. No is a normal answer for a first boat.

Control: yesno
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes; No

Cancellations for non-payment

In the past five years, have three or more insurance policies of any kind been cancelled for non-payment?

Control: yesno
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes; No

Boat or Watercraft: Coverage & policy details (5 questions)

Start date

Control: date
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Level of coverage

For the boats, are you looking for liability only, or full coverage that also pays for damage to your own unit?

Control: pills
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Liability only; Full coverage (comprehensive and collision too); Not sure, please advise

Gear on board

Roughly what are the fishing gear, electronics, water toys and other personal items kept on board worth?

Control: money
Response needed when shown: Optional
Shown when: When this step is shown in the live form.

Current policy

Optional: attach your current declarations page or renewal notice.

Control: upload
Response needed when shown: Optional
Shown when: Current insurance is Yes, with another company
Options: I'll send it later

Anything else

Is there anything else Lee should know?

Control: textarea
Response needed when shown: Optional
Shown when: When this step is shown in the live form.

Home / Dwelling Rental: Property information (4 questions)

Property address

What is the full address of the rental property?

Control: address
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

One property or several

Are you looking to quote just this one rental property, or more than one? Properties titled to different people or LLCs are fine. This form covers up to 7 properties, and you'll add each one after finishing this first property. If you have 8 or more, choose that option to upload your property list instead.

Knowing this up front shapes the rest of the questionnaire. You'll answer the full set of questions for this first property, then add each additional property with a shorter per-property card, reusing owners and other details you've already entered instead of retyping them.

Control: pills
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Just this one property; More than one property; 8 or more properties

Named insured / ownership

Is this property titled under you personally, an LLC, or another entity? Give the exact legal name that should appear on the policy as the primary named insured for THIS property. If you own other properties under different names, no problem, you can flag each one as you add it below.

The primary named insured is who the policy protects, so it needs to match how the property is titled. If the title is in an LLC but the policy names you personally, a claim can be denied.

Control: text
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Buying or already own

Is this a property you're buying now (under contract or closing soon), or one you already own?

A purchase is quoted to begin at closing, with the contract price as the value basis and no claims history expected from you. A property you already own is quoted on its current occupancy, condition, and insurance history.

Control: pills
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Buying it now (under contract / closing soon); I already own it

Home / Dwelling Rental: Property details (5 questions)

Property type

What type of property is it?

The number of units and property type change how the policy is rated and which carriers will write it.

Control: pills
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Single-family home; Condo; Townhouse; Duplex; Triplex; Fourplex; Apartment (5+ units); Other

Year built

What year was the home built? An approximate year is fine.

Age and roof/system updates are primary rating factors.

Control: number
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Not sure

Square footage

What is the total living area of the home in square feet?

Square footage drives the rebuild-cost estimate that sets your dwelling limit.

Control: number
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Number of stories

How many stories is the building?

Control: number
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Number of units

How many separate rental units are in the building? Enter 1 for a single family home.

The unit count determines which policy form and carriers fit the property.

Control: number
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Home / Dwelling Rental: Layout and construction (7 questions)

Full bathrooms

How many full bathrooms does the home have?

Control: number
Response needed when shown: Optional
Shown when: When this step is shown in the live form.

Half bathrooms

How many half bathrooms?

Control: number
Response needed when shown: Optional
Shown when: When this step is shown in the live form.

Construction type

How are the outside walls built?

Construction class is a primary rating factor and appears on the carrier application.

Control: pills
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Frame (wood); Masonry / brick; Concrete block; Steel / metal; Fire resistive (concrete); Mixed: part masonry, part frame; Other / not sure

Rental masonry wall share

About how much of the outside walls is masonry or block?

Control: pills
Response needed when shown: Optional
Shown when: Construction type is Mixed: part masonry, part frame
Options: Most of it; About half; Less than half; Not sure

Rental roof and floor framing

What are the roof and upper floors built on?

Masonry walls with a wood-framed roof are rated differently from an all-masonry building.

Control: pills
Response needed when shown: Optional
Shown when: Construction type is one of: Masonry / brick; Concrete block; Mixed: part masonry, part frame
Options: Wood framing or rafters; Concrete or steel deck; Not sure

Exterior walls

What are the exterior walls made of?

Control: pills
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Vinyl siding; Wood siding; Stucco; Brick or stone; Fiber cement; Metal; Other

Roof material

What material is the roof?

Roof material and age drive wind and hail eligibility and pricing.

Control: pills
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Asphalt shingle; Tile (clay or concrete); Metal; Wood shake; Flat / built-up; Other; Not sure

Home / Dwelling Rental: Foundation, systems and safety (5 questions)

Foundation

What type of foundation does the home sit on?

Control: pills
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Slab; Crawl space; Basement (full or partial); Pier and beam; Other

Heating type

How is the home heated?

Control: pills
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Forced air / central; Heat pump; Electric baseboard; Boiler / radiator; Wall or floor furnace; None; Other

Pool or trampoline

Is there a swimming pool, hot tub, or trampoline at the property itself? A shared community or HOA amenity doesn't count here, only one on the property you're insuring.

Pools and trampolines add liability exposure carriers ask about up front. We're only asking about the property you're insuring, so answer No if the only pool or hot tub is a shared community or HOA amenity.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Pool fencing

If there's a swimming pool, is it fully fenced with a self-closing, self-latching gate?

A pool enclosed by a fence with a self-closing, self-latching gate is a common carrier requirement and can decide whether a home is eligible.

Control: pills
Response needed when shown: Optional
Shown when: Pool or trampoline is Yes
Options: Yes, fully fenced with a self-closing, self-latching gate; Fenced, but the gate is not self-closing or self-latching; Not fully fenced; No pool (hot tub or trampoline only)

Interior condition

How would you describe the interior condition?

Updated roof, plumbing, and electrical qualify for better rates and avoid surprises at inspection.

Control: pills
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Fully remodeled; Average; Needs updates

Home / Dwelling Rental: Protection and updates (15 questions)

Roof shape

What shape is the roof?

Control: pills
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Gable (peaked); Hip; Flat; Not sure

Roof replacement

Has the roof been replaced, and if so was it a full or partial job?

This just helps us describe the roof accurately. A full replacement generally means the complete roof was replaced; a partial job generally means repairs or replacement of only a portion of the roof. Pick whichever is closest. It's fine if it predates your purchase or you're not sure. If this is a condo and the association maintains the roof, pick that instead.

Control: pills
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Full replacement; Partial repair or replacement; Not replaced, or not sure; The HOA maintains it

Year of roof work

About what year was that roof work done? An approximate year is fine.

Control: number
Response needed when shown: Optional
Shown when: Roof replacement is one of: Full replacement; Partial repair or replacement
Options: Not sure

Electrical / wiring update

Has the wiring been updated, and if so was it a full or partial update?

This just helps us describe the wiring accurately. A full update generally means replacing all wiring, outlets, and the circuit panel; a partial update generally means updates to some outlets or panel components only. Pick whichever is closest.

Control: pills
Response needed when shown: Optional
Shown when: Year built is unknown or is at least 25 calendar years ago
Options: Full update; Partial update; Not updated, or not sure

Year of electrical work

About what year was the electrical work done? An approximate year is fine.

Control: number
Response needed when shown: Optional
Shown when: Electrical / wiring update is one of: Full update; Partial update

Plumbing update

Has the plumbing been updated, and if so was it a full or partial update?

This just helps us describe the plumbing accurately. A full update generally means replacing the plumbing in the kitchens and bathrooms; a partial update generally means replacing faucets, hoses, or smaller components. Pick whichever is closest.

Control: pills
Response needed when shown: Optional
Shown when: Year built is unknown or is at least 25 calendar years ago
Options: Full update; Partial update; Not updated, or not sure

Year of plumbing work

About what year was the plumbing work done? An approximate year is fine.

Control: number
Response needed when shown: Optional
Shown when: Plumbing update is one of: Full update; Partial update

Heating / cooling (HVAC) update

Has the heating or cooling (HVAC) been updated, and if so was it a full or partial update?

Control: pills
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Full update; Partial update; Not updated, or not sure

Year of heating / cooling work

About what year was the heating or cooling work done? An approximate year is fine.

Control: number
Response needed when shown: Optional
Shown when: Heating / cooling (HVAC) update is one of: Full update; Partial update

Protective devices

Which of these does the property have?

Alarms and sprinklers can qualify for protective-device credits.

Control: multichips
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Smoke detectors; Central fire or smoke monitoring; Fire sprinkler system; Burglar alarm (monitored); Deadbolt locks; None of these

Purchase date

When did you purchase the property?

Control: date
Response needed when shown: Optional
Shown when: Buying or already own is I already own it

Purchase price

Roughly what did you pay for the property?

Control: money
Response needed when shown: Optional
Shown when: Buying or already own is I already own it

Expected closing date

When is the closing expected? Coverage is typically set to begin on the closing date.

Control: date
Response needed when shown: Optional
Shown when: Buying or already own is Buying it now (under contract / closing soon)

Contract price

Roughly what is the contract (purchase) price?

The contract price helps sanity-check the rebuild value the dwelling limit is based on.

Control: money
Response needed when shown: Optional
Shown when: Buying or already own is Buying it now (under contract / closing soon)

Other updates

Any other updates or renovations we should know about?

Control: textarea
Response needed when shown: Optional
Shown when: When this step is shown in the live form.

Home / Dwelling Rental: Upkeep and servicing (4 questions)

Maintenance and repairs

When something needs fixing at this property, how does it usually get handled?

Carriers look at how quickly a problem gets attention, because a small leak found the same day is generally a smaller claim than one found at the end of the month. Calling someone out as needed is the most common answer for a single rental.

Control: pills
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: I handle repairs myself; Called out as needed; A maintenance contract or regular schedule; A 24/7 on-call service

Parking and walkways

How would you describe the driveway, walkways and any parking area? A quick look is enough, this is not an inspection.

Most claims against a landlord personally are someone tripping outside rather than anything that happens indoors, so the walking surfaces are rated alongside the building. Pick the plainest description rather than the most flattering one, since the surface is what it is on the day someone falls on it. If an association maintains the grounds, pick that instead.

Control: pills
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Some cracking or uneven spots; Sound, with normal wear; Recently paved or resurfaced; The HOA maintains it

Heating and cooling service

When was the heating and cooling last serviced or tuned up? This is about routine servicing, not replacing the system. An approximate answer is fine.

A serviced system is one of the few upkeep facts a carrier will ask about directly, since it bears on fire and water losses. Answer for whichever systems the home actually has: if there is no cooling, the heating date is the answer, and a system that has never been serviced is the last option.

Control: pills
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Within the last year; One to two years ago; More than two years ago, or not sure

Plumbing service

When was the plumbing last serviced or inspected? If the home has a smart leak detector or an automatic water shutoff, pick that instead, it tells us more than the date does.

Water is the most common source of loss in a rental home. A monitored shutoff can shorten a burst-pipe loss from a flooded floor to a wet patch, and some carriers price for one, subject to their own guidelines.

Control: pills
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Within the last year; More than a year ago, or not sure; It has smart leak detection or an automatic water shutoff

Home / Dwelling Rental: Rental details (11 questions)

Rental type

Will this be a short-term rental (Airbnb, VRBO, etc.) or a long-term rental?

Short-term rentals need a different policy form than long-term leases; the wrong form can void coverage for guest-caused damage.

Control: pills
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Short-term (Airbnb, VRBO, etc.); Long-term lease; Both

Current occupancy

Is the property in regular use, sitting vacant, or under renovation? A short-term rental (Airbnb, VRBO, etc.) with recent and upcoming bookings counts as in regular use even if no guest is staying today. If it has had no tenant or guest for more than about 30 days and none is booked, choose Vacant.

A vacant home carries different exposures, and most standard policies limit or exclude some losses while a property sits empty and unrented for an extended period. Carriers generally do not treat a furnished, actively booked short-term rental as vacant between guests, but definitions vary by policy.

Control: pills
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Occupied or regularly rented; Vacant; Under renovation

Occupancy when coverage would start

Since the home is empty today, what do you expect on the day a policy would take effect?

A home that is empty on day one is rated and written differently from one that is already rented, and most standard forms limit or exclude certain losses while a home stays empty, subject to the policy wording. Which of the two it is on day one is the fact that decides which of those forms the property fits.

Control: pills
Response needed when shown: Optional
Shown when: Current occupancy is Vacant
Options: Still empty; A tenant will be in it by then; I or a family member will be in it by then; Not sure yet

Occupancy plans for the next year

In a sentence or two, how do you expect the home to be used over the coming year? A rough plan is fine, for example listing it for rent once a few repairs are done, holding it empty between family stays, or putting it on the market.

Vacancy is usually a phase rather than a permanent condition, and how long it is expected to last is what carriers underwrite to. A couple of sentences here often replaces a round of follow-up questions and can point toward a policy that still fits six months from now.

Control: textarea
Response needed when shown: Optional
Shown when: Occupancy when coverage would start is one of: Still empty; Not sure yet

Plan after the renovation

Once the renovation work is finished, what do you plan to do with the property?

A home being renovated to rent out generally sits on a different policy form than one being renovated to resell, so the plan after the work points to which form fits.

Control: pills
Response needed when shown: Optional
Shown when: Current occupancy is Under renovation
Options: Rent it out when the work is done; Sell it, fix and flip; Move in or keep it; Not decided yet

Anticipated rental income

What is the anticipated annual rental income for the property?

This sets your loss-of-rents coverage, so the policy can keep paying you rent while the home is repaired after a covered loss.

Control: money
Response needed when shown: Optional
Shown when: When this step is shown in the live form.

Furnished / contents coverage

Will the home be furnished, and would you like contents coverage for the furnishings and other personal property inside it?

This records whether contents coverage was requested, declined, or not applicable, so the answer is never left in doubt on a completed application.

Control: pills
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes, please add contents coverage; No, the home is unfurnished; It's furnished, but I'm declining contents coverage

Contents coverage amount

Roughly how much personal property (furniture, electronics, decor, and similar) would you like covered?

Control: money
Response needed when shown: Optional
Shown when: Furnished / contents coverage is Yes, please add contents coverage

Property management

Who handles the day to day management of this property?

Naming a professional property manager can qualify for discounts. Managing it yourself is just as normal an answer and is not a problem for a quote.

Control: pills
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: I use a property manager; I manage it myself

Property manager

What is the management company's name?

Control: text
Response needed when shown: Optional
Shown when: Property management is I use a property manager

Property manager address

What is the management company's mailing address?

A manager is often named on the policy as an additional insured, which needs their mailing address on file.

Control: address
Response needed when shown: Optional
Shown when: Property management is I use a property manager

Home / Dwelling Rental: Tenants (3 questions)

Student housing

Is the property rented to students, for example near a campus?

Student rentals are rated separately by most landlord programs. Yes does not rule anything out on its own.

Control: yesno
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes; No

Tenant screening

Which of these do you do before renting to a new tenant?

Screening practices earn credits with some landlord programs, and a renters-insurance requirement can lower your own exposure to tenant-caused losses.

Control: multichips
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Credit check; Criminal background check; Eviction history search; Employment or income check; Require the tenant to carry renters insurance; None of these

Landlord association

Do you belong to a landlord or rental-owners association?

Membership can qualify for a discount with some carriers.

Control: yesno
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes; No

Home / Dwelling Rental: Condos, townhouses & owners associations (5 questions)

Condo / townhouse or HOA

Is this property a condo or a townhouse, or otherwise part of an owners association (HOA)? You will see this question on each property you add, so properties in different associations, or in none, are all handled.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Association / management company

What is the name of the association or its management company? A phone number or email is helpful if you have it.

If the documents aren't handy, the association or its management company is the quickest source for the master policy details.

Control: text
Response needed when shown: Optional
Shown when: Condo / townhouse or HOA is Yes

What the master policy covers

Associations carry a master insurance policy for the community. Do you know which parts of a unit it covers? Pick the closest match. Not sure is a perfectly normal answer.

Control: pills
Response needed when shown: Yes when shown
Shown when: Condo / townhouse or HOA is Yes
Options: Bare walls: structure and common areas only, not the unit interior; As originally built: the unit as first constructed, but not upgrades; All-in: most permanently installed parts of the unit; Not sure

Master policy deductible

If you know the master policy deductible, enter it here. Some associations can charge part of that deductible back to a unit owner after a loss; note that too if you know it. Not sure is fine.

Control: text
Response needed when shown: Optional
Shown when: Condo / townhouse or HOA is Yes

Interior finishes and upgrades

Roughly what would it cost to redo the interior finishes of this unit: flooring, cabinets, counters, built-in fixtures, and any upgrades made since original construction? A rough estimate is fine.

Depending on what the master policy covers, some or all of the interior may be yours to insure. This estimate helps set the unit coverage limit. The association documents fill in the rest.

Control: money
Response needed when shown: Optional
Shown when: Condo / townhouse or HOA is Yes

Home / Dwelling Rental: Claims history (5 questions)

Prior claims

Any current, ongoing, or past claims or losses at this property in the past 5 years?

Control: yesno
Response needed when shown: Optional
Shown when: Buying or already own is I already own it
Options: Yes; No

Known claims or damage

Are you aware of any past damage or insurance claims at this property, for example anything the seller disclosed or an inspection found?

Control: yesno
Response needed when shown: Optional
Shown when: Buying or already own is Buying it now (under contract / closing soon)
Options: Yes; No

Number of claims

How many claims were there?

Control: pills
Response needed when shown: Yes when shown
Shown when: Prior claims starts with Yes
Options: 1; 2; 3; 4 or more

Total amount paid for the claim

About how much was paid on that claim in total? An estimate is fine.

Control: money
Response needed when shown: Yes when shown
Shown when: Number of claims is 1

Claim dates and amounts

For each claim, enter the date and about how much was paid. An estimate is fine.

Control: property_repeater
Response needed when shown: Yes when shown
Shown when: Number of claims is one of: 2; 3; 4 or more

Home / Dwelling Rental: Loan and other parties (7 questions)

Loan or mortgage

Is there a loan or mortgage on this property?

A lender named on the policy generally asks to receive the coverage documents directly. If there is no loan on this property, the next few questions are skipped.

Control: yesno
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes; No

Mortgagee / lender

Who is the lender or mortgagee on this property? The name as it appears on your loan paperwork is what we need.

A lender named on the policy is generally sent the coverage documents directly, which can help avoid force placed insurance.

Control: text
Response needed when shown: Optional
Shown when: Loan or mortgage is Yes

Clause wording

Lenders usually ask for a stock phrase after their name on the policy. Pick whichever ones your lender asked for. If they did not say, or you are not sure, choose the last option.

Control: multichips
Response needed when shown: Optional
Shown when: Loan or mortgage is Yes
Options: ISAOA (its successors and/or assigns); ATIMA (as their interests may appear); Not sure, or my lender did not specify

Loan number

What is the loan number, if you have it handy? Lenders use it to match the insurance to your loan.

Control: text
Response needed when shown: Optional
Shown when: Loan or mortgage is Yes

Lender mailing address

What mailing address does the lender want listed on the policy? It is usually on your mortgage statement, and it is often a payment processing address rather than a branch.

This is generally where the lender's copy of the policy documents is sent. With the name and the wording above, it completes the mortgagee clause, so there is nothing left to paste in.

Control: address
Response needed when shown: Optional
Shown when: Loan or mortgage is Yes

Billing

How do you expect the insurance on this property to be paid: billed to the mortgage company through escrow, or paid by you directly?

Escrow billing runs through the loan servicer, so knowing which way you expect to pay tells us where the billing paperwork should go.

Control: pills
Response needed when shown: Optional
Shown when: Loan or mortgage is Yes
Options: Mortgagee billed (escrow); I'll pay directly; Not sure yet

Additional insureds

Besides the owner and any lender above, does anyone else need to be listed on the policy for this property, such as a property manager, a member or holding LLC, or a master tenant? Choose No if the named insured above is the only party. You will see the same question on each additional property you add.

Control: yesno
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes; No

Home / Dwelling Rental: Additional properties (1 questions)

Additional rental properties

Add each of your other rental properties below, even one titled to a different LLC or a different person. Each property can go on the policy and carrier that fits it, and for details that repeat, like the owner, you can pick a name you've already entered instead of retyping it. Use the property chips above the cards to jump between properties.

Landlords often hold several properties across different names, and each address is rated and scheduled separately, so listing them lets us sort each one to the policy and carrier that fits it.

Control: property_repeater
Response needed when shown: Optional
Shown when: One property or several is More than one property

Home / Dwelling Rental: Coverage & policy details (8 questions)

Current coverage

Do you currently have active insurance coverage in place for this property?

Helps us tell a property already insured that you're remarketing apart from one where coverage may have lapsed.

Control: yesno
Response needed when shown: Optional
Shown when: Buying or already own is I already own it
Options: Yes; No

Purpose for coverage

Are you seeking coverage for a new purchase, shopping for better rates, or seeking coverage for a non-renewed policy?

Control: pills
Response needed when shown: Optional
Shown when: Buying or already own is I already own it
Options: New purchase; Shopping for better rates; Seeking coverage for a non-renewed policy

Reason for non-renewal

Please indicate the reason the policy has been terminated or non-renewed.

Please provide any information you have regarding why the prior policy was terminated or non-renewed. This may include reasons provided by the insurance company, changes in property condition, claims history, underwriting concerns, or other factors. Providing this information helps us better understand your insurance needs and identify appropriate options.

Control: textarea
Response needed when shown: Optional
Shown when: Purpose for coverage is Seeking coverage for a non-renewed policy

Effective date

When would you like the policy to begin? If you already have coverage, this is usually your current policy's renewal or cancellation date. If you're buying, it's the date you'll take ownership. You can also enter any other date, for example if you're switching mid-term. A near-term placeholder date is fine.

Control: date
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Mailing address

What is the best mailing address for your policy documents? This is usually your home or office, not the rental property.

This is where the policy and any carrier mail get sent, so it needs to be an address you actually receive mail at.

Control: address
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

CC&Rs / master policy documents

If any of the properties you listed are in an owners association, you can attach its CC&Rs, bylaws, or master policy declarations page here. Attach documents for as many associations as you have. You can also check the box to send them later, or skip this if none of the properties are in an association.

Where the association's responsibility ends and yours begins is set by these documents, not by the unit itself. Having them with your application helps get building coverage and loss assessment coverage matched to what the master policy actually leaves to you, instead of guessing.

Control: upload
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: I'll send it later

Upload your loss runs (optional)

Loss runs are a report from your insurance company that lists claims filed on your policy over the past several years, including dates and amounts paid. Uploading now is optional. Carriers often ask for loss runs before a policy can be bound, so we will likely need them later. Having them now can help make your quote more accurate. You can request loss runs from your current insurance company or from your insurance agent or broker.

Control: upload
Response needed when shown: Optional
Shown when: Prior claims starts with Yes
Options: I'll send it later

Your date of birth

What is your date of birth? If the properties are held in an LLC or a trust, give the date of birth of the person who will sign the application.

Date of birth is a standard rating and identity factor. It is asked once for the account, not for each property.

Control: date
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Manufactured / Mobile Home Rental: Property information (5 questions)

Property address

What is the address of the manufactured or mobile home to be insured?

Control: address
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

One property or several

Are you looking to quote just this one home, or more than one rental property? Properties titled to different people or LLCs are fine. This form covers up to 7 properties, and you'll add each one after finishing this first home. If you have 8 or more, choose that option to upload your property list instead.

Knowing this up front shapes the rest of the questionnaire. You'll answer the full set of questions for this first home, then add each additional property with a shorter per-property card, reusing owners and other details you've already entered instead of retyping them.

Control: pills
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Just this one home; More than one property; 8 or more properties

Named insured / ownership

The primary named insured is who the policy protects, so it needs to match how the property is titled. If the title is in an LLC but the policy names you personally, a claim can be denied.

Control: text
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Park or private land

Is the home in a mobile-home park, or on land?

Control: pills
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: In a mobile-home park (lot rent); On land I own; On land I rent

Buying or already own

Is this a home you're buying now (under contract or closing soon), or one you already own?

A purchase is quoted to begin at closing, with the contract price as the value basis and no claims history expected from you. A home you already own is quoted on its current occupancy, condition, and insurance history.

Control: pills
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Buying it now (under contract / closing soon); I already own it

Manufactured / Mobile Home Rental: Rental details (11 questions)

Rental type

Will this be a short-term rental (Airbnb, VRBO, etc.) or a long-term rental?

Short-term and long-term rentals use different policy forms; the wrong form can void guest-caused-damage coverage.

Control: pills
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Short-term (Airbnb, VRBO, etc.); Long-term lease; Both

Current occupancy

Is the home in regular use, sitting vacant, or under renovation? A short-term rental (Airbnb, VRBO, etc.) with recent and upcoming bookings counts as in regular use even if no guest is staying today. If it has had no tenant or guest for more than about 30 days and none is booked, choose Vacant.

Most standard policies limit or exclude some losses while a home sits empty and unrented for an extended period. Carriers generally do not treat a furnished, actively booked short-term rental as vacant between guests, but definitions vary by policy.

Control: pills
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Occupied or regularly rented; Vacant; Under renovation

Occupancy when coverage would start

Since the home is empty today, what do you expect on the day a policy would take effect?

Control: pills
Response needed when shown: Optional
Shown when: Current occupancy is Vacant
Options: Still empty; A tenant will be in it by then; I or a family member will be in it by then; Not sure yet

Occupancy plans for the next year

Control: textarea
Response needed when shown: Optional
Shown when: Occupancy when coverage would start is one of: Still empty; Not sure yet

Plan after the renovation

Once the renovation work is finished, what do you plan to do with the home?

A home being renovated to rent out generally sits on a different policy form than one being renovated to resell, so the plan after the work points to which form fits.

Control: pills
Response needed when shown: Optional
Shown when: Current occupancy is Under renovation
Options: Rent it out when the work is done; Sell it, fix and flip; Move in or keep it; Not decided yet

Anticipated rental income

What is the anticipated annual rental income?

Sets loss-of-rents coverage while the home is repaired after a covered loss.

Control: money
Response needed when shown: Optional
Shown when: When this step is shown in the live form.

Furnished / contents coverage

Will the home be furnished, and would you like contents coverage for the furnishings and other personal property inside it?

This records whether contents coverage was requested, declined, or not applicable, so the answer is never left in doubt on a completed application.

Control: pills
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes, please add contents coverage; No, the home is unfurnished; It's furnished, but I'm declining contents coverage

Contents coverage amount

Roughly how much personal property would you like covered?

Control: money
Response needed when shown: Optional
Shown when: Furnished / contents coverage is Yes, please add contents coverage

Property management

Who handles the day to day management of this home?

Naming a professional property manager can qualify for discounts. Managing it yourself is just as normal an answer and is not a problem for a quote.

Control: pills
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: I use a property manager; I manage it myself

Property manager

What is the management company's name?

Control: text
Response needed when shown: Optional
Shown when: Property management is I use a property manager

Property manager address

What is the management company's mailing address?

A manager is often named on the policy as an additional insured, which needs their mailing address on file.

Control: address
Response needed when shown: Optional
Shown when: Property management is I use a property manager

Manufactured / Mobile Home Rental: Condos, townhouses & owners associations (5 questions)

Condo / townhouse or HOA

Is this home part of an owners association (HOA)? You will see this question on each property you add, so properties in different associations, or in none, are all handled.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Association / management company

What is the name of the association or its management company? A phone number or email is helpful if you have it.

If the documents aren't handy, the association or its management company is the quickest source for the master policy details.

Control: text
Response needed when shown: Optional
Shown when: Condo / townhouse or HOA is Yes

What the master policy covers

Associations carry a master insurance policy for the community. Do you know which parts of a unit it covers? Pick the closest match. Not sure is a perfectly normal answer.

Control: pills
Response needed when shown: Yes when shown
Shown when: Condo / townhouse or HOA is Yes
Options: Bare walls: structure and common areas only, not the unit interior; As originally built: the unit as first constructed, but not upgrades; All-in: most permanently installed parts of the unit; Not sure

Master policy deductible

If you know the master policy deductible, enter it here. Some associations can charge part of that deductible back to a unit owner after a loss; note that too if you know it. Not sure is fine.

Control: text
Response needed when shown: Optional
Shown when: Condo / townhouse or HOA is Yes

Interior finishes and upgrades

Roughly what would it cost to redo the interior finishes of this unit: flooring, cabinets, counters, built-in fixtures, and any upgrades made since original construction? A rough estimate is fine.

Depending on what the master policy covers, some or all of the interior may be yours to insure. This estimate helps set the unit coverage limit. The association documents fill in the rest.

Control: money
Response needed when shown: Optional
Shown when: Condo / townhouse or HOA is Yes

Manufactured / Mobile Home Rental: About the home (5 questions)

Home type

Which best describes the home?

Control: pills
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Single Wide; Double Wide; Triple Wide; Park Model; Fifth Wheel

Year built

What year was the home built? An approximate year is fine.

Age drives eligibility and rate.

Control: number
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Not sure

Make / model

What is the make and model of the home?

Control: text
Response needed when shown: Optional
Shown when: When this step is shown in the live form.

Serial / HUD number

What is the serial number or HUD tag number? (Leave blank if not handy.)

Control: text
Response needed when shown: Optional
Shown when: When this step is shown in the live form.

Square footage

Approximately how many square feet is the home?

Control: number
Response needed when shown: Optional
Shown when: When this step is shown in the live form.

Manufactured / Mobile Home Rental: Size, foundation and roof (6 questions)

Length x width

What are the home's outside length and width, in feet?

Control: dimensions
Response needed when shown: Optional
Shown when: When this step is shown in the live form.

How it's secured

How is the home installed or secured?

Anchoring / tie-downs affect wind eligibility and pricing.

Control: pills
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Permanent foundation; Tie-downs / anchored; Blocks & piers; Not sure

Skirting

Is the home skirted around the base?

Skirting closes off the underside of the home. Carriers generally look at it for both wind and freeze exposure.

Control: pills
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes, fully skirted; Partially skirted; No skirting; Not sure

Roof material

What is the roof made of?

Control: pills
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Metal; Composition shingle; Rubber or membrane; Tar and gravel; Other; Not sure

Roof replacement

Has the roof been replaced, and if so was it a full or partial job?

A full replacement generally means the complete roof was replaced; a partial job generally means repairs or replacement of only a portion. Pick whichever is closest. It's fine if it predates your purchase or you're not sure.

Control: pills
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Full replacement; Partial repair or replacement; Not replaced, or not sure

Year of roof work

About what year was that roof work done? An approximate year is fine.

Control: number
Response needed when shown: Optional
Shown when: Roof replacement is one of: Full replacement; Partial repair or replacement
Options: Not sure

Manufactured / Mobile Home Rental: Heating, protection and value (3 questions)

Heating type

How is the home heated?

Heating source is a standard rating question. Wood or pellet stoves and portable space heaters are generally looked at more closely, and some carriers ask for photos.

Control: pills
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Forced air / central; Heat pump; Electric baseboard; Wall or floor furnace; Wood or pellet stove; Portable space heaters; None; Other

Protective devices

Which of these does the home have?

Smoke detectors, monitored alarms and deadbolts commonly earn credits, subject to each carrier's own guidelines.

Control: multichips
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Smoke detectors; Central fire or smoke monitoring; Burglar alarm (monitored); Deadbolt locks; None of these

Insured value

About what amount would you like the home insured for?

Sets the dwelling limit used to rebuild or replace the home.

Control: money
Response needed when shown: Optional
Shown when: When this step is shown in the live form.

Manufactured / Mobile Home Rental: Upkeep and servicing (4 questions)

Maintenance and repairs

When something needs fixing at this home, how does it usually get handled?

Control: pills
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: I handle repairs myself; Called out as needed; A maintenance contract or regular schedule; A 24/7 on-call service

Parking and walkways

How would you describe the driveway, walkways and any parking area? A quick look is enough, this is not an inspection.

Control: pills
Response needed when shown: Optional
Shown when: Park or private land is one of: On land I own; On land I rent
Options: Some cracking or uneven spots; Sound, with normal wear; Recently paved or resurfaced; The HOA maintains it

Heating and cooling service

When was the heating and cooling last serviced or tuned up? This is about routine servicing, not replacing the system. An approximate answer is fine.

Control: pills
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Within the last year; One to two years ago; More than two years ago, or not sure

Plumbing service

When was the plumbing last serviced or inspected? If the home has a smart leak detector or an automatic water shutoff, pick that instead, it tells us more than the date does.

Control: pills
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Within the last year; More than a year ago, or not sure; It has smart leak detection or an automatic water shutoff

Manufactured / Mobile Home Rental: Home eligibility (7 questions)

On stilts

Is the home raised up on stilts, posts, or open pilings?

A home elevated on stilts or open pilings is rated differently, and not every carrier will write one.

Control: yesno
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes; No

Condemned

Has the home been condemned, or is it currently condemned?

Carriers ask this to confirm the home is safe and legal to occupy.

Control: yesno
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes; No

Utilities connected

Is the home currently without utilities, meaning no electricity, water, or gas connected?

A home with the utilities shut off is treated differently from one in regular use.

Control: yesno
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes; No

Unrepaired damage

Does the home or any attached structure have any damage that has not been repaired?

Existing unrepaired damage is usually excluded until it is fixed, so carriers ask about it up front.

Control: yesno
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes; No

Liability hazards

Are there any hazardous liability exposures on the premises or in the home, such as a dog with a bite history, a trampoline, or a similar hazard?

These are the exposures carriers most often ask about before quoting the liability coverage.

Control: yesno
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes; No

Community pool

Does the mobile-home park or community have a swimming pool or hot tub?

Carriers rating a home inside a park ask which shared amenities the community has, so we note a park pool or hot tub either way. This one is about the park's own amenity, not anything on the lot your tenant rents.

Control: yesno
Response needed when shown: Optional
Shown when: Park or private land is In a mobile-home park (lot rent)
Options: Yes; No

Swimming pool

Is there a swimming pool or hot tub on the premises?

Control: yesno
Response needed when shown: Optional
Shown when: Park or private land is one of: On land I own; On land I rent
Options: Yes; No

Manufactured / Mobile Home Rental: Claims history (5 questions)

Prior claims

Any current, ongoing, or past claims or losses at this home in the past 5 years?

Control: yesno
Response needed when shown: Optional
Shown when: Buying or already own is I already own it
Options: Yes; No

Known claims or damage

Are you aware of any past damage or insurance claims at this home, for example anything the seller disclosed or an inspection found?

Control: yesno
Response needed when shown: Optional
Shown when: Buying or already own is Buying it now (under contract / closing soon)
Options: Yes; No

Number of claims

How many claims were there?

Control: pills
Response needed when shown: Yes when shown
Shown when: Prior claims starts with Yes
Options: 1; 2; 3; 4 or more

Total amount paid for the claim

About how much was paid on that claim in total? An estimate is fine.

Control: money
Response needed when shown: Yes when shown
Shown when: Number of claims is 1

Claim dates and amounts

For each claim, enter the date and about how much was paid. An estimate is fine.

Control: property_repeater
Response needed when shown: Yes when shown
Shown when: Number of claims is one of: 2; 3; 4 or more

Manufactured / Mobile Home Rental: Loan and other parties (7 questions)

Loan or mortgage

Is there a loan or mortgage on this home?

A lender named on the policy generally asks to receive the coverage documents directly. If there is no loan on this home, the next few questions are skipped.

Control: yesno
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes; No

Mortgagee / lender

Who is the lender or mortgagee on this home? The name as it appears on your loan paperwork is what we need.

A lender named on the policy is generally sent the coverage documents directly, which can help avoid force placed insurance.

Control: text
Response needed when shown: Optional
Shown when: Loan or mortgage is Yes

Clause wording

Lenders usually ask for a stock phrase after their name on the policy. Pick whichever ones your lender asked for. If they did not say, or you are not sure, choose the last option.

Control: multichips
Response needed when shown: Optional
Shown when: Loan or mortgage is Yes
Options: ISAOA (its successors and/or assigns); ATIMA (as their interests may appear); Not sure, or my lender did not specify

Loan number

What is the loan number, if you have it handy? Lenders use it to match the insurance to your loan.

Control: text
Response needed when shown: Optional
Shown when: Loan or mortgage is Yes

Lender mailing address

What mailing address does the lender want listed on the policy? It is usually on your mortgage statement, and it is often a payment processing address rather than a branch.

This is generally where the lender's copy of the policy documents is sent. With the name and the wording above, it completes the mortgagee clause, so there is nothing left to paste in.

Control: address
Response needed when shown: Optional
Shown when: Loan or mortgage is Yes

Billing

How do you expect the insurance on this home to be paid: billed to the mortgage company through escrow, or paid by you directly?

Escrow billing runs through the loan servicer, so knowing which way you expect to pay tells us where the billing paperwork should go.

Control: pills
Response needed when shown: Optional
Shown when: Loan or mortgage is Yes
Options: Mortgagee billed (escrow); I'll pay directly; Not sure yet

Additional insureds

Control: yesno
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes; No

Manufactured / Mobile Home Rental: Additional properties (1 questions)

Additional rental properties

Landlords often hold several properties across different names, and each address is rated and scheduled separately, so listing them lets us sort each one to the policy and carrier that fits it.

Control: property_repeater
Response needed when shown: Optional
Shown when: One property or several is More than one property

Manufactured / Mobile Home Rental: Coverage & policy details (11 questions)

Current coverage

Do you currently have active insurance coverage in place for this property?

Helps us tell a property already insured that you're remarketing apart from one where coverage may have lapsed.

Control: yesno
Response needed when shown: Optional
Shown when: Buying or already own is I already own it
Options: Yes; No

Purpose for coverage

New purchase, shopping for better rates, or seeking coverage for a non-renewed policy?

Control: pills
Response needed when shown: Optional
Shown when: Buying or already own is I already own it
Options: New purchase; Shopping for better rates; Seeking coverage for a non-renewed policy

Reason for non-renewal

Please indicate the reason the policy has been terminated or non-renewed.

Control: textarea
Response needed when shown: Optional
Shown when: Purpose for coverage is Seeking coverage for a non-renewed policy

Expected closing date

When is the closing expected? Coverage is typically set to begin on the closing date.

Control: date
Response needed when shown: Optional
Shown when: Buying or already own is Buying it now (under contract / closing soon)

Effective date

Control: date
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Mailing address

What is the best mailing address for your policy documents? This is usually your home or office, not the rental property.

This is where the policy and any carrier mail get sent, so it needs to be an address you actually receive mail at.

Control: address
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

CC&Rs / master policy documents

Control: upload
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: I'll send it later

Upload your loss runs (optional)

Control: upload
Response needed when shown: Optional
Shown when: Prior claims starts with Yes
Options: I'll send it later

Registration / title

Optional: attach a copy of the manufactured-home registration or title.

Control: upload
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: I'll send it later

Your date of birth

What is your date of birth? If the homes are held in an LLC or a trust, give the date of birth of the person who will sign the application.

Date of birth is a standard rating and identity factor. It is asked once for the account, not for each home.

Control: date
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Anything else

Is there anything else I should know or be aware of?

Control: textarea
Response needed when shown: Optional
Shown when: When this step is shown in the live form.

Rental Portfolio (8 or more properties): Portfolio overview (4 questions)

Number of properties

About how many rental properties would you like quoted?

Control: number
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Total rental units

About how many rental units are there across all the properties? A duplex counts as 2.

Control: number
Response needed when shown: Optional
Shown when: When this step is shown in the live form.

States

Which states are the properties in?

Control: text
Response needed when shown: Optional
Shown when: When this step is shown in the live form.

Property types

What kinds of properties are in the portfolio? Choose all that apply.

Control: multichips
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Single-family homes; Condos or townhouses; 2 to 4 unit buildings; Apartment buildings (5 or more units); Manufactured homes; Commercial or mixed-use

Rental Portfolio (8 or more properties): Property documents (2 questions)

Property list or ledger

Attach your property list, rent roll, or ledger. A spreadsheet is ideal. It helps most when it shows each property's address, the owner or LLC on the title, the number of units, the year built, and any lender. You can attach more than one file.

A property list lets the whole portfolio be reviewed at once, instead of you answering the same questions for every property.

Control: upload
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Current insurance documents

Optional: attach any current insurance documents for these properties, such as declarations pages, policies, or renewal notices. You can attach more than one file.

Control: upload
Response needed when shown: Optional
Shown when: When this step is shown in the live form.

Rental Portfolio (8 or more properties): Coverage & policy details (8 questions)

Prior claims

Have there been any insurance claims or losses on the properties in the past 5 years?

Control: yesno
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes; No

Number of claims

How many claims were there?

Control: pills
Response needed when shown: Yes when shown
Shown when: Prior claims starts with Yes
Options: 1; 2; 3; 4 or more

Total amount paid for the claim

About how much was paid on that claim in total? An estimate is fine.

Control: money
Response needed when shown: Yes when shown
Shown when: Number of claims is 1

Claim dates and amounts

For each claim, enter the date and about how much was paid. An estimate is fine.

Control: property_repeater
Response needed when shown: Yes when shown
Shown when: Number of claims is one of: 2; 3; 4 or more

Upload your loss runs (optional)

Control: upload
Response needed when shown: Optional
Shown when: Prior claims starts with Yes
Options: I'll send it later

Purpose for coverage

Are you seeking coverage for a new purchase, shopping for better rates, or seeking coverage for a non-renewed policy?

Control: pills
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: New purchase; Shopping for better rates; Seeking coverage for a non-renewed policy

Effective date

Control: date
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Anything else

Is there anything else I should know or be aware of?

Control: textarea
Response needed when shown: Optional
Shown when: When this step is shown in the live form.

Builder's Risk: Property information (4 questions)

Property address

What is the address of the property?

Control: address
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Occupancy during the term

Will anyone be living in or using the structure at any point during the policy term?

Occupancy during construction changes eligibility and which builder's risk form applies.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Square footage

What is the square footage of the existing structure, including basement if there is one?

Control: number
Response needed when shown: Optional
Shown when: When this step is shown in the live form.

Prior damage

Has this property had any prior damage from earthquake, flood, wind, fire, vandalism, hail, or water?

Control: yesno
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes; No

Builder's Risk: Who's responsible (5 questions)

Policy name

Should the policy be in the name of your LLC, or under a different name? Please give the exact name for the policy.

Control: text
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Responsible party

Full name of the person who will be responsible for the policy.

Control: text
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Date of birth

Date of birth of the responsible person.

Control: date
Response needed when shown: Optional
Shown when: When this step is shown in the live form.

Mailing address

What is the mailing address?

Control: address
Response needed when shown: Optional
Shown when: When this step is shown in the live form.

Your role in the project

What is your role in the project?

Control: pills
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Owner and Contractor; Owner Only; Contractor Only

Builder's Risk: Builder / project eligibility (4 questions)

Builder name

Is the general contractor or builder name different from your name / LLC?

Control: yesno
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes; No

Contractor general liability insurance

Do you currently carry general liability insurance as a contractor?

Carriers writing a builder's risk policy generally ask whether the contractor on the project carries their own liability coverage.

Control: yesno
Response needed when shown: Yes when shown
Shown when: Your role in the project is one of: Owner and Contractor; Contractor Only
Options: Yes; No

General liability explanation

Please explain why not, or describe your situation

Control: textarea
Response needed when shown: Yes when shown
Shown when: Contractor general liability insurance is No

Years of experience

How many years of experience does the builder, remodeler, owner, or GC have managing building projects of a similar nature and size?

Most carriers look for at least two years of relevant experience on projects of a similar size and type.

Control: number
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Builder's Risk: Policy details (4 questions)

Project type

What do you need covered?

If you are buying the property, your lender may ask for the existing building to be included.

Control: pills
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: New Construction; Remodel excluding existing structure; Remodel including existing structure; Installation

Coverage start

What date would you like coverage to start?

Control: date
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Coverage length

How long would you like coverage in place?

Control: pills
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: 6 months; 9 months; 1 year

Job-site liability

Would you like liability coverage for the job site as well? Premises liability is typically needed on a project like this, and it may be required by your lender, your contract, or the property owner.

A builder's risk policy generally covers the structure and the materials, not injury or property-damage claims arising from the job site, so premises liability is usually written alongside it, subject to the policy wording and carrier guidelines.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Builder's Risk: Project details (9 questions)

Earliest date on site

What is the earliest date of the ground breaking, or of materials being delivered to this job site?

A builder's risk policy generally cannot respond to work that began before the policy start date, subject to the policy wording, so the earliest date on site is what the coverage start has to line up with.

Control: date
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Project started

Has the project already started?

Control: yesno
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes; No

Expected completion

What is the estimated date of completion of the building at this location?

Carriers rate a builder's risk term against the expected completion date, and a project that runs past the term generally needs an extension requested before the policy expires.

Control: date
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Plan after the project

When the project is finished, what do you plan to do with the property?

A builder's risk policy generally ends when the project is complete, so what happens next points to which permanent policy would fit the property afterward.

Control: pills
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Rent it out; Sell it when the work is done, fix and flip; Move in or keep it; Not decided yet

Modular structure

Is the structure modular?

Control: yesno
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes; No

Scope of the work

Is the work cosmetic and finish only, or does it include structural work?

Control: pills
Response needed when shown: Optional
Shown when: Project type is one of: Remodel excluding existing structure; Remodel including existing structure; Installation
Options: Cosmetic and finish work only; Mostly cosmetic with some structural work; Substantial structural work

Structural integrity

Does this job change the structural integrity of the existing structure? This includes foundation work, removing or relocating a load-bearing wall or support, building extensions or additional floors, and fire, earthquake or wind damage restoration.

Structural work carries a different exposure than finish work, and several builder's risk programs price or limit it separately.

Control: yesno
Response needed when shown: Yes when shown
Shown when: Project type is one of: Remodel excluding existing structure; Remodel including existing structure; Installation
Options: Yes; No

Work description

Please describe the work that will be performed, including which rooms or areas are involved and what is being replaced, added, or removed.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Solar

Will the project involve solar installation?

Control: yesno
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes; No

Builder's Risk: Coverage amounts (3 questions)

Renovation value

Estimated value of the construction, renovation, or improvement work itself. This amount feeds the total completed value below.

Control: money
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Existing structure value

Estimated value of the existing building or structure. It is added to the renovation value to set the total completed value below.

Control: money
Response needed when shown: Yes when shown
Shown when: Project type is one of: Remodel including existing structure

Total completed value

Calculated automatically from the renovation value plus the existing structure value above: the total value used to set your coverage limit, not what you expect to sell the property for.

This is the main limit on a builder's risk policy, the full value of the finished project.

Control: money
Response needed when shown: Optional
Shown when: When this step is shown in the live form.

Builder's Risk: About the existing structure (18 questions)

Year built

What year was the existing structure built?

Age drives the construction, wiring, plumbing and roof assumptions a carrier makes about the structure being worked on.

Control: number
Response needed when shown: Yes when shown
Shown when: Project type is one of: Remodel excluding existing structure; Remodel including existing structure; Installation
Options: Not sure

Number of stories

How many stories is the structure?

Control: number
Response needed when shown: Optional
Shown when: Project type is one of: Remodel excluding existing structure; Remodel including existing structure; Installation

Construction type

How are the outside walls built?

Control: pills
Response needed when shown: Optional
Shown when: Project type is one of: Remodel excluding existing structure; Remodel including existing structure; Installation
Options: Frame (wood); Masonry / brick; Concrete block; Steel / metal; Fire resistive (concrete); Mixed: part masonry, part frame; Other / not sure

Masonry wall share

About how much of the outside walls is masonry or block?

Control: pills
Response needed when shown: Optional
Shown when: (Project type is one of: Remodel excluding existing structure; Remodel including existing structure; Installation AND Construction type is Mixed: part masonry, part frame)
Options: Most of it; About half; Less than half; Not sure

Roof and floor framing

What are the roof and upper floors built on?

Masonry walls with a wood-framed roof are rated differently from an all-masonry building.

Control: pills
Response needed when shown: Optional
Shown when: (Project type is one of: Remodel excluding existing structure; Remodel including existing structure; Installation AND Construction type is one of: Masonry / brick; Concrete block; Mixed: part masonry, part frame)
Options: Wood framing or rafters; Concrete or steel deck; Not sure

Roof replacement

Has the roof been replaced, and if so was it a full or partial job?

Control: pills
Response needed when shown: Optional
Shown when: Project type is one of: Remodel excluding existing structure; Remodel including existing structure; Installation
Options: Full replacement; Partial repair or replacement; Not replaced, or not sure

Year of roof work

About what year was that roof work done? An approximate year is fine.

Control: number
Response needed when shown: Optional
Shown when: Roof replacement is one of: Full replacement; Partial repair or replacement
Options: Not sure

Plumbing update

Has the plumbing been updated, and if so was it a full or partial update?

Control: pills
Response needed when shown: Optional
Shown when: Project type is one of: Remodel excluding existing structure; Remodel including existing structure; Installation
Options: Full update; Partial update; Not updated, or not sure

Year of plumbing work

About what year was the plumbing work done? An approximate year is fine.

Control: number
Response needed when shown: Optional
Shown when: Plumbing update is one of: Full update; Partial update

Electrical update

Has the wiring been updated, and if so was it a full or partial update?

Control: pills
Response needed when shown: Optional
Shown when: Project type is one of: Remodel excluding existing structure; Remodel including existing structure; Installation
Options: Full update; Partial update; Not updated, or not sure

Year of electrical work

About what year was the electrical work done? An approximate year is fine.

Control: number
Response needed when shown: Optional
Shown when: Electrical update is one of: Full update; Partial update

Heating / cooling update

Has the heating or cooling system been updated, and if so was it a full or partial update?

Control: pills
Response needed when shown: Optional
Shown when: Project type is one of: Remodel excluding existing structure; Remodel including existing structure; Installation
Options: Full update; Partial update; Not updated, or not sure

Year of heating / cooling work

About what year was the heating or cooling work done? An approximate year is fine.

Control: number
Response needed when shown: Optional
Shown when: Heating / cooling update is one of: Full update; Partial update

Roof material

What is the roof material?

Control: pills
Response needed when shown: Optional
Shown when: Project type is one of: Remodel excluding existing structure; Remodel including existing structure; Installation
Options: Asphalt shingle; Tile (clay or concrete); Metal; Wood shake; Flat / built-up; Other; Not sure

Historical status

Is the building on a historical registry or subject to historical preservation rules?

Control: yesno
Response needed when shown: Optional
Shown when: Project type is one of: Remodel excluding existing structure; Remodel including existing structure; Installation
Options: Yes; No

Purchase date

Date the existing structure was purchased.

Control: date
Response needed when shown: Optional
Shown when: Project type is one of: Remodel excluding existing structure; Remodel including existing structure; Installation

Current condition

What is the current condition of the structure?

Control: pills
Response needed when shown: Optional
Shown when: Project type is one of: Remodel excluding existing structure; Remodel including existing structure; Installation
Options: Poor; Fair; Good

Structure description

Brief description of the structure being renovated.

Control: textarea
Response needed when shown: Optional
Shown when: Project type is one of: Remodel excluding existing structure; Remodel including existing structure; Installation

Builder's Risk: Additional parties (5 questions)

Loan or mortgage

Is there a loan or mortgage on this property?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Lender name

What is the lender's name?

Control: text
Response needed when shown: Yes when shown
Shown when: Loan or mortgage is Yes

Lender mailing address

What is the lender's mailing address?

Control: address
Response needed when shown: Yes when shown
Shown when: Loan or mortgage is Yes

Additional parties

Does anyone else need to be listed on the policy, such as a builder or premium finance company?

Control: yesno
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes; No

Anything else

Is there anything else I should know or be aware of?

Control: textarea
Response needed when shown: Optional
Shown when: When this step is shown in the live form.

Special Event: About the event (6 questions)

Professional event planner

Are you a professional event planner looking to insure your event planning business, rather than one specific event?

Planning events for others as a business is covered by a business policy instead of a one-time event policy. Answer Yes and it can be quoted that way; you can still finish this form with the event details.

Control: yesno
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes; No

Organized athletics

Does the event include any organized athletic competitions, games, or tournaments?

Organized sports are usually quoted on a sports or tournament program instead. If that fits better it can be quoted there; your event basics here still help.

Control: yesno
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes; No

Who is holding the event

Is the event being held by an organization, business, or nonprofit, rather than by you personally?

The policy protects whoever is named on it, so it needs to match who is actually putting on the event.

Control: yesno
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes; No

Event name

What is the name of the event?

Control: text
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Type of event

What kind of event is it? Pick a close match or type your own.

Control: text
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Festival or fair; Banquet or awards dinner; Fundraiser or charity auction; Farmers market or craft fair; Trade show, expo, or consumer show; Meeting, conference, or seminar; Holiday or company party; Graduation or school ceremony; Reunion, picnic, or barbecue; Car, art, or collector show; Concert, recital, or stage show; Religious or cultural celebration; Dance or social event; Memorial or celebration of life; Grand opening or open house

Private or public

Is the event private and invitation only, or open to the public or ticketed?

A private guest list and a ticketed public crowd are rated differently. This one answer matters more than the exact event type.

Control: pills
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Private, invitation only; Open to the public or ticketed

Special Event: About the business (3 questions)

Business stage

Which best describes the business today: brand new and not operating yet, recently started and operating for less than a year, established and operating for a year or more, or are you buying an existing business?

A new venture and an established business are quoted differently. Where there's operating history, carriers ask for it; where there isn't, they rate on the owner's experience instead. Knowing the stage up front keeps every later answer, and your application, accurate.

Control: pills
Response needed when shown: Yes when shown
Shown when: Who is holding the event starts with Yes
Options: Brand new (not operating yet); Recently started (under a year); Established (1+ years); Buying an existing business

Year business established

What year was the business established?

Most carrier applications ask how long the business has been in operation. Answering it once here means it's filled consistently on every carrier form. If ownership has changed, use the year it began operating under current ownership.

Control: number
Response needed when shown: Yes when shown
Shown when: (Who is holding the event starts with Yes AND Business stage is one of: Recently started (under a year); Established (1+ years))

Your experience in this line of work

Because the business started within the last two years, please describe your experience in this type of work and your experience managing a business or a crew, including years and roles. Carriers typically ask this about newer businesses before they are comfortable offering a quote, so a complete answer here helps.

Underwriters use the owner's background to rate a business that does not yet have its own operating history. This is a description, not a guarantee of any outcome.

Control: textarea
Response needed when shown: Optional
Shown when: (Who is holding the event starts with Yes AND (Business stage is one of: Brand new (not operating yet); Recently started (under a year) OR Year business established is between the current calendar year minus 2 and the current calendar year))

Special Event: Where and when (8 questions)

Venue name

What is the name of the venue?

Control: text
Response needed when shown: Optional
Shown when: When this step is shown in the live form.

Event address

What is the address where the event takes place?

Control: address
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Coverage start

What date should coverage start? Include your setup days.

Event policies are written for the exact dates you're on site, so setup and teardown days belong inside them.

Control: date
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Coverage end

What date should coverage end? Include your teardown days.

Control: date
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Event days

How many consecutive event days are there, not counting setup and teardown?

Control: number
Response needed when shown: Optional
Shown when: When this step is shown in the live form.

Daily attendance

Roughly how many people do you expect per day?

Attendance is the main rating basis for event liability. A good-faith estimate is fine.

Control: number
Response needed when shown: Optional
Shown when: When this step is shown in the live form.

More than one location

Is the event held at more than one location?

Control: yesno
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes; No

Overnight stays

Are overnight accommodations or camping part of the event?

Control: yesno
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes; No

Special Event: Alcohol, vendors & activities (4 questions)

Live music

Will there be incidental live music, like a background band or a DJ?

Incidental music is routine. A concert or music festival with headline acts is rated on its own program instead, so it helps to mention the acts if that's your event.

Control: yesno
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes; No

Alcohol

How is alcohol handled at the event?

Whether alcohol is sold, given away, or absent changes the liquor liability picture. There's a fit for each answer.

Control: pills
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Not available at the event; Furnished free of charge or BYOB; Sold; Both sold and furnished

Vendors & exhibitors

Will any vendors, concessionaires, or exhibitors be at the event?

Vendors usually carry their own coverage and name your event as additional insured. Knowing the plan up front avoids gaps on event day.

Control: yesno
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes; No

Attractions & activities

Do any of these apply to your event?

These attractions carry their own liability treatment. Selecting one just tells us which markets to shop.

Control: multichips
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Mechanical rides, inflatables, dunk tanks, or bungee equipment; Petting zoo or other animals; Fireworks or pyrotechnics; None of these apply

Special Event: Certificates & insurance history (4 questions)

Certificate for the venue

Does the venue or an event organizer require a certificate of insurance or ask to be named as additional insured?

Most venues hand you exact insurance wording. Matching it on the first try means your certificate is accepted without a re-issue.

Control: yesno
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes; No

Current carrier

If you already have coverage for this event or organization, is the current carrier non-renewing it?

Control: yesno
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes; No

Recent liability claims

Have any liability claims been paid under your or your organization's insurance in the last 3 years?

Control: yesno
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes; No

Claims & incidents

In the past 5 years, have there been any insurance claims or losses involving you or your organization? Answer Yes as well if you're aware of any incident or circumstance that could reasonably give rise to a claim, even if nothing has been filed yet.

Every carrier asks this. A past claim or a known incident rarely stops a quote, it just needs to be described accurately up front.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Special Event: Coverage & policy details (2 questions)

Liability limit

What general liability limit would you like quoted?

Venue contracts usually spell out a minimum limit. If you're not sure, pick the last option and the quote can be matched to the contract.

Control: pills
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: $1 million; $2 million; $3 million; $4 million; $5 million; Not sure, recommend for me

Mailing address

What is the best mailing address for your policy documents?

This is where the policy and any carrier mail get sent. A home address is fine.

Control: address
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Wedding / Private Celebration: The celebration (3 questions)

What to cover

Which celebrations should the policy cover?

One policy can usually cover the ceremony, reception, and rehearsal dinner together, even on different days.

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Ceremony; Reception; Rehearsal dinner; Other

Wedding date

What is the wedding date?

Control: date
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Other dates to include

Any other dates the policy should include, like a rain date, a rehearsal dinner on a different day, or setup and teardown days?

Control: textarea
Response needed when shown: Optional
Shown when: When this step is shown in the live form.

Wedding / Private Celebration: Venue & guests (5 questions)

Venue name

What is the name of the venue?

Control: text
Response needed when shown: Optional
Shown when: When this step is shown in the live form.

Venue address

What is the venue's address?

Control: address
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Second venue

Is the ceremony at a different venue than the reception?

Control: yesno
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes; No

Destination wedding

Is the wedding outside the United States?

A celebration abroad is still insurable. It just goes to a different set of markets, so it helps to know up front.

Control: yesno
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes; No

Guest count

About how many guests will attend?

Guest count is the main rating basis for wedding liability. A good-faith estimate is fine.

Control: number
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Wedding / Private Celebration: Alcohol & activities (4 questions)

Alcohol

How is alcohol handled?

Whether guests are served free drinks or buy them changes which liquor liability applies. There's a fit either way.

Control: pills
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Not served; Served but not sold (host provided or BYOB); Sold or cash bar

Host liquor liability

Would you like host liquor liability included in the quote if available?

Host liquor liability responds if a guest you served causes an alcohol-related injury or damage. Many venues ask for it by name.

Control: yesno
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes; No

Firearms or weapons

Will the event involve firearms or other weapons, for example a ceremonial saber arch?

Control: yesno
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes; No

Animals & attractions

Do any of these apply to your celebration?

These extras are common and quotable. They just change which markets we shop.

Control: multichips
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Live animals; Inflatable or bounce devices; Dunk tank or mechanical rides; Fireworks or a sparkler send-off; None of these apply

Wedding / Private Celebration: Coverage & policy details (4 questions)

Certificate for the venue

Does the venue require a certificate of insurance or ask to be named as additional insured?

Most venues spell out exactly what they need. Matching it the first time keeps your booking on track.

Control: yesno
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes; No

Cancellation coverage

Would you also like a quote for wedding cancellation or postponement coverage?

This is a separate policy that can reimburse deposits and costs if the celebration has to be called off or moved for a covered reason.

Control: yesno
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes; No

Claims & incidents

In the past 5 years, have there been any insurance claims or losses involving you? Answer Yes as well if you're aware of any incident or circumstance that could reasonably give rise to a claim, even if nothing has been filed yet.

Every carrier asks this. A past claim or a known incident rarely stops a quote, it just needs to be described accurately up front.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Mailing address

What is the best mailing address for your policy documents?

This is where the policy and any carrier mail get sent. A home address is fine.

Control: address
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Vendor / Exhibitor / Concessionaire: About the business (5 questions)

Legal entity type

Is the business an LLC, corporation, partnership, sole proprietorship, or non-profit?

The legal entity goes on the policy, and coverage options for owners differ between sole proprietors, LLCs, and corporations.

Control: entity
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: LLC; Corporation; S corporation; Partnership; Sole proprietorship; Non-profit organization; Other

Trade name / DBA (optional)

Only if customers see a different name than the legal name above, such as the name on your signs, invoices, or website. Not a license number or license classification. Leave blank if the legal name is the only name you use.

Control: text
Response needed when shown: Optional
Shown when: When this step is shown in the live form.

Business stage

Control: pills
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Brand new (not operating yet); Recently started (under a year); Established (1+ years); Buying an existing business

Year business established

What year was the business established?

Control: number
Response needed when shown: Yes when shown
Shown when: Business stage is one of: Recently started (under a year); Established (1+ years)

Your experience in this line of work

Underwriters use the owner's background to rate a business that does not yet have its own operating history. This is a description, not a guarantee of any outcome.

Control: textarea
Response needed when shown: Optional
Shown when: (Business stage is one of: Brand new (not operating yet); Recently started (under a year) OR Year business established is between the current calendar year minus 2 and the current calendar year)

Vendor / Exhibitor / Concessionaire: Your coverage (5 questions)

How much coverage

Do you need coverage for a single event, several events, or year-round?

One-event policies and annual vendor policies are different products. This answer picks the right shelf.

Control: pills
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: A single event; Several events this year; Year-round (annual) coverage

Event / show name

What is the name of the event or show?

Control: text
Response needed when shown: Optional
Shown when: How much coverage is A single event

Event start

What date does the event start for you, including setup?

Control: date
Response needed when shown: Optional
Shown when: How much coverage is A single event

Event end

What date does it end for you, including teardown?

Control: date
Response needed when shown: Optional
Shown when: How much coverage is A single event

Effective date

When would you like coverage to begin? A near-term placeholder date is fine.

Control: date
Response needed when shown: Optional
Shown when: How much coverage is one of: Several events this year; Year-round (annual) coverage

Vendor / Exhibitor / Concessionaire: What you sell & how you set up (6 questions)

What you offer

What do you sell, display, demonstrate, or promote?

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Food & cooking

If you offer food or drink, which of these apply?

Cooking on site, especially with fryers or open flame, is rated differently than prepackaged goods.

Control: multichips
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Food or drink prepared on site; Open flame or grills; Deep fryers; Prepackaged food or drink only; No food or drink

Your setup

Which best describes your setup?

Control: pills
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Food concession stand or trailer; Tent or outdoor booth; Tradeshow exhibit or booth; Push cart or kiosk; Non-food trailer; Home-based vendor; Other

Customer interaction

How do customers interact with your space?

Control: pills
Response needed when shown: Optional
Shown when: Your setup is one of: Tent or outdoor booth; Tradeshow exhibit or booth
Options: They walk up to a counter or table; They walk in and around the space

Number of units

How many booths, stands, carts, or trailers do you operate?

Control: number
Response needed when shown: Optional
Shown when: When this step is shown in the live form.

Booth / tent area

Roughly how many square feet is your booth or tent space in total?

Control: number
Response needed when shown: Optional
Shown when: Your setup is one of: Tent or outdoor booth; Tradeshow exhibit or booth

Vendor / Exhibitor / Concessionaire: Requirements & screeners (3 questions)

Show organizer requirements

Does the show organizer or venue require a certificate of insurance or ask to be named as additional insured?

Most shows send exhibitors exact insurance requirements. Matching them the first time keeps your booth confirmed.

Control: yesno
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes; No

A few screeners

Do any of these apply to what you sell or do?

These exposures are placed with specific markets. Selecting one just tells us where to shop.

Control: multichips
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Alcohol sales or samples; Weapons, knives, or tasers; Tattooing, piercing, or hot wax; Mechanical or inflatable amusement devices; Animals; Motorized vehicles in motion; None of these apply

Where you operate

Are all the events you're insuring located within the United States?

Control: yesno
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes; No

Vendor / Exhibitor / Concessionaire: Beyond this policy (3 questions)

Vehicle use

Does your business use any vehicle for its operations, including a personally owned one? Driving to venues, events, classes, or client locations counts.

If a vehicle helps get the work done, even an owner's personal car, it's worth checking that the driving is actually covered. Personal auto policies can leave business driving out, so if this applies we can bring commercial or hired and non-owned auto into the conversation.

Control: pills
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes; No; Not sure

Employees & helpers

Does your business have any employees or paid helpers, even part-time, seasonal, or as-needed?

If anyone works for you, workers compensation may come into play depending on your state. Knowing now means the quote covers the whole picture.

Control: yesno
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes; No

Other coverage to consider

Beyond this policy, which of these would you like us to also look at?

If any of these fit your operation, we can quote them at the same time. If nothing fits right now, or you already have it handled elsewhere, the last two choices let you say exactly that.

Control: multichips
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Commercial auto; Workers compensation; Equipment coverage; Cyber liability; None of these right now; I already have other coverage in place

Vendor / Exhibitor / Concessionaire: Policy details (2 questions)

Claims & incidents

In the past 5 years, have there been any insurance claims or losses involving you or your business? Answer Yes as well if you're aware of any incident or circumstance that could reasonably give rise to a claim, even if nothing has been filed yet.

Every carrier asks this. A past claim or a known incident rarely stops a quote, it just needs to be described accurately up front.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Mailing address

What is the best mailing address for your policy documents?

This is where the policy and any carrier mail get sent. A home address is fine.

Control: address
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Entertainer / Performer / Band: About the business (5 questions)

Legal entity type

Is the business an LLC, corporation, partnership, sole proprietorship, or non-profit?

The legal entity goes on the policy, and coverage options for owners differ between sole proprietors, LLCs, and corporations.

Control: entity
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: LLC; Corporation; S corporation; Partnership; Sole proprietorship; Non-profit organization; Other

Trade name / DBA (optional)

Control: text
Response needed when shown: Optional
Shown when: When this step is shown in the live form.

Business stage

Control: pills
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Brand new (not operating yet); Recently started (under a year); Established (1+ years); Buying an existing business

Year business established

What year was the business established?

Control: number
Response needed when shown: Yes when shown
Shown when: Business stage is one of: Recently started (under a year); Established (1+ years)

Your experience in this line of work

Underwriters use the owner's background to rate a business that does not yet have its own operating history. This is a description, not a guarantee of any outcome.

Control: textarea
Response needed when shown: Optional
Shown when: (Business stage is one of: Brand new (not operating yet); Recently started (under a year) OR Year business established is between the current calendar year minus 2 and the current calendar year)

Entertainer / Performer / Band: Your act (7 questions)

Individual or group

Is coverage for you as an individual performer, or for a group or band?

Control: pills
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: An individual performer; A group or band

Type of act

What type of performer or act are you? Pick a close match or type your own.

Control: text
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Musician, singer, or vocalist; DJ or KJ; Band (wedding, tribute, or cover); Choral group or ensemble; Magician; Clown; Comedian; Caricature artist; Face or body painter; Balloon artist; Juggler; Mime; Ventriloquist; Puppeteer; Storyteller; Impersonator or celebrity look-alike; Holiday character; Belly dancer; Psychic or fortune teller; Contortionist

Group name

What is the group or band name, exactly as it should appear on the policy?

Control: text
Response needed when shown: Optional
Shown when: Individual or group is A group or band

Group size

How many members are in the group?

Larger groups sometimes take an extra look from the broker. The count just helps us pick the right market.

Control: number
Response needed when shown: Optional
Shown when: Individual or group is A group or band

Adult representative

Is at least one member or representative of the group 18 or older?

Control: yesno
Response needed when shown: Optional
Shown when: Individual or group is A group or band
Options: Yes; No

Your age

Are you under 18?

A minor performer usually needs an adult listed with the policy. It just changes the paperwork.

Control: yesno
Response needed when shown: Optional
Shown when: Individual or group is An individual performer
Options: Yes; No

Promoted tour

Are any of your performances part of a promoted tour?

Control: yesno
Response needed when shown: Optional
Shown when: Individual or group is A group or band
Options: Yes; No

Entertainer / Performer / Band: Performances & income (4 questions)

Outside the U.S.

Do you perform outside the United States?

Control: yesno
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes; No

Performance income

Roughly how much do you earn per year from performing?

Annual performance income is the usual rating basis for entertainer liability. A ballpark figure is fine.

Control: money
Response needed when shown: Optional
Shown when: When this step is shown in the live form.

In the act

Do any of these appear in your performances?

Some features need specific markets. Selecting one just points us to the right carriers.

Control: multichips
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Pyrotechnics or fire; Animals in the act; Stunts, acrobatics, or strength acts; Audience participation or objects thrown to the crowd; Face or body paint; Hypnotism; Weapons as props; None of these apply

Where you perform

What kinds of venues do you typically perform at, and about how many performances do you do per year?

Control: textarea
Response needed when shown: Optional
Shown when: When this step is shown in the live form.

Entertainer / Performer / Band: Equipment & facility (2 questions)

Your own facility

Do you own or operate your own performance facility?

A facility you run is its own exposure and is quoted alongside, not inside, a performer policy.

Control: yesno
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes; No

Equipment & instruments

Roughly what value of instruments, sound gear, and equipment would you like covered? Enter 0 if you don't need equipment coverage.

Control: money
Response needed when shown: Optional
Shown when: When this step is shown in the live form.

Entertainer / Performer / Band: Beyond this policy (3 questions)

Vehicle use

Do you or your act use any vehicle for the work, including a personally owned one? Driving to venues, events, classes, or client locations counts.

Control: pills
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes; No; Not sure

Employees & helpers

Do you or your act have any employees or paid helpers, like crew or assistants, even part-time, seasonal, or as-needed?

If anyone works for you, workers compensation may come into play depending on your state. Knowing now means the quote covers the whole picture.

Control: yesno
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes; No

Other coverage to consider

Beyond this policy, which of these would you like us to also look at?

If any of these fit your operation, we can quote them at the same time. If nothing fits right now, or you already have it handled elsewhere, the last two choices let you say exactly that.

Control: multichips
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Commercial auto; Workers compensation; Equipment coverage; Cyber liability; None of these right now; I already have other coverage in place

Entertainer / Performer / Band: Policy details (3 questions)

Claims & incidents

In the past 5 years, have there been any insurance claims or losses involving you or your act? Answer Yes as well if you're aware of any incident or circumstance that could reasonably give rise to a claim, even if nothing has been filed yet.

Every carrier asks this. A past claim or a known incident rarely stops a quote, it just needs to be described accurately up front.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Effective date

When would you like coverage to begin? A near-term placeholder date is fine.

Control: date
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Mailing address

What is the best mailing address for your policy documents?

This is where the policy and any carrier mail get sent. A home address is fine.

Control: address
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Walk or Run Event: About the business (5 questions)

Legal entity type

Is the business an LLC, corporation, partnership, sole proprietorship, or non-profit?

The legal entity goes on the policy, and coverage options for owners differ between sole proprietors, LLCs, and corporations.

Control: entity
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: LLC; Corporation; S corporation; Partnership; Sole proprietorship; Non-profit organization; Other

Trade name / DBA (optional)

Control: text
Response needed when shown: Optional
Shown when: When this step is shown in the live form.

Business stage

Control: pills
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Brand new (not operating yet); Recently started (under a year); Established (1+ years); Buying an existing business

Year business established

What year was the business established?

Control: number
Response needed when shown: Yes when shown
Shown when: Business stage is one of: Recently started (under a year); Established (1+ years)

Your experience in this line of work

Underwriters use the owner's background to rate a business that does not yet have its own operating history. This is a description, not a guarantee of any outcome.

Control: textarea
Response needed when shown: Optional
Shown when: (Business stage is one of: Brand new (not operating yet); Recently started (under a year) OR Year business established is between the current calendar year minus 2 and the current calendar year)

Walk or Run Event: The event (6 questions)

Event name

What is the name of the event?

Control: text
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Organizer

What is the name of the organization putting on the event, exactly as it should appear on the policy?

The policy is written to the organizing charity, club, or company rather than to the event itself, so the exact legal name matters.

Control: text
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Walk or run

Is it a walk, a run, or both?

Control: pills
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Walk; Run; Both walk and run

Coverage start

What date should coverage start? Include setup and any packet-pickup or kickoff days.

Control: date
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Coverage end

What date should coverage end? Include teardown.

Control: date
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Charity or commercial

Is the event a charity or fundraiser, or a commercial event?

Control: pills
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Charity or fundraiser; Commercial or for-profit

Walk or Run Event: Course & participants (6 questions)

Course location name

What is the name of the course location, like the park, venue, or start line?

Control: text
Response needed when shown: Optional
Shown when: When this step is shown in the live form.

Course address

What is the address of the course or start line?

Control: address
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Course setting

Where does the course run?

Road courses involve traffic control and permits that carriers price for.

Control: pills
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Public roads; Park or trail; Track or closed course; Mixed

Distances

Which distances are offered?

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: 1 mile; 5K; 10K; Half marathon; Longer than a half marathon

Timed participants

How many competitive or timed participants do you expect? Enter 0 if none.

Control: number
Response needed when shown: Optional
Shown when: When this step is shown in the live form.

Non-competitive participants

How many non-competitive participants do you expect? Enter 0 if none.

Control: number
Response needed when shown: Optional
Shown when: When this step is shown in the live form.

Walk or Run Event: Event features (7 questions)

Event format

Do any of these describe the event?

Specialty formats are quoted on different programs than a standard walk or run. Selecting one just routes us there.

Control: multichips
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Obstacle or mud course; Color powder or glow theme; Night-time running; Endurance or multi-day format; Water or cycling legs; None of these apply

Animals

Does the event involve animals other than service animals, for example a dog-friendly division?

Control: yesno
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes; No

Professional athletics

Is this a professional sporting event, tryout, or training camp?

Control: yesno
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes; No

College championship

Is this a college or university championship event?

Control: yesno
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes; No

Vendors

Will vendors be at the event?

Control: yesno
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes; No

Waivers

Do all participants, or parents or guardians of minors, sign a release or waiver?

A signed waiver is one of the strongest facts in your favor when carriers price a participant event.

Control: yesno
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes; No

Alcohol

Will alcohol be sold or provided at the event, for example a finish-line beer garden?

Control: yesno
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes; No

Walk or Run Event: Policy details (2 questions)

Claims & incidents

Every carrier asks this. A past claim or a known incident rarely stops a quote, it just needs to be described accurately up front.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Mailing address

What is the best mailing address for your policy documents?

This is where the policy and any carrier mail get sent. A home address is fine.

Control: address
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Amateur Sports Team / League / Association: About the business (5 questions)

Legal entity type

Is the business an LLC, corporation, partnership, sole proprietorship, or non-profit?

The legal entity goes on the policy, and coverage options for owners differ between sole proprietors, LLCs, and corporations.

Control: entity
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: LLC; Corporation; S corporation; Partnership; Sole proprietorship; Non-profit organization; Other

Trade name / DBA (optional)

Control: text
Response needed when shown: Optional
Shown when: When this step is shown in the live form.

Business stage

Control: pills
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Brand new (not operating yet); Recently started (under a year); Established (1+ years); Buying an existing business

Year business established

What year was the business established?

Control: number
Response needed when shown: Yes when shown
Shown when: Business stage is one of: Recently started (under a year); Established (1+ years)

Your experience in this line of work

Underwriters use the owner's background to rate a business that does not yet have its own operating history. This is a description, not a guarantee of any outcome.

Control: textarea
Response needed when shown: Optional
Shown when: (Business stage is one of: Brand new (not operating yet); Recently started (under a year) OR Year business established is between the current calendar year minus 2 and the current calendar year)

Amateur Sports Team / League / Association: Your organization (8 questions)

Organization name

What is the team, league, or association name, exactly as it should appear on the policy?

Control: text
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Type of organization

Which best describes the organization?

Control: pills
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Individual team; League, club, or local association; National governing body or association

Sport(s)

What sport or sports do you play? Pick a close match or type your own, and list every sport if there's more than one.

If your sport isn't in the list, just type it in. Every sport has a home somewhere.

Control: text
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Archery; Baseball; Basketball; Bowling; Cheerleading; Cross country; Fencing; Field hockey; Figure skating; Flag or touch football; Golf; Kickball; Pickleball; Roller hockey; Running club (5K or 10K); Soccer; Softball; Swimming; Tennis; Track and field; Ultimate frisbee; Volleyball; Wrestling (amateur youth); Youth tackle football; Youth lacrosse

Home state

In which state is the team or league based?

Control: text
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Alabama; Alaska; Arizona; Arkansas; California; Colorado; Connecticut; Delaware; Florida; Georgia; Hawaii; Idaho; Illinois; Indiana; Iowa; Kansas; Kentucky; Louisiana; Maine; Maryland; Massachusetts; Michigan; Minnesota; Mississippi; Missouri; Montana; Nebraska; Nevada; New Hampshire; New Jersey; New Mexico; New York; North Carolina; North Dakota; Ohio; Oklahoma; Oregon; Pennsylvania; Rhode Island; South Carolina; South Dakota; Tennessee; Texas; Utah; Vermont; Virginia; Washington; West Virginia; Wisconsin; Wyoming; District of Columbia

Coverage period

Do you need coverage for a single season, year-round, or a single tournament or event?

Control: pills
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Single season; Year-round; Single tournament or event

National program

Is the organization a member of a national program, like Little League, Pop Warner, Babe Ruth, or SAY Soccer?

Some national programs come with their own group insurance or endorsement rules, so it changes what we quote.

Control: yesno
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes; No

Nonprofit

Is the organization a not-for-profit?

Control: yesno
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes; No

Municipal program

Is the organization a municipality or a parks-and-recreation program?

Control: yesno
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes; No

Amateur Sports Team / League / Association: Participants & teams (6 questions)

Participants 12 and under

How many participants are 12 and under? Enter 0 if none.

Carriers rate each age band separately, so rough counts per band beat one overall total.

Control: number
Response needed when shown: Optional
Shown when: When this step is shown in the live form.

Participants 13 to 15

How many participants are 13 to 15? Enter 0 if none.

Control: number
Response needed when shown: Optional
Shown when: When this step is shown in the live form.

Participants 16 to 19

How many participants are 16 to 19? Enter 0 if none.

Control: number
Response needed when shown: Optional
Shown when: When this step is shown in the live form.

Participants 20 and over

How many participants are 20 and over? Enter 0 if none.

Control: number
Response needed when shown: Optional
Shown when: When this step is shown in the live form.

Number of teams

How many teams are you covering?

Control: number
Response needed when shown: Optional
Shown when: When this step is shown in the live form.

Waivers

Do participants, or parents or guardians of minors, sign a release or waiver?

A signed waiver is one of the strongest facts in your favor when carriers price a participant sport.

Control: yesno
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes; No

Amateur Sports Team / League / Association: Operations (5 questions)

Facilities

Do you own or operate any sports fields, courts, or facilities on a 24-hour basis?

Running a facility around the clock is a premises exposure on top of the team activity, so it's quoted accordingly.

Control: yesno
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes; No

Paid players

Are any players compensated or paid to play?

Control: yesno
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes; No

School sanctioned

Is the organization school-sanctioned, like a school team or district program?

Control: yesno
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes; No

Residential property

Are any activities held on residential property?

Control: yesno
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes; No

Pool activities

Do any activities take place at a pool you own, operate, or manage?

Control: yesno
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes; No

Amateur Sports Team / League / Association: Coverage preferences (2 questions)

Liability limit

What general liability limit would you like quoted?

Sanctioning bodies and field owners often set a minimum. If you're not sure, pick the last option and Lee can recommend one.

Control: pills
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: $1 million; $2 million; $3 million; $4 million; $5 million; Not sure, recommend for me

Participant medical payments

What limit would you like for participant medical payments?

This pays participants' medical bills after an injury regardless of fault, which often heads off a liability claim.

Control: pills
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: $25,000; $100,000; $250,000; Not sure, recommend for me

Amateur Sports Team / League / Association: Optional coverages (12 questions)

Abuse & molestation coverage

Would you like abuse and molestation (sexual misconduct) liability included in the quote?

Most youth-sports organizations carry this today, and many sanctioning bodies and facilities ask to see it.

Control: yesno
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes; No

Participant contact

Do you have employees, volunteers, or independent contractors who are in contact with participants?

Control: yesno
Response needed when shown: Optional
Shown when: Abuse & molestation coverage is Yes
Options: Yes; No

Screening practices

Which of these screening practices are in place for staff and volunteers?

Carriers price this coverage on prevention practices. Whatever is in place today is the right answer.

Control: multichips
Response needed when shown: Optional
Shown when: Abuse & molestation coverage is Yes
Options: Written applications; Applicants are asked about criminal convictions; Third-party background checks; Applicants with a violent or sex-offense history are not accepted; None of these apply

Written procedures & training

Which of these written procedures and trainings are in place?

Control: multichips
Response needed when shown: Optional
Shown when: Abuse & molestation coverage is Yes
Options: Recognizing signs of abuse; Reporting to law enforcement or authorities; Procedures are available to staff and volunteers; No unsupervised one-on-one contact with participants; Supervision procedures; Physical-contact and communication policy; None of these apply

Prior situations

Have there been any abuse or misconduct claims, allegations, charges, or situations you're aware of that could lead to a claim?

Control: yesno
Response needed when shown: Optional
Shown when: Abuse & molestation coverage is Yes
Options: Yes; No

Hosted tournaments

Do you host tournaments and want them covered?

Tournaments you host bring in outside participants and spectators, so each one is listed on the policy individually.

Control: yesno
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes; No

Same sports and ages

Do your hosted tournaments follow the same sports and age groups as the team or league?

Control: yesno
Response needed when shown: Optional
Shown when: Hosted tournaments is Yes
Options: Yes; No

Tournament schedule

Add each tournament you host.

Control: property_repeater
Response needed when shown: Optional
Shown when: Hosted tournaments is Yes

Equipment & contents

Would you like coverage for equipment and contents, like team gear, field maintenance equipment, concession equipment, or storage units?

Control: yesno
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes; No

Equipment value

What is the total replacement value of the equipment and contents?

Insuring the full replacement value means a loss can actually re-buy the gear.

Control: money
Response needed when shown: Optional
Shown when: Equipment & contents is Yes

High-value items

List any single item valued over $5,000 with its value, or write None.

Control: textarea
Response needed when shown: Optional
Shown when: Equipment & contents is Yes

Directors & officers

Would you like directors & officers liability included for the organization's board?

D&O protects board members personally for decisions they make running the organization, separate from injury liability.

Control: yesno
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes; No

Amateur Sports Team / League / Association: Beyond this policy (3 questions)

Vehicle use

Does the organization use any vehicle for its activities, including a personally owned one? Driving to venues, events, classes, or client locations counts.

Control: pills
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes; No; Not sure

Employees & helpers

Does the organization have any employees or paid staff, even part-time, seasonal, or as-needed?

If anyone works for you, workers compensation may come into play depending on your state. Knowing now means the quote covers the whole picture.

Control: yesno
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes; No

Other coverage to consider

Beyond this policy, which of these would you like us to also look at?

If any of these fit your operation, we can quote them at the same time. If nothing fits right now, or you already have it handled elsewhere, the last two choices let you say exactly that.

Control: multichips
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Commercial auto; Workers compensation; Equipment coverage; Cyber liability; None of these right now; I already have other coverage in place

Amateur Sports Team / League / Association: Certificates & policy details (4 questions)

Certificates & additional insureds

Does anyone require a certificate of insurance or ask to be named as additional insured, like a field owner, sponsor, or co-promoter?

Control: yesno
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes; No

Claims & incidents

In the past 5 years, have there been any insurance claims or losses involving the organization? Answer Yes as well if you're aware of any incident or circumstance that could reasonably give rise to a claim, even if nothing has been filed yet.

Every carrier asks this. A past claim or a known incident rarely stops a quote, it just needs to be described accurately up front.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Effective date

When would you like coverage to begin? A near-term placeholder date is fine.

Control: date
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Mailing address

What is the best mailing address for your policy documents?

This is where the policy and any carrier mail get sent. A home address is fine.

Control: address
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Fitness, Yoga, Dance or Sports Instructor: About the business (3 questions)

Business stage

Control: pills
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Brand new (not operating yet); Recently started (under a year); Established (1+ years); Buying an existing business

Year business established

What year was the business established?

Control: number
Response needed when shown: Optional
Shown when: Business stage is one of: Recently started (under a year); Established (1+ years)

Your experience in this line of work

Underwriters use the owner's background to rate a business that does not yet have its own operating history. This is a description, not a guarantee of any outcome.

Control: textarea
Response needed when shown: Optional
Shown when: (Business stage is one of: Brand new (not operating yet); Recently started (under a year) OR Year business established is between the current calendar year minus 2 and the current calendar year)

Fitness, Yoga, Dance or Sports Instructor: What you teach (7 questions)

Your focus

What do you teach?

Control: pills
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Fitness or exercise; Yoga; Dance; Sports skills; Multiple of these

Classes & activities

What activities or classes do you teach?

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Yoga styles

What styles of yoga do you teach? Pick a close match or type your own, listing all that apply.

If you teach aerial or anti-gravity yoga, include your certification details under certifications below. Carriers ask for them on those styles.

Control: text
Response needed when shown: Optional
Shown when: Your focus is one of: Yoga; Multiple of these
Options: Hatha; Vinyasa; Ashtanga; Yin; Restorative; Hot yoga; Power; Kundalini; Iyengar; Prenatal or postnatal; Acrobatic or partner yoga; Aerial or anti-gravity yoga

Aerial or acrobatic formats

Do you teach any aerial, suspended, or acrobatic formats?

Control: yesno
Response needed when shown: Optional
Shown when: Your focus is one of: Yoga; Dance; Multiple of these
Options: Yes; No

Sports you teach

Which sports do you teach? Pick a close match or type your own, listing all that apply.

Control: text
Response needed when shown: Optional
Shown when: Your focus is one of: Sports skills; Multiple of these
Options: Baseball; Basketball; Soccer; Softball; Volleyball; Tennis; Pickleball; Golf; Swimming; Track and field; Running or cross country; Football skills; Hockey; Lacrosse; Figure skating

Instruction screeners

Does your instruction include any of these?

These disciplines are placed with specific markets. Selecting one just tells us where to shop.

Control: multichips
Response needed when shown: Optional
Shown when: Your focus is one of: Sports skills; Multiple of these
Options: Gymnastics or tumbling on apparatus; Martial arts; Equestrian; Water sports or open water; Climbing; Cycling on roads; None of these apply

Certifications

What certifications do you hold?

Control: textarea
Response needed when shown: Optional
Shown when: When this step is shown in the live form.

Fitness, Yoga, Dance or Sports Instructor: How and where you teach (6 questions)

Where you teach

Where do you teach?

A facility you own or lease is its own exposure and is quoted alongside your instructor policy.

Control: pills
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Client homes or online; Gyms or studios I rent or drop into; A studio or facility I own or lease; Outdoors or public spaces; A mix of these

Other instructors

Do you employ or contract other instructors?

An individual instructor policy covers only the named instructor. If others teach under you, we can quote a policy shaped for that instead.

Control: yesno
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes; No

Your age

Are you under 18?

Control: yesno
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes; No

School employment

Are you employed by a school, college, or university for this teaching?

Teaching done as a school employee is usually covered by the school, so your own policy is aimed at the work that's actually yours.

Control: yesno
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes; No

Team coaching

Do you coach organized competitive teams?

Coaching a competitive team is a different product than teaching skills. We can quote both.

Control: yesno
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes; No

Athletic trainer

Are you a certified athletic trainer working in that capacity?

Athletic trainers carry a professional liability policy of their own. This just routes you correctly.

Control: yesno
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes; No

Fitness, Yoga, Dance or Sports Instructor: Business details (2 questions)

Instruction revenue

Roughly how much do you earn per year from instruction?

Control: money
Response needed when shown: Optional
Shown when: When this step is shown in the live form.

Students per week

About how many students do you teach in a typical week?

Control: number
Response needed when shown: Optional
Shown when: When this step is shown in the live form.

Fitness, Yoga, Dance or Sports Instructor: Beyond this policy (2 questions)

Vehicle use

Do you use any vehicle for your teaching work, including a personally owned one? Driving to venues, events, classes, or client locations counts.

Control: pills
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes; No; Not sure

Other coverage to consider

Beyond this policy, which of these would you like us to also look at?

If any of these fit your operation, we can quote them at the same time. If nothing fits right now, or you already have it handled elsewhere, the last two choices let you say exactly that.

Control: multichips
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Commercial auto; Workers compensation; Equipment coverage; Cyber liability; None of these right now; I already have other coverage in place

Fitness, Yoga, Dance or Sports Instructor: Policy details (3 questions)

Claims & incidents

Every carrier asks this. A past claim or a known incident rarely stops a quote, it just needs to be described accurately up front.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Effective date

When would you like coverage to begin? A near-term placeholder date is fine.

Control: date
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Mailing address

What is the best mailing address for your policy documents?

This is where the policy and any carrier mail get sent. A home address is fine.

Control: address
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Dance School / Studio: About the business (5 questions)

Legal entity type

Is the business an LLC, corporation, partnership, sole proprietorship, or non-profit?

The legal entity goes on the policy, and coverage options for owners differ between sole proprietors, LLCs, and corporations.

Control: entity
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: LLC; Corporation; S corporation; Partnership; Sole proprietorship; Non-profit organization; Other

Trade name / DBA (optional)

Control: text
Response needed when shown: Optional
Shown when: When this step is shown in the live form.

Business stage

Control: pills
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Brand new (not operating yet); Recently started (under a year); Established (1+ years); Buying an existing business

Year business established

What year was the business established?

Control: number
Response needed when shown: Yes when shown
Shown when: Business stage is one of: Recently started (under a year); Established (1+ years)

Your experience in this line of work

Underwriters use the owner's background to rate a business that does not yet have its own operating history. This is a description, not a guarantee of any outcome.

Control: textarea
Response needed when shown: Optional
Shown when: (Business stage is one of: Brand new (not operating yet); Recently started (under a year) OR Year business established is between the current calendar year minus 2 and the current calendar year)

Dance School / Studio: Your studio (4 questions)

School / studio name

What is the school or studio name, exactly as it should appear on the policy?

Control: text
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Concert & performance styles

Which of these styles do you teach? Social and cultural styles are next.

Control: multichips
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Ballet; Tap; Jazz; Contemporary; Modern; Hip hop; Acro dance; Clogging; Irish step; Flamenco; Belly dancing

Social & cultural styles

And which of these?

Between the two lists, select every style on your schedule. The mix of styles drives rating on studio policies.

Control: multichips
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Ballroom; Latin; Salsa; Swing; Tango; Country western; Square; Folk; Cultural or ethnic; Hawaiian; Scottish; Zumba or dance fitness

Your space

Is your studio space owned or leased?

Control: pills
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: We own our space; We lease our space; No dedicated space (we rent rooms as needed)

Dance School / Studio: Students & instructors (4 questions)

Enrolled students

How many students are enrolled?

Control: number
Response needed when shown: Optional
Shown when: When this step is shown in the live form.

Student ages

Which age groups do you teach?

Control: multichips
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: 5 and under; 6-12; 13-17; 18 and over

Employed instructors

How many W-2 employee instructors do you have? Enter 0 if none.

Control: number
Response needed when shown: Optional
Shown when: When this step is shown in the live form.

Independent contractors

Do independent-contractor instructors teach at your facility?

Contractor instructors are common. Carriers just want to know whether they're covered under your policy or their own.

Control: yesno
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes; No

Dance School / Studio: Programs & safety (7 questions)

Off-premises activities

Do you hold activities away from your facility, other than competitions, demonstrations, parades, or fundraisers?

Control: yesno
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes; No

Recitals & competitions

About how many recitals or competitions do you host per year? Enter 0 if none.

Control: number
Response needed when shown: Optional
Shown when: When this step is shown in the live form.

Inflatables

Do you use any inflatable devices, like bounce houses at events?

Control: yesno
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes; No

Parkour & tricking

Do you have programs involving parkour, extreme tumbling, tricking, free-running, or similar?

Control: yesno
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes; No

Aerial & acro programs

Do you offer aerial or acro programs, like silks, hoop, or acro dance beyond floor work?

Control: yesno
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes; No

Head-injury practices

Which of these practices are in place for suspected head injuries?

Carriers give credit for a written concussion protocol. Whatever you do today is the right answer.

Control: multichips
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Participants are removed from class or practice immediately after a suspected head injury; Participants are cleared by a professional before returning; A written concussion action plan is shared with staff and parents; None of these apply

Waivers

Do students, or parents or guardians of minors, sign a release or waiver?

Control: yesno
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes; No

Dance School / Studio: Beyond this policy (2 questions)

Vehicle use

Does the studio use any vehicle for its operations, including a personally owned one? Driving to venues, events, classes, or client locations counts.

Control: pills
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes; No; Not sure

Other coverage to consider

Beyond this policy, which of these would you like us to also look at?

If any of these fit your operation, we can quote them at the same time. If nothing fits right now, or you already have it handled elsewhere, the last two choices let you say exactly that.

Control: multichips
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Commercial auto; Workers compensation; Equipment coverage; Cyber liability; None of these right now; I already have other coverage in place

Dance School / Studio: Policy details (4 questions)

Current carrier

If you have coverage today, is your current carrier non-renewing it?

Control: yesno
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes; No

Claims & incidents

In the past 5 years, have there been any insurance claims or losses involving the studio? Answer Yes as well if you're aware of any incident or circumstance that could reasonably give rise to a claim, even if nothing has been filed yet.

Every carrier asks this. A past claim or a known incident rarely stops a quote, it just needs to be described accurately up front.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Effective date

When would you like coverage to begin? A near-term placeholder date is fine.

Control: date
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Mailing address

What is the best mailing address for your policy documents?

This is where the policy and any carrier mail get sent. A home address is fine.

Control: address
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Activity & Social Club: About the business (5 questions)

Legal entity type

Is the business an LLC, corporation, partnership, sole proprietorship, or non-profit?

The legal entity goes on the policy, and coverage options for owners differ between sole proprietors, LLCs, and corporations.

Control: entity
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: LLC; Corporation; S corporation; Partnership; Sole proprietorship; Non-profit organization; Other

Trade name / DBA (optional)

Control: text
Response needed when shown: Optional
Shown when: When this step is shown in the live form.

Business stage

Control: pills
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Brand new (not operating yet); Recently started (under a year); Established (1+ years); Buying an existing business

Year business established

What year was the business established?

Control: number
Response needed when shown: Yes when shown
Shown when: Business stage is one of: Recently started (under a year); Established (1+ years)

Your experience in this line of work

Underwriters use the owner's background to rate a business that does not yet have its own operating history. This is a description, not a guarantee of any outcome.

Control: textarea
Response needed when shown: Optional
Shown when: (Business stage is one of: Brand new (not operating yet); Recently started (under a year) OR Year business established is between the current calendar year minus 2 and the current calendar year)

Activity & Social Club: Your club (5 questions)

Club name

What is the club's name, exactly as it should appear on the policy?

Control: text
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Club activities

What does the club do? Select all that apply.

Pick Something else if nothing fits. Almost every club has a home somewhere, and Lee can find the right market for it.

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Art; Birdwatching; Book club; Calligraphy; Collector club; Cooking; Craft making; Cultural club; Games or cards (non-gambling); Garden; Genealogy; History; Model trains or model cars; Needlework; Peer support group (no licensed facilitators); Puppetry; Scrapbooking; Something else

Club or association

Is this an individual club or group, or an association with chapters or member groups?

Control: pills
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Individual club or group; Association (chapters or member groups)

Members

About how many members does the club have?

Control: number
Response needed when shown: Optional
Shown when: When this step is shown in the live form.

Who's covered

Are you seeking coverage for all members and participants of the club?

Control: yesno
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes; No

Activity & Social Club: Meetings & activities (4 questions)

Where you meet

Where does the club usually meet?

Control: pills
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: A rented hall or room; Member homes; A facility we own; Public spaces; Mostly online

Facility responsibility

Is the club responsible for the ownership, operation, or maintenance of a facility?

A facility the club runs is a premises exposure on top of the club activity, so it's quoted accordingly.

Control: yesno
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes; No

Public events

Do you host, sponsor, or organize any activities or events that are open to the public?

Control: yesno
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes; No

Annual budget

Roughly what is the club's annual budget or revenue, including dues and fundraising?

Control: money
Response needed when shown: Optional
Shown when: When this step is shown in the live form.

Activity & Social Club: Beyond this policy (3 questions)

Vehicle use

Does the club use any vehicle for its activities, including a personally owned one? Driving to venues, events, classes, or client locations counts.

Control: pills
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes; No; Not sure

Employees & helpers

Does the club have any employees or paid staff, even part-time, seasonal, or as-needed?

If anyone works for you, workers compensation may come into play depending on your state. Knowing now means the quote covers the whole picture.

Control: yesno
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes; No

Other coverage to consider

Beyond this policy, which of these would you like us to also look at?

If any of these fit your operation, we can quote them at the same time. If nothing fits right now, or you already have it handled elsewhere, the last two choices let you say exactly that.

Control: multichips
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Commercial auto; Workers compensation; Equipment coverage; Cyber liability; None of these right now; I already have other coverage in place

Activity & Social Club: Policy details (3 questions)

Claims & incidents

In the past 5 years, have there been any insurance claims or losses involving the club? Answer Yes as well if you're aware of any incident or circumstance that could reasonably give rise to a claim, even if nothing has been filed yet.

Every carrier asks this. A past claim or a known incident rarely stops a quote, it just needs to be described accurately up front.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Effective date

When would you like coverage to begin? A near-term placeholder date is fine.

Control: date
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Mailing address

What is the best mailing address for your policy documents?

This is where the policy and any carrier mail get sent. A home address is fine.

Control: address
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Outfitters & Guides: About the business (5 questions)

Legal entity type

Is the business an LLC, corporation, partnership, sole proprietorship, or non-profit?

The legal entity goes on the policy, and coverage options for owners differ between sole proprietors, LLCs, and corporations.

Control: entity
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: LLC; Corporation; S corporation; Partnership; Sole proprietorship; Non-profit organization; Other

Trade name / DBA (optional)

Control: text
Response needed when shown: Optional
Shown when: When this step is shown in the live form.

Business stage

Control: pills
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Brand new (not operating yet); Recently started (under a year); Established (1+ years); Buying an existing business

Year business established

What year was the business established?

Control: number
Response needed when shown: Yes when shown
Shown when: Business stage is one of: Recently started (under a year); Established (1+ years)

Your experience in this line of work

Underwriters use the owner's background to rate a business that does not yet have its own operating history. This is a description, not a guarantee of any outcome.

Control: textarea
Response needed when shown: Optional
Shown when: (Business stage is one of: Brand new (not operating yet); Recently started (under a year) OR Year business established is between the current calendar year minus 2 and the current calendar year)

Outfitters & Guides: Your operation (3 questions)

Business name

What is the business or operation name, exactly as it should appear on the policy?

Control: text
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Years operating

How many years has the operation been running?

Control: number
Response needed when shown: Optional
Shown when: When this step is shown in the live form.

Where you operate

Where do you operate? List the states, the public lands or waters you use, and any permits you hold.

Control: textarea
Response needed when shown: Optional
Shown when: When this step is shown in the live form.

Outfitters & Guides: Activities offered (5 questions)

Land activities

Which land-based activities do you offer?

Control: multichips
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Backpacking; Camping; Guided hiking; Guided hunting; Snowshoeing; Cross-country skiing; Eco tours; Guided bicycle tours; None of these apply

Water activities

Which water-based activities do you offer?

Control: multichips
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Guided fishing; Non-guided fishing; Paddling or paddleboarding trips; Kayak, canoe, raft, or tube rentals; Paddling or surf schools; Surfing or windsurfing; Snorkeling; Shoreline sailing; None of these apply

Facilities & retail

Do any of these round out the operation?

Control: multichips
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Campgrounds; Lodges or cabins we own; Retail sales; Livery or shuttle service for our own trips; Bicycle rentals alongside our trips; None of these apply

Revenue mix

Roughly what share of your revenue comes from each activity? Ballpark percentages are fine.

Several outdoor activities are rated by their share of revenue, so a rough split gets you a truer quote.

Control: textarea
Response needed when shown: Optional
Shown when: When this step is shown in the live form.

A few screeners

Do any of these apply to your operation?

These are placed with specialty markets. Selecting one just tells us where to shop.

Control: multichips
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Water trips more than 1 mile from shore or on Class IV or V water; Climbing, rappelling, canyoneering, or ice climbing; ATVs, snowmobiles, or motorized bikes; Horses or other saddle animals; Transporting other people's property or charter services; Alcohol sales; None of these apply

Outfitters & Guides: People & practices (5 questions)

Annual receipts

Roughly what are your annual gross receipts?

Control: money
Response needed when shown: Optional
Shown when: When this step is shown in the live form.

Employee guides

How many employee guides do you have? Enter 0 if none.

Control: number
Response needed when shown: Optional
Shown when: When this step is shown in the live form.

Contract & seasonal guides

Do you use 1099 or seasonal guides?

Control: yesno
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes; No

Participants per year

About how many participants or guests do you serve per year?

Control: number
Response needed when shown: Optional
Shown when: When this step is shown in the live form.

Waivers

Do participants sign a release or waiver?

A signed waiver is one of the strongest facts in your favor when carriers price guided recreation.

Control: yesno
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes; No

Outfitters & Guides: Beyond this policy (2 questions)

Vehicle use

Does the operation use any vehicle for its work, including a personally owned one? Driving to venues, events, classes, or client locations counts.

Control: pills
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes; No; Not sure

Other coverage to consider

Beyond this policy, which of these would you like us to also look at?

If any of these fit your operation, we can quote them at the same time. If nothing fits right now, or you already have it handled elsewhere, the last two choices let you say exactly that.

Control: multichips
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Commercial auto; Workers compensation; Equipment coverage; Cyber liability; None of these right now; I already have other coverage in place

Outfitters & Guides: Policy details (3 questions)

Claims & incidents

In the past 5 years, have there been any insurance claims or losses involving the operation? Answer Yes as well if you're aware of any incident or circumstance that could reasonably give rise to a claim, even if nothing has been filed yet.

Every carrier asks this. A past claim or a known incident rarely stops a quote, it just needs to be described accurately up front.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Effective date

When would you like coverage to begin? A near-term placeholder date is fine.

Control: date
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Mailing address

What is the best mailing address for your policy documents?

This is where the policy and any carrier mail get sent. A home address is fine.

Control: address
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Nonprofit Board (D&O): About the business (5 questions)

Legal entity type

Is the business an LLC, corporation, partnership, sole proprietorship, or non-profit?

The legal entity goes on the policy, and coverage options for owners differ between sole proprietors, LLCs, and corporations.

Control: entity
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: LLC; Corporation; S corporation; Partnership; Sole proprietorship; Non-profit organization; Other

Trade name / DBA (optional)

Control: text
Response needed when shown: Optional
Shown when: When this step is shown in the live form.

Business stage

Control: pills
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Brand new (not operating yet); Recently started (under a year); Established (1+ years); Buying an existing business

Year business established

What year was the business established?

Control: number
Response needed when shown: Yes when shown
Shown when: Business stage is one of: Recently started (under a year); Established (1+ years)

Your experience in this line of work

Underwriters use the owner's background to rate a business that does not yet have its own operating history. This is a description, not a guarantee of any outcome.

Control: textarea
Response needed when shown: Optional
Shown when: (Business stage is one of: Brand new (not operating yet); Recently started (under a year) OR Year business established is between the current calendar year minus 2 and the current calendar year)

Nonprofit Board (D&O): Your organization (5 questions)

Organization name

What is the organization's name, exactly as it should appear on the policy?

Control: text
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

What it does

What does the organization do? Pick a close match or type your own.

Control: text
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Chamber of commerce; Community center; Camp; Fair or festival organizer; Youth sports organization; Amateur sports league or event; Museum; Historical society or site; Parade organizer; Arts or cultural organization; Youth club or mentoring program; Botanical garden or zoo; Trade show or convention organizer; Charity event organizer; Social or community group

Nonprofit status

What is the organization's nonprofit status?

For-profit boards are quoted on different D&O forms, so this just points us to the right market.

Control: pills
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: 501(c)(3) nonprofit; Other nonprofit; Not a nonprofit

Government entity

Is the organization a government entity?

Control: yesno
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes; No

State or national headquarters

Is this entity the headquarters or main office of a state or national association?

Control: yesno
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes; No

Nonprofit Board (D&O): People & finances (6 questions)

Full-time employees

How many full-time compensated employees? Enter 0 if none.

Control: number
Response needed when shown: Optional
Shown when: When this step is shown in the live form.

Part-time employees

How many part-time compensated employees? Enter 0 if none.

Control: number
Response needed when shown: Optional
Shown when: When this step is shown in the live form.

Volunteers

About how many volunteers? Enter 0 if none.

Control: number
Response needed when shown: Optional
Shown when: When this step is shown in the live form.

Annual gross revenue

What is the organization's annual gross revenue, including fees, sponsorships, fundraising, membership, and ticket sales?

Control: money
Response needed when shown: Optional
Shown when: When this step is shown in the live form.

Total assets

What are the organization's total assets on its financial statement?

Control: money
Response needed when shown: Optional
Shown when: When this step is shown in the live form.

Total liabilities

And its total liabilities?

Assets and liabilities give the carrier a quick read on the organization's financial footing, a standard D&O rating input.

Control: money
Response needed when shown: Optional
Shown when: When this step is shown in the live form.

Nonprofit Board (D&O): Insurance history (5 questions)

Current D&O

Does the organization currently carry directors & officers coverage?

Control: yesno
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes; No

General liability

Does the organization currently carry general liability insurance?

Control: yesno
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes; No

Employment practices

Would you like employment practices liability included in the quote?

Employment claims, like wrongful termination or discrimination allegations, are the most common claim source for nonprofit boards, so most D&O buyers add it.

Control: yesno
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes; No

Carrier history

Has any carrier cancelled, rescinded, non-renewed, or declined similar coverage in the past 5 years?

Control: yesno
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes; No

Claims & incidents

In the past 5 years, have there been any insurance claims or losses involving the organization or its board? Answer Yes as well if you're aware of any incident or circumstance that could reasonably give rise to a claim, even if nothing has been filed yet.

Every carrier asks this. A past claim or a known incident rarely stops a quote, it just needs to be described accurately up front.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Nonprofit Board (D&O): Beyond this policy (2 questions)

Vehicle use

Does the organization use any vehicle for its activities, including a personally owned one? Driving to venues, events, classes, or client locations counts.

Control: pills
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Yes; No; Not sure

Other coverage to consider

Beyond this policy, which of these would you like us to also look at?

If any of these fit your operation, we can quote them at the same time. If nothing fits right now, or you already have it handled elsewhere, the last two choices let you say exactly that.

Control: multichips
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Commercial auto; Workers compensation; Equipment coverage; Cyber liability; None of these right now; I already have other coverage in place

Nonprofit Board (D&O): Policy details (2 questions)

Effective date

When would you like coverage to begin? A near-term placeholder date is fine.

Control: date
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Mailing address

What is the best mailing address for your policy documents?

This is where the policy and any carrier mail get sent. A home address is fine.

Control: address
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Business: About the Business (9 questions)

Business description

What services or products will the business provide? The more detail you can share, the better I can match your quote and policy correctly.

This is the most important answer on the form. Carriers match your operations to specific classifications, and an accurate description prevents coverage gaps or disputes later.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Trade name (DBA)

Does the business go by a public name that is different from its legal name? A DBA, or trade name, is the name customers see on your signs, invoices, and website. For example, a company registered as Sonoran Holdings LLC that everyone knows as Desert Drywall. It is not a license number or a license classification. If the legal name is the only name you use, just answer No.

Certificates and policy documents should show the exact name your clients and landlord see. If the legal name is the only name in use, there is nothing to add here.

Control: text
Response needed when shown: Optional
Shown when: When this step is shown in the live form.

Legal entity type

Is the business an LLC, corporation, partnership, sole proprietorship, or non-profit?

The legal entity goes on the policy, and coverage options for owners differ between sole proprietors, LLCs, and corporations.

Control: entity
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: LLC; Corporation; S corporation; Partnership; Sole proprietorship; Non-profit organization; Other

Business stage

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Brand new (not operating yet) The business has been formed or planned but has not started operations yet.; Recently started (under a year) The business is actively operating and has been open for less than 12 months.; Established (1+ years) The business has been operating for at least one full year.; Buying an existing business You are under contract or negotiating to acquire a business that is already operating. You will need your own coverage in place at or before closing — the seller's policy does not transfer to you.

Year business established

What year was the business established?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Your experience in this line of work

Underwriters use the owner's background to rate a business that does not yet have its own operating history. This is a description, not a guarantee of any outcome.

Control: textarea
Response needed when shown: Yes when shown
Shown when: (Business stage is one of: Brand new (not operating yet); Recently started (under a year) OR Year business established is between the current calendar year minus 2 and the current calendar year)

Business being acquired

If you're buying an existing business: what is the name of the business you're acquiring, roughly how long has it been operating, and when do you expect the purchase to close?

To a carrier, your purchase is usually a new venture for the new entity even though the operation has history. The seller's policy doesn't transfer to you, so coverage is set up to start at closing, and the operation's track record is disclosed so you get credit for it.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Experience & qualifications

How much experience do you have in this line of work, and do you hold any relevant licenses, certifications, or training?

Experience and licensing directly affect which carriers will offer coverage and at what price. More experience usually means better rates.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Website / marketing

Do you have a website, social media page, or other materials you can share?

A quick look at how you present the business helps us describe your operations to underwriters accurately.

Control: passthru
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Business: Coverage You're Looking For (1 questions)

Coverages to consider

What coverage are you looking for today? Select any you are already interested in. You do not need to know exactly what you need: if you pick 'I'm not sure, help me identify what to consider', the questions that follow will help surface what is worth discussing. Lee may also identify other coverages worth considering. (for example general liability, workers comp, commercial auto, tools & equipment, Not-for-profit directors & officers liability (D&O), or 'I'm not sure, help me identify what to consider')

Your selections tell us what you are initially interested in. They are a starting point, not a limit on what your business may need. We also ask a few brief questions about your operations so Lee can spot other coverages worth considering.

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: I'm not sure, help me identify what to consider; General liability; Workers compensation; Commercial auto; Commercial property; Tools & equipment; Inland marine; Professional liability (E&O); Cyber liability; Umbrella; Not-for-profit directors & officers liability (D&O)

Business: Location & Operations (15 questions)

Home office or commercial space

Is your business location a home office, or a rented or owned commercial space?

A home office and a rented space carry different property exposures, and landlords usually require specific coverage in the lease. It also sets the square footage we use to rate the space.

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Home office; Rented commercial space; Owned commercial space

Business address

What is the street address of the business, and roughly how many square feet is the space? For a home office, just the office area is fine.

Carriers rate partly by location, and the address appears on your policy documents.

Control: address
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Additional locations

Does the business operate from more than one location? If so, please list the address and approximate square footage of each additional location.

Every location is listed and rated separately on the policy, so we need the address and size of each additional place you operate.

Control: locations
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: No, just one location; Yes, more than one

Who owns the space

If you own your space: is it owned by you or the business directly, or by another entity you manage that rents it back to the business?

When a separate LLC owns the building and leases it to the operating business, both entities need to be set up correctly on the policy for claims to pay.

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Owned by me or the business; Owned by another entity I manage, rented back to the business; Not sure

Building coverage

If you own the building: do you want building coverage included in the quote?

Building coverage rebuilds the structure itself after fire, storm, or other covered damage, separate from your contents and equipment. If there's a mortgage, the lender will require it.

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes, include building coverage; No; Not sure

Year built

What year was the building built?

Property carriers rate on age before almost anything else, so the year built lets us go straight to the right market. Only needed if the quote will cover the building or your business property.

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Construction type

What is the building's construction type?

Wood frame, masonry or block, steel, and concrete each rate very differently for fire. Only needed if the quote will cover the building or your business property.

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Wood frame; Masonry or block; Steel; Concrete; Not sure

Number of stories

How many stories is the building?

Height affects property rating and, for some operations, liability. Only needed if the quote will cover the building or your business property.

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Fire sprinkler system

Is the building protected by a fire sprinkler system?

A monitored sprinkler system can meaningfully lower the property rate. Only needed if the quote will cover the building or your business property.

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Roof last replaced

Roughly what year was the roof last replaced? If it is the original roof, give the year the building was built. If you do not know, answer Not sure.

Roof age is one of the first things a property carrier checks. Only needed if the quote will cover the building or your business property.

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Mailing address

Is your mailing address the same as the business address? If it's different, please share it.

This is where your policy documents and any important notices are sent.

Control: mailing
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Same as the business address

Where you interact with customers

Where will you interact with customers: do they come to your location, do you go to their homes or job sites, is everything online/remote, or a mix?

This is really a general liability question: whether clients visit you, you work at their property, or everything is remote changes which liability exposures matter and how carriers class the risk.

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Customers come to our location; We go to customer homes or job sites; Online / remote only

States of operation

Will all of your work take place in Arizona? If not, list every state where you will work or have employees.

Policies can carry state-specific exclusions, and workers compensation must be arranged for every state where you have employees or jobs, so this changes how we structure your coverage.

Control: states
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Alabama; Alaska; Arizona; Arkansas; California; Colorado; Connecticut; Delaware; Florida; Georgia; Hawaii; Idaho; Illinois; Indiana; Iowa; Kansas; Kentucky; Louisiana; Maine; Maryland; Massachusetts; Michigan; Minnesota; Mississippi; Missouri; Montana; Nebraska; Nevada; New Hampshire; New Jersey; New Mexico; New York; North Carolina; North Dakota; Ohio; Oklahoma; Oregon; Pennsylvania; Rhode Island; South Carolina; South Dakota; Tennessee; Texas; Utah; Vermont; Virginia; Washington; West Virginia; Wisconsin; Wyoming; District of Columbia

Professional advice or services

Does the business give advice or provide professional, design, consulting, healthcare, technology, financial, or similar services where a client could claim your work caused them a financial loss? (Yes / No / I'm not sure)

General liability generally is not meant to cover claims that arise purely from professional advice or errors in your work. Your answer just helps Lee flag whether professional liability (also called errors and omissions) is worth discussing. It does not commit you to buying anything.

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No; I'm not sure

Products or completed work

Does the business make, import, distribute, sell, install, repair, or alter any products, or leave finished work behind such as an installation or a repair? (Yes / No / I'm not sure)

Finished work includes jobs you complete and leave behind, for example a floor you cleaned, a fixture you installed, a lawn you treated, or a repair you made. Claims can arise after the job is done, which is why carriers ask.

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No; I'm not sure

Business: People & Payroll (5 questions)

Owners

How many owners does the business have, and what are their names? For each owner, if we quote workers compensation, would they want to be included in coverage or excluded?

Owner names go on the application. Owners can usually choose to be included in or excluded from workers comp: excluding lowers the premium but leaves the owner without work-injury coverage, and some client contracts require owners to be covered.

Control: owners
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Ownership in another business

Do you or any other owner hold 50% or more of another business? (Yes / No / Not sure)

Carriers use this answer to understand whether related business operations affect the quote. Not sure is fine.

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No; Not sure

Employees & 1099 workers

Do you have or plan to hire any employees, including 1099 workers who really work like employees (they work mainly for you, don't carry their own insurance, and don't run a separate business)? If yes: how many full-time and part-time, what do they do, and in which state(s)?

Employee counts, duties, and locations decide whether workers compensation is required and how it's classed and priced. A 1099 worker who doesn't pass the 'sniff test' (their own business, own insurance, own clients) gets treated as your employee at audit, so it's better to count them here up front. True subcontractors who carry their own insurance go in the next question.

Control: employees
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No; Not sure yet

Annual payroll

What is your estimated annual payroll for employees (not counting owners)?

Payroll means the total wages you expect to pay your employees over a year, not your revenue, and not the owners' own draws or profit. Workers compensation and some liability policies are priced per $100 of payroll, so this sets the premium basis.

Control: money
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Subcontractors

Will you subcontract any work to true independent subcontractors who carry their own insurance and can hand you a certificate of insurance (COI)?

These are genuine outside businesses, not 1099 helpers who really work like employees (those go in the previous question). Requiring subs to carry their own insurance and provide a COI keeps their cost off your audit and your premium down; uninsured sub cost gets charged back to your policy.

Control: subs
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No; Not sure yet; Not sure

Business: Revenue & Property (5 questions)

Projected revenue

What is your estimated revenue for the 12 months starting when your coverage begins?

Revenue (also called sales or gross receipts) is the total money the business takes in before expenses, not your take-home profit and not payroll. It's one of the main ways carriers size a business, and several policies are rated directly on it. An honest estimate is fine and can be adjusted later.

Control: money
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Revenue for the past 12 months

Roughly what was the business's revenue over the past 12 months?

Established businesses are rated on actual revenue as well as the projection. If last year's number differs a lot from what you project, the difference is better explained to the underwriter up front than discovered at audit time.

Control: money
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Office equipment & furniture

Roughly what is the total value of the computers, office equipment, furniture, and fixtures at your location? If you have none, say None; if you have them but do not want them insured, say no coverage desired.

Sets the limit for replacing the contents at your business location if they're stolen or damaged.

Control: money
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: None (nothing to insure); No coverage desired

Tools & equipment that travel

If you take tools or equipment to job sites, roughly what total value would you want covered? If nothing travels, say None; if gear travels but you do not want it insured, say no coverage desired.

Gear that leaves your premises needs coverage that follows it. A standard property policy may not protect tools out on a job site.

Control: money
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: None (nothing travels); No coverage desired

High-value items to schedule

Do not list cars, trucks, vans, or trailers here. Every business vehicle goes in its own Vehicles section later in the form. This schedule is for tools and equipment only. If any single tool or piece of equipment is worth more than $500, it may need to be listed (scheduled) individually on the policy. If that applies, list each item below: the model and value are required; the year, make, and serial number are optional.

Carriers often cap how much they'll pay per unscheduled item, so listing your most valuable pieces by model and value now prevents an underinsured gap if one is lost or damaged. This schedule is for equipment only. A vehicle you drive for the business belongs on your commercial auto coverage, not here, so we collect it (with its VIN) in the vehicles section.

Control: scheduled
Response needed when shown: Optional
Shown when: When this step is shown in the live form.

Business: Umbrella & Excess Liability (8 questions)

Umbrella limit

What umbrella (excess liability) limit would you like quoted? An umbrella generally adds a layer of liability protection on top of your general liability, commercial auto, and (if you carry it) employer's liability limits, subject to the policy wording.

A common request is $1 million, but higher limits are available and often surprisingly inexpensive. If a limit does not come to mind, pick Not sure yet and a couple of options can be quoted to compare.

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: $1,000,000; $2,000,000; $3,000,000; $4,000,000; $5,000,000; $10,000,000; Not sure yet

Policies the umbrella sits over

Which of your liability policies would you like the umbrella to sit over? Select all that apply. (General liability / Commercial auto / Employer's liability (the liability part of workers compensation) / Professional liability (E&O) / Liquor liability / I'm not sure)

An umbrella generally provides extra limits above the policies listed underneath it, and carriers price it from those policies and their limits. Telling us which ones you have in mind helps Lee approach the right markets. If you are not sure, pick that and it can be sorted out before anything is quoted.

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: General liability; Commercial auto; Employer's liability (the liability part of workers compensation); Professional liability (E&O); Liquor liability; I'm not sure

Underlying policies

Please list the liability policies the umbrella would sit over. For each one, share the coverage, the carrier, the policy number, the each-occurrence and aggregate limits, the annual premium, and the expiration date. If a detail is not handy, leave that box blank.

An excess or umbrella policy is rated from what sits beneath it, so the carrier, limits, premium, and expiration of each underlying policy are the core of the application. Carriers also set a minimum limit they require underneath, so listing these up front usually avoids a round trip. Anything you leave blank can be picked up from the declarations pages.

Control: rows
Response needed when shown: Optional
Shown when: When this step is shown in the live form.

Endorsements already on the underlying policy

Which of these are already included on your underlying general liability policy? Select all that apply, or None of these. (Hired and non-owned auto / Per project aggregate / Liquor liability / Products and completed operations / Employee benefits liability / I'm not sure / None of these)

An umbrella generally follows the coverage sitting underneath it, so carriers ask which endorsements are already on that policy. If you are not sure, pick I'm not sure; the declarations page will show it.

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Hired and non-owned auto; Per project aggregate; Liquor liability; Products and completed operations; Employee benefits liability; I'm not sure; None of these

Underlying declarations pages

If you have them, upload the declarations page for each underlying policy. A declarations page is the summary page at the front of a policy that lists the carrier, the limits, the premium, and the policy period.

The declarations pages carry nearly every underlying detail an excess carrier asks for, so sending them is usually faster and more accurate than typing it all in. If you do not have them handy, you can send them later.

Control: upload
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: I'll send it later

Current umbrella or excess policy

Does the business carry an umbrella or excess liability policy today? (Yes / No)

If a layer is already in place, its carrier, limit, and expiration date tell us whether this is a renewal, a replacement, or an additional layer on top of what you have. If this would be your first umbrella, answer No.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Gaps in liability coverage

Over roughly the last four years, has there been any gap in the business's liability coverage? (No gap / A gap of less than 60 days / A gap of 60 days or more / The business has not carried liability coverage before / I'm not sure)

Excess carriers ask about continuity of coverage and often rate on it. A gap does not disqualify you; disclosing it up front lets Lee approach the markets that treat it best.

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: No gap; A gap of less than 60 days; A gap of 60 days or more; The business has not carried liability coverage before; I'm not sure

Higher-hazard operations

Do any of these describe work the business performs? Select all that apply, or None of these. (Work on buildings more than three stories tall / Demolition / Oil, gas, or mining work / Road, bridge, tunnel, or dam work / Work at airports, refineries, or other secured facilities / Work involving explosives or blasting / None of these)

Excess carriers each have their own appetite, and these are the operations they ask about most often. Selecting one is not a problem; it simply tells Lee which markets to approach.

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Work on buildings more than three stories tall; Demolition; Oil, gas, or mining work; Road, bridge, tunnel, or dam work; Work at airports, refineries, or other secured facilities; Work involving explosives or blasting; None of these

Business: Insurance Details (21 questions)

Cyber liability

Cyber liability helps cover data breaches, hacked email accounts, funds-transfer fraud, and ransomware. It comes two ways: packaged into your business policy when the carrier offers it (convenient, but typically lower limits and fewer coverages), or as a standalone cyber policy, which typically offers higher limits and broader coverage. Would you like it quoted? (Yes, package it into my policy if available / Yes, quote a standalone cyber policy / No thanks / I'm not sure, tell me more)

Small businesses that take payments, store customer information, or simply use email are common targets. A packaged cyber add-on is not the same thing as a standalone cyber policy, which typically carries higher limits and additional coverages. Not every carrier can include the packaged option; if yours can't, a standalone policy is still an option to consider. Whichever way you answer, it's documented in your file so it's clear both options were offered.

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes, package it into my policy if available; Yes, quote a standalone cyber policy; No thanks; I'm not sure, tell me more

Standalone cyber limit

What limit would you like quoted for the standalone cyber policy?

A common request is $1 million, but smaller and larger limits are available. If a limit does not come to mind, pick Not sure yet and a couple of options can be quoted to compare.

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: $500,000; $1,000,000; $2,000,000; $3,000,000; $5,000,000; Not sure yet

Records held

Roughly how many people's records does the business store or handle, counting anyone whose personal, medical, or payment-card information you keep (customers, patients, employees)?

Cyber carriers rate partly on how many people's records you hold, since that drives the cost of notifying and protecting them after a breach. A good-faith estimate is fine.

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Under 1,000; 1,000 to 10,000; 10,000 to 100,000; Over 100,000; Not sure

Multi-factor authentication

Is multi-factor authentication (MFA) required to sign in to your business email, remote access, and other important business systems? If it covers some of these but not all, answer No. (Yes / No)

MFA is one of the security controls cyber carriers weigh most heavily. Answer exactly as things stand today: this becomes part of your application, and an inaccurate answer can jeopardize a claim later. A No is fine to disclose; it affects pricing and which carriers we approach, and a few carriers require MFA before offering coverage. Many email and cloud systems include MFA at no extra cost.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Verifying payment requests

Before sending money to a new bank account or changing payment instructions, does the business verify the request through a second channel, such as calling a number you already know? (Yes / No)

Fraudulent payment instructions are among the most common and costly small-business cyber losses, so carriers ask whether a call-back or similar verification step exists. Answer as things actually work today; this becomes part of your application.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Data backups

How often is your important business data backed up?

Backup frequency is one of the biggest factors in how bad a ransomware event gets, so carriers rate on it. Count automatic cloud backup (for example Microsoft 365 or Google Workspace) as well as manual copies, and answer for how backups actually run today.

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Daily; Weekly; Monthly; Quarterly; Annually; Rarely or never

Prior cyber incidents

In the past 3 years, has the business had any cyber claims or incidents, such as a data breach, a hacked account, ransomware, or money lost to fraudulent payment instructions? (Yes / No)

Carriers always ask, and a past incident doesn't automatically disqualify you. Disclosing it up front lets us pick the market that treats your history best and keeps the application accurate.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Company structure changes

Do any of these apply to the business: it is a subsidiary or franchisee of another company, it completed a merger or acquisition in the past 12 months, or it plans one in the next 12 months? Select all that apply, or None of these.

Standalone cyber applications ask this because mergers and parent companies join computer networks and inherit each other's exposures. If none of these describes the business, select None of these.

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Subsidiary or franchisee of another company; Merger or acquisition completed in the past 12 months; Merger or acquisition planned in the next 12 months; None of these

Terrorism coverage (TRIA)

Terrorism coverage is generally offered as an option on commercial liability and property policies under the federal Terrorism Risk Insurance Act (TRIA). Broadly, it responds to damage or injury arising from an event the federal government certifies as an act of terrorism, which policies commonly exclude or limit otherwise. It is usually quoted for an additional premium, and some leases, contracts, and lenders call for it. Availability, cost, and exactly what is covered depend on the carrier and the policy wording. Would you like terrorism coverage included in your quote? (No, do not include terrorism coverage / Yes, include terrorism coverage / I'm not sure, tell me more)

This is your election, and it is recorded either way so it is clear the option was presented. Picking No simply leaves it off the quote you are shown, and you can ask about pricing it at any point before you decide, subject to what the carrier offers. If a lease, loan, or contract calls for terrorism coverage, pick Yes so the quote is built to match. The description above is a general summary, not a statement of coverage: the policy language controls.

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: No, do not include terrorism coverage Leave the terrorism option off the quote. This is only your election today; you can ask what it would cost at any point before you decide.; Yes, include terrorism coverage Price the terrorism option alongside the rest of the quote so you can see what it adds. Pick this if a lease, lender, or contract calls for it.; I'm not sure, tell me more You would like to talk through what the terrorism option does and does not cover before choosing. It can be quoted both ways so you can compare.

Prior insurance & losses

Have you carried insurance for this business, and have there been any claims or losses in the past 5 years?

Carriers always ask. Gaps or past claims don't disqualify you, but knowing up front lets us pick the market that treats your history best.

Control: prior
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Prior history

Has the business, or any owner, officer, partner, or manager, had any of the following? Use the time frame shown for each item, and count claims and incidents whether or not you were insured for them. - a claim, complaint, charge, hearing, demand, or administrative, regulatory, civil, or criminal proceeding involving an employment matter (such as wrongful termination, discrimination, harassment, retaliation, or a wage-and-hour dispute) against the business or any owner, partner, officer, or manager who would be covered (past 3 years) - a claim against the business or anyone this policy would cover, including for professional work done before this business started (past 5 years, or earlier if still open) - an incident or situation you are aware of that could reasonably lead to a claim (no time limit) - a bankruptcy filing by the business, or the business being placed into bankruptcy (ever) - a felony conviction of the business or an owner, officer, or partner (past 5 years) - a bankruptcy declared by the business or an owner, officer, or partner (past 3 years) - a business-related lawsuit, mediation, or arbitration filed against the business or an owner, officer, partner, or manager (ever, no time limit) - an insurance policy for the business that a carrier cancelled, or declined to renew or issue (ever) (No, none of these / Yes)

Carriers ask these together on almost every application. Choosing No, none of these records a No for each item. Choosing Yes shows each item so you can answer it individually. A past matter does not automatically prevent coverage, and an inaccurate answer can affect coverage after a policy binds, so it is worth answering carefully.

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: No, none of these; Yes

Employment-related claims

In the past 3 years, have any claims, complaints, charges, hearings, demands, or administrative, regulatory, civil, or criminal proceedings involving an employment matter been made against the business, or against any owner, partner, officer, or manager who would be covered, whether or not you were insured for it? Employment matters include things like wrongful termination, discrimination, harassment, retaliation, or a wage-and-hour dispute. (Yes / No)

Carriers ask this on nearly every application, and employment claims are usually handled by a separate coverage called employment practices liability (EPLI) rather than by general liability. Answering it just lets Lee flag whether that coverage is worth discussing and approach the market that treats your history best. A past matter does not automatically disqualify you, and an honest answer keeps your application accurate.

Control: yesno
Response needed when shown: Yes when shown
Shown when: Prior history is Yes
Options: Yes; No

Known claims or circumstances

Aside from anything you have already told us, has any claim been made in the past 5 years, or earlier if it is still open, against the business or against anyone this policy would cover, including for professional work done before this business started, or are you aware of any incident or situation that could reasonably lead to a claim, whether or not you were insured for it? (Yes / No)

This is a standard underwriting question, and it follows the people the policy would cover rather than the entity, so it applies even to a brand-new business whose owners worked elsewhere first. A 'circumstance that may give rise to a claim' means something has already happened that a claim could still come from, even if no one has filed one yet. Disclosing it up front keeps your application accurate and protects your coverage if that matter later turns into an actual claim.

Control: yesno
Response needed when shown: Yes when shown
Shown when: Prior history is Yes
Options: Yes; No

Bankruptcy history

Has the business ever filed for, or been placed into, bankruptcy? (Yes / No)

Carriers ask this as a routine financial question. A past bankruptcy does not necessarily prevent coverage; disclosing it simply keeps the application accurate and helps us approach the right market.

Control: yesno
Response needed when shown: Yes when shown
Shown when: Prior history is Yes
Options: Yes; No

Owner background disclosures

Has the business, or any of its owners, officers, or partners, had any of the following? Select all that apply: Convicted of a felony in the past 5 years; Declared bankruptcy in the past 3 years; Had business-related lawsuits, mediations, or arbitrations filed against them; None of the above.

Almost every carrier asks this before it will quote, and it asks about the owners personally, not just the business, so it applies even to a brand-new company. Answering it up front lets Lee prepare an accurate application without following up for more information. Any of these items may affect which carriers will offer terms, and an inaccurate answer can affect coverage after a policy binds, so it is worth getting right.

Control: multichips
Response needed when shown: Yes when shown
Shown when: Prior history is Yes
Options: Convicted of a felony in the past 5 years; Declared bankruptcy in the past 3 years; Business-related lawsuits, mediations, or arbitrations filed against them; None of the above

Prior cancellation or non-renewal

Has any insurance carrier ever cancelled a policy for the business, or declined to renew or issue one? (Yes / No)

This is a standard application question. A prior cancellation, non-renewal, or declination will not necessarily stop us from placing your coverage, but knowing about it up front lets Lee approach carriers that will look past it and keeps the application accurate.

Control: yesno
Response needed when shown: Yes when shown
Shown when: Prior history is Yes
Options: Yes; No

Certificates & additional insureds

Does anyone need proof of your insurance (a certificate), or need to be named on your policy? This includes a landlord, client, property manager, or lender that your lease or contract requires you to add as an additional insured, mortgagee, or loss payee, and anyone who simply needs a certificate proving your coverage. If yes, for each one please share what they need, their name, mailing address, and their relationship to you. If no one does, just answer No.

A certificate proves your coverage to a landlord or client; an additional insured, mortgagee, or loss payee is a party your policy also protects or names, usually because a lease or contract requires it. Capturing exactly who needs what up front means your certificates can go out as soon as the policy binds, with no re-quote.

Control: addl-parties
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: No; Yes

Adding insureds regularly

Beyond anyone above, do you expect to regularly add clients, vendors, or others to your policy as additional insureds, for example because your customer contracts routinely require it?

If your contracts keep requiring you to add new parties, a blanket additional insured endorsement can cover them automatically, so you avoid a policy change and a new certificate every time someone asks. Your answer just tells me whether to build that into the quote.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Landlord requirements

Does your lease or landlord spell out insurance requirements for your space, such as limits, being named additional insured, or wording like primary & non-contributory or waiver of subrogation? If yes, paste or attach them so the quote can be built to match them.

Quoting to the exact requirements in your lease the first time avoids re-quotes and rejected certificates.

Control: contract
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No; Not sure

Federal EIN

What is your Federal EIN (Employer Identification Number)? If you have one, answer Yes and share it, or let us know you will send it later. If you are a sole proprietor without an EIN, answer No and leave it blank; there is no need to send your Social Security number.

Insurance applications use the EIN to identify the business, like a Social Security number for the company. If you do not have an EIN yet, that is fine; for most lines of business except workers compensation we can quote without it.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No; I'll provide my EIN later

Coverage start date

When would you like coverage to begin? A near-term date works as a placeholder for quotes; it can be adjusted before anything is finalized.

This sets the policy's effective date, so coverage can line up with a lease, a contract, or your first job.

Control: date
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Business: Drone / Aerial Operations (12 questions)

Drone / UAV use

Most commercial policies (general liability, property, and business owners policies) exclude the use of drones or other unmanned aircraft. Do you use, or plan to use, a drone in your business? If you'd like a quote, we can place separate drone coverage for you through SkyWatch. (Yes, and I'd like a drone quote / Yes, but it's already insured elsewhere / No)

Almost every standard business policy carves out drone (UAV) operations, so flying one for work leaves a gap unless a dedicated drone policy covers it. Flagging it here means separate drone coverage can be quoted alongside the rest from the start, and if a drone policy is already in place we can offer a competing quote when it's timely.

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes, and I'd like a drone quote; Yes, but it's already insured elsewhere; No

Current drone policy renewal date

When does your current drone policy renew or expire?

Sharing your renewal date means we can offer a competing drone quote when it's timely, so you have time to compare before your current policy renews.

Control: date
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

How drones are used

How do you use drones in your business? (for example roof or structure inspections, aerial photos or video, mapping and surveying, agriculture)

How a drone is used decides which carriers can write it at all: inspection and photography sit inside most drone programs, while spraying, delivery and flying over crowds usually do not.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Number of drones

How many drones would you like to insure?

Drone policies are rated per aircraft, so the count sets the base premium before anything else.

Control: countslider
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: None

Drone makes and models

What is the make and model of each drone? (for example DJI Mavic 3, DJI Matrice 350)

Make and model tell the carrier the airframe weight and capability, which is what the hull rate is built on.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Total drone / equipment value

What is the total value of the drones and attached equipment you'd want covered for physical damage (hull)?

Hull coverage generally pays up to a stated value, so a figure that is too low leaves a gap and one that is too high buys premium you could not collect on.

Control: money
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

FAA Part 107 certified

Do all drone operators hold a current FAA Part 107 Remote Pilot certificate? (Yes / No)

Insurers price commercial drone coverage around the FAA Part 107 certificate that authorizes paid drone work, so it is one of the first things SkyWatch asks.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Number of drone pilots

How many drone pilots or operators does the business have?

Pilot count, and the ratio of pilots to aircraft, are rating factors, and carriers generally want every operator named.

Control: countslider
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: None

Desired liability limit

What liability limit would you like for the drone coverage? SkyWatch offers limits from $500,000 to $5,000,000.

The limit you choose drives the premium and also whether the policy satisfies the contracts you fly under; many clients and venues state a minimum.

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: $500,000; $1,000,000; $2,000,000; $5,000,000; Not sure yet

Hull (physical damage) coverage

Would you like hull coverage, which pays to repair or replace the drone itself if it is damaged, lost, or stolen? (Yes / No)

Hull is optional and is the expensive half of a drone policy, so knowing whether you want it lets us quote what you actually need instead of pricing both.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Where drones are flown

Which states do you fly in, and is it mostly outdoors, indoors, or both?

Drone programs are filed state by state, and indoor flying is rated differently from outdoor, so this decides which markets can quote you.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Prior drone claims

Have you had any drone-related accidents, damage, or claims in the past 5 years? Describe each, or write None.

Loss history is the single biggest factor in a drone quote, and a claim a carrier learns about later can undo an offer that was made without it.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Contact and review: Additional Comments (1 questions)

Additional comments or requirements

Is there anything else we should know? Any specific coverage requirements, must-have inclusions, exposures you're worried about, or timing concerns. Add anything here and it goes into your file with the rest of your answers.

Details that don't fit the questions above still shape your coverage. Anything you flag here goes straight into your file alongside your other answers.

Control: textarea
Response needed when shown: Optional
Shown when: When this step is shown in the live form.

Contact and review: Your Coverage Priorities (1 questions)

How would you generally like us to prioritize our recommendations?

Please select the option that best reflects your preferences. This helps us tailor our recommendations but does not determine what coverage is available or appropriate. (Comprehensive Protection / Balanced Coverage and Cost / Budget-Focused)

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Comprehensive Protection I would like recommendations intended to address my insurance needs and potential exposures as comprehensively as reasonably possible, recognizing that broader protection may result in a higher premium.; Balanced Coverage and Cost Recommended for most applicants I would like recommendations that balance meaningful protection with keeping premiums as reasonable as possible.; Budget-Focused Keeping premiums as low as reasonably possible is my primary goal. I understand that lower-cost options may include reduced limits, fewer coverages, higher deductibles, or additional exclusions. I would still like BrokerPro to identify significant coverage recommendations or potential coverage gaps for my consideration.

Contact and review: Preferred Contact Method (1 questions)

Preferred contact method

How would you prefer we reach out to you about your quote? (Email / Phone call / Text message)

So we follow up the way that is easiest for you. You can change this anytime by letting us know.

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Email; Phone call; Text message

Contact and review: Preferred Contact Method (1 questions)

Preferred name

What should we call you, if it is different from your first name? For example, James who goes by Jim. Leave this blank if your first name is already what you go by.

So our emails and calls use the name you actually go by. It does not change the name on your application or on any policy documents.

Control: text
Response needed when shown: Optional
Shown when: When this step is shown in the live form.

Healthcare & Allied Health: Professional Background & Licensing (6 questions)

License or certification

What professional license, certification, or designation do you hold, what is the license number, and which state issued it? For example: Arizona Physical Therapist license #12345.

A professional-liability (malpractice) policy is built around your credential. The license number and issuing state let the carrier confirm you're in good standing and quote the right class.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

NPI number

If you're a healthcare provider, what is your National Provider Identifier (NPI)? Leave this blank if you don't have one.

The NPI is the standard identifier for healthcare providers. It's optional here and only helps the carrier match your record. Skip it if it doesn't apply to you.

Control: line
Response needed when shown: Optional
Shown when: When this step is shown in the live form.

Specialty & services

What is your specialty or main type of work, and roughly what services do you personally provide?

Your specialty and the exact services you perform drive how a professional policy is classed and priced. A pediatric focus and a sports-injury focus underwrite differently even within the same license.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Years in practice

How many years have you practiced in this profession, including any time before starting this business?

Years of experience is a standard underwriting input; brand-new practitioners and seasoned ones are rated differently, and time in practice before this business still counts.

Control: years
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Prior claims or incidents

In the past 5 years, has any client or patient alleged a mistake, error, or negligence in your professional work, whether or not a formal claim was filed? (Yes / No)

Carriers ask about prior allegations on every malpractice application. Answering up front keeps the quote accurate and avoids a surprise at binding; your answer is documented in your file either way.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

License actions

Has your professional license ever been suspended, revoked, restricted, or disciplined, or have you been the subject of a licensing-board complaint or investigation? (Yes / No)

Licensing-board history is a standard malpractice underwriting question. It rarely prevents a quote on its own, but it has to be disclosed up front so the carrier can place you correctly.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Healthcare/Care: Background & Conduct Disclosures (6 questions)

Criminal history

Have you, or has any owner or officer of the business, ever been charged with, indicted for, or convicted of any act in violation of any law or ordinance, other than traffic offenses? (Yes / No)

Care applications ask this because carriers look closely at the people who go into a client's home. A disclosure here does not by itself decide the outcome, and an answer that turns out to be inaccurate can affect coverage after a policy binds, so it is worth answering carefully.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

License or privilege actions

Have you, or has any owner or officer, ever had hospital privileges, a DEA registration, a healthcare or professional license, or reimbursement privileges denied, refused, revoked, suspended, restricted, reprimanded, placed on probation, or voluntarily surrendered? (Yes / No)

This covers any action taken by a licensing board, a hospital, or a payer, including one that was agreed to voluntarily. Carriers ask about all of them together on care and medical applications.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Sexual misconduct allegations

Have you, or has any owner or officer, ever been accused of sexual misconduct of any kind? (Yes / No)

Abuse and molestation is the exposure care carriers look at most closely, and applications in this space ask about allegations rather than only findings. An inaccurate answer can affect coverage after a policy binds.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Health conditions affecting the work

Are you, or is any owner or officer, aware of a health condition that could impair the ability to carry out the duties of this business, including addiction to alcohol, narcotics, or other controlled substances? (Yes / No)

Care work is hands-on and often unsupervised, which is why this question appears on the application. Disclosing it keeps the application accurate.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Prior policy cancelled, declined, or rescinded

Has any insurance company ever cancelled, declined, non-renewed, or rescinded a policy for you or for this business? (Yes / No)

This is a standard application question, and it follows both the business and the people behind it, so it applies even to a brand-new company. A prior cancellation or declination does not necessarily stop a placement; knowing about it up front keeps the application accurate.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Claims, lawsuits, or known incidents

Have you, or has this business, ever been involved in a claim or a demand for money, been involved in a lawsuit, or become aware of any complication, incident, or adverse outcome that could reasonably lead to a claim or lawsuit? (Yes / No)

Carriers ask about known incidents as well as filed claims. A circumstance that may give rise to a claim means something has already happened that a claim could still come from, even if no one has filed one. Disclosing it up front keeps the application accurate and documents it in your file.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Professional Services: A Few Details Specific to Your Business (2 questions)

Written client agreements

How often do you use a standardized written contract, engagement letter, or service agreement with your clients: never, sometimes (1 to 74%), most of the time (75 to 99%), or in all cases (100%)?

Professional liability carriers commonly consider how consistently written agreements define the services and fees before work begins.

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Never; Sometimes (1 to 74%); Most of the time (75 to 99%); In all cases (100%)

Preventing scope misunderstandings

If you answered Never or Sometimes, how do you and your clients confirm what work is included, what is excluded, and what it will cost?

When written agreements are not used consistently, carriers may ask how the business confirms the scope of work and fees with its clients.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Contractor/Trades: A Few Details Specific to Your Business (37 questions)

Contractor license

Do you currently hold an Arizona ROC contractor license, are you working on getting one, or do you not plan to get one?

Whether you're licensed, still getting licensed, or working unlicensed changes both which carriers can quote you and whether the Registrar requires a contractor license bond.

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: I currently hold one or more; I'm working on getting my first one; I hold some and am working on getting more; No, I don't plan to get a license; This trade isn't licensed by the ROC (does not apply)

License(s) you currently hold

Which Arizona ROC contractor license classification(s) do you currently hold? You can list more than one (for example CR-42 Roofing, C-11 Electrical).

Your ROC classification tells carriers exactly which trades you're licensed for.

Control: licenses
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

License(s) you're getting

Which Arizona ROC contractor license classification(s) are you working on getting or plan to get? You can list more than one (for example CR-42 Roofing, C-11 Electrical).

Knowing the classification you're applying for tells carriers which trades to expect, and it's what determines the type of contractor license bond the Registrar will require.

Control: licenses
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Residential or commercial work

Is the work you do residential, commercial, or both? (Residential / Commercial / Both)

Residential and commercial work are underwritten and priced differently, and some carriers will only write one or the other. Telling us which you do gets your quote to the markets that actually want your kind of work.

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Residential; Commercial; Both

Residential / commercial split

Since you do both, roughly what percent of your work is residential and what percent is commercial? (should total 100%)

A rough split is enough. Carriers rate the two differently, so an even mix and a mostly-residential book with the occasional commercial job land in different places. Estimating by revenue is fine.

Control: percentage mix
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Residential; Commercial

Years in this trade

How many years have you and any other owners worked in this trade, counting experience at other companies before this business?

Carriers underwrite the trades partly on the owner's hands-on years, which is a different fact from how long the company has existed. If you bought an established business, or worked for years at someone else's before starting your own, that time is part of how a carrier assesses the risk, so it is worth stating. A round number is fine.

Control: years
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Maximum working height

What is the greatest height above ground at which you or your staff work? Select one: 0 - 6 feet / 7 - 15 feet / 16 - 30 feet / >30 feet. Not sure is fine.

Carriers use the height band to identify whether additional safety questions apply. Pick the highest band you ever work at, not just your usual jobs.

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: 0 - 6 feet; 7 - 15 feet; 16 - 30 feet; >30 feet

Recent jobs

If you don't have a website yet, could you share a list of your last few jobs or current bids?

Recent jobs are how a carrier classifies a business that has no website yet. Without either, an underwriter is guessing at what you actually do, and guesses go to the higher rate.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Completed-work inspection

Is completed work inspected against the plans or specification, with the results documented?

Carrier applications may ask how completed work is checked and recorded when they review a contractor's operations.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Background checks

Do you run background checks on employees who work inside customers' homes or premises?

Carrier applications may use this information to understand controls for work performed in customers' homes or premises.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Hot-work safety guidelines

Do you have written safety guidelines for any cutting, welding, soldering or other hot work at a customer's location?

Carrier applications may ask about controls used for cutting, welding, soldering, and similar hot work.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Utility location services

Do you contact utility location services (811) before any digging or trenching?

Carrier applications may ask how contractors manage underground utility exposure before digging or trenching.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Motor vehicle record prescreening

Do you check motor vehicle records before letting an employee drive for the business?

Carriers may consider driver screening practices when evaluating business auto exposure.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

General contractor role

Do you act as a general contractor, hiring and coordinating subcontractors on your projects? (Yes/No)

General contractors who manage subcontractors are rated differently than trades that self-perform their work, so this one answer changes which applications we prepare.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Percent of work subcontracted

Roughly what percentage of your total job costs go to subcontractors? (Enter a number, e.g. 40)

When more than a quarter of the work is subcontracted, carriers require a dedicated contractor supplement, so this number decides whether we need the extra detail below.

Control: countslider
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: None

New residential / tract / apartments

Will any of your work involve NEW construction of condominiums, townhouses, duplexes/triplexes/four-plexes, patio homes, apartments, or single-family homes in tract developments (10+ homes)? (Yes/No)

New tract and multi-unit residential construction carries the construction-defect exposure carriers underwrite hardest, so this is a knockout question on every contractor supplement.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

New residential work, described

If yes: describe that new residential construction work, and the largest number of individual living units in any one project.

Unit count is what separates a duplex from a 200-unit complex on a construction-defect rating, and the two go to different carriers.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Special hazards

Do any of your operations involve the following? Select all that apply: cranes; tower cranes; EIFS (synthetic stucco); demolition of structures; structural alterations; blasting; foundation repair; shoring or underpinning; pile driving; caisson or cofferdam work; none of these.

Each of these is separately excluded or separately rated by most contractor programs. Naming the ones that apply lets us look for a market that can consider them instead of waiting on a declination.

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Cranes; Tower cranes; EIFS (synthetic stucco); Demolition of structures; Structural alterations; Blasting; Foundation repair; Shoring or underpinning; Pile driving; Caisson or cofferdam work; None of these

COIs collected from subcontractors

Do you require a certificate of insurance from every subcontractor before they start work? (Yes/No)

Subcontractors who cannot show their own insurance are generally charged back to your policy at audit, so whether you collect certificates changes both the premium and the audit bill.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Subcontractor written contract

Do you use a signed subcontract with every sub that includes an indemnification / hold-harmless clause in your favor? (A copy is required to bind.) (Yes/No)

A signed indemnity in your favor is what lets your carrier pursue the subcontractor's insurer instead of paying the claim itself, so it is one of the first things a contractor underwriter asks about.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Named as additional insured by subs

Do your subcontractors name your business as an additional insured (including completed operations) on their policy? (Yes/No)

Being named as an additional insured on the subcontractor's policy, including completed operations, is generally what gives you access to their coverage for work they performed, subject to policy wording and carrier guidelines.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Subs required to carry workers comp

Do you require your subcontractors to carry their own workers compensation? (Yes/No)

A subcontractor without workers compensation generally rates as your own employee at audit, so this can drive the comp premium as much as your payroll does.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Minimum limits required of subcontractors

What minimum general liability limits do you require subcontractors to carry? (e.g. $1M / $2M)

The lowest limit anywhere in your subcontractor chain is the one your own policy tends to stand behind, so carriers rate the account on it.

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Subs carry lower limits than you

Do any of your subcontractors carry coverage or limits lower than yours? (Yes/No)

Same reason as the limits question above: a subcontractor carrying less than you leaves the difference sitting on your policy.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Annual subcontractor cost

What is your estimated annual subcontractor cost (all sub labor and materials)?

Subcontractor cost is a rating basis on most contractor policies, alongside payroll and receipts.

Control: money
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Self-performed vs subcontracted trades

Which trades do your own employees self-perform, and which do you subcontract? List each and note E (employee) or S (sub), one per line (e.g. 'Framing - S', 'Concrete - E').

Every trade has its own class code and rate. Splitting what your crew performs from what you sub out is what keeps the classification accurate instead of rating the whole account at the highest trade on the list.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Percent of work as GC vs sub

Of your total work, roughly what percent do you perform as the general contractor versus as a subcontractor to others? (e.g. '80% GC / 20% sub')

Working as the general contractor carries the subcontractors' exposure on top of your own, so the split changes both classification and price.

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Percent structural work

Roughly what percentage of your work is structural (framing, concrete, foundation, load-bearing) versus finish / non-structural?

Structural work carries the construction-defect exposure carriers underwrite hardest, and several programs cap the share of it they will write.

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Maximum height of buildings worked on

What is the maximum height of the buildings you work on? (number of stories)

Height drives the fall exposure carriers rate hardest, and many contractor programs stop writing above a set number of stories.

Control: countslider
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: None

Below-grade work

Do you perform any work below grade? (Yes/No; if yes, what percent of your work and to what maximum depth?)

Excavation and below-grade work bring collapse and buried-utility exposures that a standard contractor class does not contemplate.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Asbestos / hazardous material

Have you or your subcontractors ever removed or worked on asbestos, PCBs, fuel tanks, or other hazardous materials? (Yes/No)

Work touching asbestos or other contaminants is generally excluded from a standard contractor policy and needs a separate pollution market.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Torch-down / hot-tar roofing

Do you or your subcontractors perform torch-down or hot-tar roofing? (Yes/No)

Torch-down and hot-tar work is a leading cause of contractor fire claims, and many programs exclude it outright.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Construction defect / mold history

Are you aware of any pending litigation, loss, or claim (past 8 years) alleging construction defect, faulty construction, or fungus / mold against you or any named insured? (Yes/No)

Construction-defect and mold history is the first thing a contractor underwriter looks at, and a claim a carrier finds later can undo an offer made without it.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Wrap-up / OCIP / CCIP projects

Are you working on any current Wrap-Up / OCIP / CCIP projects? (Yes/No; if yes, projected cost?)

On a wrap-up the project owner provides the liability coverage, so that payroll is treated differently on your own policy and is usually taken out of the rating basis.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Written safety program

Do you have a written safety program? (Yes/No; if yes, briefly describe the precautions in place.)

A written program with documented precautions is one of the first things a contractor underwriter asks for, and accounts without one generally have a harder time at underwriting.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Contractor license

What is your contractor license number and license type? (If unlicensed, say so.)

Carriers check the ROC classification against the work being quoted, and a license that does not cover the trade can stop a quote before it starts.

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Other business ownership

Do you own or operate, or have a controlling interest in, any other business or similar construction operation (active, inactive, or dissolved)? (Yes/No)

Related businesses often share tools, crews and vehicles, which can pull their exposure onto this policy unless they are disclosed and rated.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Trucking/Transport: A Few Details Specific to Your Business (9 questions)

Vehicles you'll insure

List every car, van, or truck the business owns, leases, or operates. This is where your commercial-auto vehicles belong, including a personal vehicle used for the business. For each one, enter the VIN and tap Look up vehicle to fill in the year, make, and model automatically (or type them in), then add the approximate value and roughly how many miles it is driven in a year.

These are the vehicles that go on your commercial auto policy. The VIN and value let carriers identify and schedule each vehicle for physical-damage coverage, and annual mileage is a rating factor. Enter every business vehicle here, not on the tools-and-equipment schedule earlier in the form, which is for equipment only.

Control: vehicle_rows
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Drivers

For each driver, their full name, date of birth, license number, and the state that issued the license.

Carriers order motor vehicle records on every listed driver, and an unlisted driver is the most common reason a commercial auto claim gets questioned.

Control: driver_rows
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

USDOT number

What is your USDOT number?

The USDOT number is how a carrier pulls your federal safety and inspection history, which is a large part of a trucking quote.

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

MC number

What is your MC (motor carrier) number?

The MC number shows you are authorized to haul for hire across state lines, which is a different filing from intrastate work and a different market.

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Authority active

Is your operating authority active yet? (Yes / No)

A new venture whose authority is not active yet is quoted differently from an operating carrier, and some markets will not bind until it is granted.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Cargo & radius

What commodities will you haul, and will you run intrastate (Arizona only) or interstate?

Commodity and radius are the two biggest rating factors on a trucking policy, and several commodities are excluded outright by most cargo forms.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Commodity type

What type of commodity do you primarily haul? Choose the category that best fits, and the next question will list the specific commodities within it.

Cargo carriers classify and rate based on what you haul, and some commodities carry more risk than others. Picking the closest category helps match your operation to the right cargo program.

Control: select
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Aircraft/Auto/Boats; Building Supplies; Chemicals; Construction Materials (Raw); Consumer Goods; Farming/Agriculture/Livestock; Food & Beverage; Machinery & Equipment; Metals/Minerals/Coal; Miscellaneous; Paper/Plastic/Glass

Commodity

Which specific commodity best describes your primary freight? This list updates based on the commodity type you chose above.

The specific commodity refines the cargo classification within the type you selected. If you haul several, pick your most common one and note the others in the comments at the end.

Control: commodity
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Cargo coverage limit

Motor truck cargo coverage pays for direct loss or damage to the freight you are hauling. What cargo limit would you like quoted? A good guide is the highest value of goods you would carry on one truck at one time. ($50,000 / $100,000 / $250,000 / $500,000 / $1,000,000 / Other / Not sure yet)

Cargo limits are set per truck, based on the most valuable load you would carry at once. Choosing a limit close to your typical maximum load helps the quote reflect your real exposure. If a limit does not come to mind, pick Not sure yet and a couple of options can be quoted to compare.

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: $50,000; $100,000; $250,000; $500,000; $1,000,000; Other; Not sure yet

Food & Beverage: A Few Details Specific to Your Business (7 questions)

Setup

Which best describes your setup: a fixed storefront or shop, a food truck, a trailer, a cart/stand/booth, or catering out of a commissary kitchen? If it's more than one, pick the main one and tell me the rest.

This is the fork for the rest of your quote. A fixed location is rated on the building and its contents; anything mobile adds commercial auto and usually event coverage. Getting this right up front keeps me from asking you questions that don't apply to your operation.

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Fixed storefront or shop; Food truck; Trailer; Cart / stand / booth; Catering from a commissary kitchen; Other

Street and neighborhood vending

Do you sell directly to customers on public streets or in residential neighborhoods, including driving a route and stopping for people who flag you down?

Some general liability programs exclude selling from a vehicle stopped in the roadway, and street vending is generally rated separately from a truck that parks at an event or on a lot.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Alcohol

Will you serve or sell alcohol? If so, will you provide it, and do you hold a liquor license?

Serving or selling alcohol generally brings a liquor liability exposure that a general liability policy does not cover on its own, and it changes which carriers can write the account.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Cooking equipment

Will you use any cooking equipment beyond a microwave, such as fryers, grills, or stoves?

Commercial cooking equipment brings a fire exposure that carriers rate separately, and hood and suppression requirements usually follow it.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Refrigeration and spoilage

Do you rely on refrigeration or freezers to keep product from spoiling? If yes, roughly what value of product do you hold at one time, and is the equipment owned or leased?

A refrigeration or power failure that spoils product is generally addressed by a separate spoilage coverage rather than by general liability, subject to the policy wording and carrier guidelines.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Venues

If you sell at events, fairs, festivals, farmers markets, or other venues rather than only at your own location: which ones do you work? If you operate only from your own location, just say so.

Venues and events sometimes require you to name them on your policy or show them a certificate. If any venue asks for that, list it in the Certificates & additional insureds question under Insurance Details so it goes on the certificate.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Venue insurance requirements

For any events, fairs, festivals, or markets you work: do any of them spell out insurance requirements, such as a limit, being named as additional insured, or specific wording? If you have the requirements in writing, you can share them here.

Venue and event contracts commonly set their own limits and endorsement wording, so the actual document generally answers more than a summary of it can.

Control: contract
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No; Not sure

Rental property: Property Information (21 questions)

Property address

What is the full address of the property to be insured?

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Named insured / ownership

Is the property titled under an LLC, or under another individual or entity? Please enter the exact legal name that should appear on the policy as the primary named insured, normally the same name the property is titled under.

The primary named insured is who the policy protects, so it needs to match how the property is titled. If the title is in an LLC but the policy names you personally, a claim can be denied.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Billing

Will the insurance be mortgagee billed from escrow, or paid directly by you?

If your mortgage company pays from escrow, the policy can be set up so the bill goes to them directly.

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Mortgagee billed from escrow; I'll pay directly

Property condition

How would you describe the interior condition of the home (for example fully remodeled, average, or in need of updates)?

Updated systems (roof, plumbing, electrical) qualify for better rates; honest condition up front avoids surprises at inspection.

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Fully remodeled; Average; Needs updates

Property type

What type of property is it (single-family home, condo, townhouse, duplex, triplex, fourplex, or an apartment building of 5+ units)?

The property type and unit count change how the policy is rated and which carriers will write it.

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Single-family home; Condo; Townhouse; Duplex; Triplex; Fourplex; Apartment (5+ units); Other

Number of units

How many separate rental units are in the building? Enter 1 for a single-family home.

Control: countslider
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: None

HOA master policy (condos and townhouses)

If any of the properties are condos or townhouses: which owners association is each one in, and do you know what the association's master insurance policy covers? Common setups are bare walls (structure and common areas only), the unit as originally built, or all-in (most permanently installed parts of the unit). If several units share one association, you only need to give that association's details once. If you have the CC&Rs or the master policy declarations page, please attach a copy to your reply. Write N/A if none of the properties are condos or townhouses.

The association's documents set where its responsibility ends and yours begins, so they drive how much building coverage and loss assessment coverage a unit owner policy needs. Not sure is fine; the documents themselves are the best answer, which is why a copy is so helpful.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Year built

What year was the home built?

Property carriers rate on age before almost anything else, so the year built lets us go straight to the right market.

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Square footage

What is the approximate living area square footage of the home?

Square footage sets the replacement cost the building coverage is based on, so an accurate figure keeps the dwelling limit right.

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Number of stories

How many stories is the home?

Height affects how the property is rated.

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Construction type

What is the home's construction type?

Wood frame, masonry or block, steel, and concrete each rate very differently for fire.

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Wood frame; Masonry or block; Steel; Concrete; Not sure

Roof last replaced

Roughly what year was the roof last replaced? If it is the original roof, give the year the building was built. If you do not know, answer Not sure.

Roof age is one of the first things a property carrier checks.

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Planned renovations

Do you plan to make any renovations to the property? If so, please describe the work.

A property under renovation generally needs a different policy form than one that is ready to rent.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Plan after the renovation

What do you plan to do with the property once any renovation work is finished? (No renovations planned / Renovate and rent it out / Renovate and resell, fix and flip / Renovate and move in or keep it / Not decided yet)

A property being renovated to rent out generally sits on a different policy form than one being renovated to resell, so the plan after the work points to which form fits.

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: No renovations planned; Renovate and rent it out; Renovate and resell, fix and flip; Renovate and move in or keep it; Not decided yet

Rental type

Will this be a short-term rental (Airbnb, VRBO, and similar) or a long-term rental?

Short-term rentals need a different policy form than long-term leases, and using the wrong one can void coverage for guest-caused damage.

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Short-term (Airbnb/VRBO); Long-term

Prior claims

Any current, ongoing, or past claims or losses at this property in the past 5 years? (Yes / No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Number of claims

If you answered Yes to prior claims, how many were there? (1 / 2 / 3 / 4 or more)

Control: pillset
Response needed when shown: Yes when shown
Shown when: Prior claims starts with Yes
Options: 1; 2; 3; 4 or more

Total amount paid for the claim

If there was one claim, about how much was paid on that claim in total? An estimate is fine.

Control: money
Response needed when shown: Yes when shown
Shown when: Number of claims is 1

Claim dates and amounts

If there were two or more claims, list each claim's date and about how much was paid. An estimate is fine for each amount.

Control: rows
Response needed when shown: Optional
Shown when: Number of claims is one of: 2; 3; 4 or more

Upload your loss runs (optional)

Control: upload
Response needed when shown: Yes when shown
Shown when: Prior claims starts with Yes
Options: I'll send it later

Additional properties

Do you own other rental properties you'd like us to quote as well? For each one, list the property address, who holds title (you personally, or the exact LLC or entity name), any lender or mortgagee on that property, and anyone else who needs to be listed on that property's policy, such as a property manager or a master tenant. Write None if this is the only property. If you have 8 or more properties, you can attach your property list or ledger instead of listing each one.

Landlords often hold several properties across different names, and each address is rated and scheduled separately, so listing them lets us sort each one to the policy and carrier that fits it.

Control: rows
Response needed when shown: Optional
Shown when: When this step is shown in the live form.

Rental property: Applicant Information (3 questions)

Full name

What is your full legal name?

Control: name
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Date of birth

What is your date of birth?

Control: date
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Home address

What is your home address?

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Rental property: Coverage & Policy Details (11 questions)

Anticipated rental income

What is the anticipated annual rental income for the property?

Sets your loss-of-rents coverage. The policy can keep paying you rent while the home is being repaired after a covered loss.

Control: money
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Contents coverage

Will the home be furnished, and would you like contents coverage for the furnishings and other personal property inside it? (Yes, please add contents coverage / No, the home is unfurnished / It's furnished, but I'm declining contents coverage)

This records whether contents coverage was requested, declined, or not applicable, so the answer is never left in doubt on a completed application.

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes, please add contents coverage; No, the home is unfurnished; It's furnished, but I'm declining contents coverage

Contents coverage amount

If you're adding contents coverage, roughly how much personal property (furniture, electronics, decor, and similar) would you like covered?

Sets the contents (personal property) coverage limit.

Control: money
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Property management

Will a property manager be involved? If so, please share the company name and address, as it may help qualify for discounts.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Additional insureds

For the property above, does anyone else need to be listed on the policy as an additional insured, mortgagee, or loss payee, for example a lender or mortgage company, a property manager, a member or holding LLC, or a master tenant? If so, give each party's name, mailing address, and their relationship to you. Write None if there aren't any. You don't need to repeat parties for the other properties; we collect those with the property itself above.

An additional insured, mortgagee, or loss payee is a party you've agreed to protect or name on the policy. Listing them up front avoids a mid-term policy change and a re-issued certificate later.

Control: addl-parties
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: No; Yes

Umbrella / excess liability

Would you like us to consider an umbrella (excess liability) policy that adds a layer of liability protection above this rental's coverage? If yes, tell us the limit you have in mind (for example $1 million) and whether you own other rental properties, homes, or vehicles it should also sit over.

An umbrella is often an inexpensive way to raise your liability protection well above the base policy limit, and a single umbrella can frequently sit over several properties and vehicles at once. Saying no here just records your preference; you can bring it up again anytime, and Lee may still suggest it if it looks like a good fit.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Current coverage

Do you currently have active insurance coverage in place for this property? (Yes/No)

Helps us tell a new purchase that needs coverage right away apart from a property already insured that you're remarketing, or one where coverage may have lapsed.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Purpose for coverage

Are you seeking coverage for a new purchase, shopping for better rates, or seeking coverage for a non-renewed policy?

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: New purchase; Shopping for better rates; Seeking coverage for a non-renewed policy

Reason for non-renewal

If you answered that you're seeking coverage for a non-renewed policy, please indicate the reason the policy has been terminated or non-renewed.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Effective date

When would you like the policy to begin?

Control: date
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Contact information

What is your preferred phone number and mailing address?

Control: contact details
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Roofing: A Few Details Specific to Your Business (42 questions)

Roofing safety

Do you have a written safety program and a fire-watch procedure for cutting, welding, soldering, or other hot work at a customer's location?

Most roofing carriers ask for a written program and a documented fire watch, and hot work without one is a common reason a roofer is declined.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Years in business

How many years has the business been operating?

Carriers rate roofers partly on how long the business has operated.

Control: years
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: New venture; In business for…

Years of roofing experience

How many years of experience do you personally have in roofing?

Owner experience is a key underwriting factor for roofing risks.

Control: years
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

New multi-family / tract work

Will any of your work involve new construction of tract homes, multi-family buildings, or apartment complexes? (Yes / No)

New tract and multi-family construction is a much higher-risk category for roofers and many carriers exclude it, so we need to know up front to place you with the right market.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Type of work

Roughly what percent of your roofing work is new construction, repair/patching, and replacement? (should total 100%)

New construction, repair and replacement carry different defect exposures, so the mix decides the rate and sometimes the market.

Control: percentage mix
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: New construction; Repair / patching; Replacement

Property types

Roughly what percent of your work is commercial, residential, and industrial? (should total 100%)

Commercial, residential and industrial roofing are rated separately, and some programs write only one of the three.

Control: percentage mix
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Commercial; Residential; Industrial

Roof types

Roughly what percent of your work is each roof type: flat, metal, pitched, asphalt shingle, single-ply, tile, fiberglass, wood, polyurethane foam, hot tar, slate, torch down, other? (should total 100%)

Roof type drives both the fire exposure and the defect exposure. Hot tar and torch-down price very differently from shingle work, so the mix matters more than the total.

Control: percentage mix
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Flat roofs; Metal; Pitched roofs; Asphalt shingle; Single-ply; Tile; Fiberglass; Wood; Polyurethane foam; Hot tar; Slate; Torch down; Other

Other operations

Do you do any work besides roofing, for example waterproofing, siding, rain gutters, or carpentry? If so, what, and roughly what share of your revenue?

Work outside roofing is its own class code. Left undeclared it can be uncovered at claim time, and declared it may simply move the account to a carrier that writes both.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Wrap-up / OCIP projects

Are you currently working on any wrap-up or OCIP (owner-controlled insurance program) projects? If yes, what is the projected cost?

On wrap-up/OCIP projects the project owner provides the liability coverage, so those payrolls are handled differently on your policy.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Hot-process precautions

If you use hot tar, torch-down, or other hot processes: what safety precautions are in place during the work?

Hot processes are the leading cause of roofing fire claims, so the precautions in place are what a carrier prices the exposure against.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Maximum building height

What is the tallest building you work on? (number of stories)

Height is the single biggest driver of the fall exposure carriers rate, and several roofing programs stop writing above a set number of stories.

Control: countslider
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: None

Fall protection

Which fall-protection systems do you use on buildings over 3 stories?

Fall protection is one of the biggest liability and workers-comp rating factors for roofers. Carriers price the risk very differently depending on what's in place.

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Guardrail system with toe boards; Safety net; Personal fall arrest system; None of these

Public protection

How do you keep people on the ground away from falling material at a job site? Select all that apply: ground barricades, cones or caution tape; a spotter or flagger on the ground; debris netting or a covered walkway; enclosed debris chutes; warning signs posted; the dumpster or drop zone roped off; work scheduled outside normal business hours; none of these.

Falling material is the roofing claim that hits a third party rather than a crew member, so this is the answer a general liability underwriter looks for first. Picking from the list is also how the carrier's own supplement asks it.

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Ground barricades, cones or caution tape; A spotter or flagger on the ground; Debris netting or a covered walkway; Enclosed debris chutes; Warning signs posted; The dumpster or drop zone roped off; Work scheduled outside normal business hours; None of these

Material handling

How do shingles, tile and other material get up to the roof? Select all that apply: ladder hoist or conveyor; boom truck or telehandler; crane; forklift; carried up by hand; hoisted by rope or pulley; the supplier stocks the roof for us.

Hoisting is where the crew and the public are both exposed at once, and carrying material up a ladder by hand rates very differently from a boom truck, so carriers ask exactly how it is done.

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Ladder hoist or conveyor; Boom truck or telehandler; Crane; Forklift; Carried up by hand; Hoisted by rope or pulley; The supplier stocks the roof for us

Overnight openings

How is an open roof protected overnight? Select all that apply: Tarped and weighted down; Plywood decked over; Temporary membrane or dry-in layer; Safety railing or perimeter warning line; Debris netting; We never leave a roof open overnight.

An open roof overnight is a water-damage claim waiting on the weather, and it is one of the few exposures a carrier can see you actively managing.

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Tarped and weighted down; Plywood decked over; Temporary membrane or dry-in layer; Safety railing or perimeter warning line; Debris netting; We never leave a roof open overnight

Rainstorm precautions

What do you do when a rainstorm is forecast? Select all that apply: Dry in the exposed area before leaving; Tarp and weight everything down; Stop tearing off new area; Clear drains and scuppers; Move materials off the roof; Watch the forecast and reschedule the work.

Sudden-storm procedure is the other half of the open-roof exposure, and in Arizona monsoon season concentrates it into a few months.

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Dry in the exposed area before leaving; Tarp and weight everything down; Stop tearing off new area; Clear drains and scuppers; Move materials off the roof; Watch the forecast and reschedule the work

Completion inspection

Does a foreman or supervisor inspect every job on completion? (Yes/No)

A documented completion inspection is a credit with most roofing carriers and is often the difference between a defect claim being defensible or not.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Asbestos

Have you ever used, sold, installed, or removed asbestos? (Yes/No; if yes, explain)

Older roofs can contain asbestos, and any work touching it is generally excluded from a standard roofing policy and needs a separate pollution market.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Cranes

Do you use cranes?

Crane use adds a rigging and overhead exposure that is rated on top of the roofing class, and some programs exclude it.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Crane size (tons)

If you use cranes, what size (tons) do you typically use?

Capacity is how carriers size the crane exposure, since a boom truck and a lattice crane are not the same risk.

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Crane boom length

What is the boom length of the crane(s) you use?

Boom length sets the reach and the radius a dropped load could travel, which is what the third-party exposure is measured on.

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Crane owned or rented

Are the cranes you use owned by the business or rented?

Owned cranes need physical-damage coverage and rented ones usually need rented-equipment coverage, so this decides which part of the policy has to respond.

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Owned; Rented

Crane work-area barriers

Do you set up barriers or a controlled work area around the crane while it's operating?

A controlled area under an operating crane is the precaution that separates a struck-by claim from a near miss, and carriers ask about it directly.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Crane maintenance schedule

Is the crane equipment on a regular maintenance schedule?

A documented maintenance schedule is a credit, and mechanical failure on an unmaintained crane is a claim most carriers will contest.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Crane operator training

Are crane operators trained and certified?

Untrained crane operation is one of the fastest ways a roofing risk gets declined, so carriers ask this directly.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Plans & design

Do you draw plans, designs, or specifications? (Yes/No; if yes, describe)

Drawing plans or specifications adds a professional exposure that a general liability policy generally does not cover, so it may need a separate errors and omissions line.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Warranties

Do you offer warranties on your work? (Yes/No)

A workmanship warranty is a contractual promise, and how far it goes past the standard is something carriers rate and sometimes exclude.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Owner/partner payroll

What is the annual payroll for owners/partners actively working in the field?

Owner payroll is rated separately from employee payroll on the roofing supplement.

Control: money
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Subcontractor cost

What is the total annual amount you pay to subcontractors?

Subcontractor cost is a rating basis on roofing policies alongside payroll, and uninsured sub cost is generally charged back to your policy at audit.

Control: money
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Uninsured subcontractor payroll

Of that subcontractor cost, roughly how much goes to subcontractors who do NOT carry their own insurance?

Uninsured subcontractor payroll gets charged to your own policy at audit, so carriers price for it up front.

Control: money
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Leased employee payroll

If you use leased employees (from a staffing or PEO firm), what is their annual payroll?

Leased and PEO staff are generally rated differently from your own employees, so their payroll is separated to keep the rating basis honest.

Control: money
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Subcontractor minimum limits

Do you require subcontractors to carry minimum liability limits? If yes, what are they?

The lowest limit anywhere in your subcontractor chain is the one your own policy tends to stand behind, so carriers rate the account on it.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Subs carry lower limits than you

Do any of your subcontractors carry coverage or limits lower than yours? (Yes/No)

Same reason as the limits question above: a subcontractor carrying less than you leaves the difference sitting on your policy.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Subcontractor COI required

Do you require a certificate of insurance from every subcontractor before they start work?

Subcontractors who cannot show their own insurance are generally charged back to your policy at audit, which affects both the premium and the audit bill.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Years requiring subcontractor COIs

How many years have you required certificates of insurance from subcontractors?

How long you have collected certificates tells a carrier how much of your completed-operations tail is backed by someone else's insurance rather than yours.

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Subcontractor names you as AI

Do you require subcontractors to name your business as an additional insured on their policy?

Being named as an additional insured on the subcontractor's policy is generally what gives you access to their coverage for work they performed, subject to policy wording and carrier guidelines.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Subcontractor hold-harmless

Do you use a signed subcontract with an indemnification / hold-harmless clause in your favor?

A signed indemnity in your favor is what lets your carrier pursue the subcontractor's insurer instead of paying the claim itself.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Leases equipment to others

Do you lease or loan any of your equipment to others? If yes, please describe.

Equipment in someone else's hands is a separate exposure from equipment your crew operates, and it is generally not covered the same way.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Largest jobs

List your three largest jobs in the last five years and the type of roofing process used on each, one per line as “Job / process used.”

Your largest jobs show the top of your range rather than the average, and the roofing process used on each is what the carrier rates the defect exposure against.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Gross sales history

What were your gross sales for the last 3 years? One per line, as “Year: $amount.”

Three years of sales show whether the business is growing, flat or shrinking, which carriers read as a risk signal on its own and use to set the rating basis.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Contractual hold-harmless agreements

Do any of your contracts include a hold-harmless or indemnification agreement in someone else's favor? If so, please describe.

A hold-harmless clause where you indemnify someone else shifts liability onto your policy, so carriers want to see the wording.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

OSHA compliance

Are you complying with all state and OSHA regulations? (Yes/No)

An open OSHA matter is something carriers find on their own, and it is far better placed as a disclosure than as a discovery.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Tract development: Tract / new development supplemental (41 questions)

Other businesses

If the ownership-in-another-business answer was Yes, list each business and describe its operations.

Control: textarea
Response needed when shown: Yes when shown
Shown when: ((New residential / tract / apartments starts with Yes OR New multi-family / tract work starts with Yes OR New developments starts with Yes OR New condo, tract or townhome construction includes the selected option condominiums (ignoring letter case) OR New condo, tract or townhome construction includes the selected option condo conversions (ignoring letter case) OR New condo, tract or townhome construction includes the selected option tract housing (ignoring letter case) OR New condo, tract or townhome construction includes the selected option townhomes (ignoring letter case) OR Operations outside drywall contains more than 50% of work on new construction (ignoring letter case)) AND Ownership in another business starts with Yes)

Bankruptcy detail

If the bankruptcy answer was Yes, provide the entity, date, court or jurisdiction, and current status.

Control: textarea
Response needed when shown: Yes when shown
Shown when: ((New residential / tract / apartments starts with Yes OR New multi-family / tract work starts with Yes OR New developments starts with Yes OR New condo, tract or townhome construction includes the selected option condominiums (ignoring letter case) OR New condo, tract or townhome construction includes the selected option condo conversions (ignoring letter case) OR New condo, tract or townhome construction includes the selected option tract housing (ignoring letter case) OR New condo, tract or townhome construction includes the selected option townhomes (ignoring letter case) OR Operations outside drywall contains more than 50% of work on new construction (ignoring letter case)) AND Bankruptcy history starts with Yes)

Five-year financial history

Provide gross sales, payroll, and subcontractor cost for the next 12 months and each of the prior four years.

Control: tract-grid
Response needed when shown: Yes when shown
Shown when: (New residential / tract / apartments starts with Yes OR New multi-family / tract work starts with Yes OR New developments starts with Yes OR New condo, tract or townhome construction includes the selected option condominiums (ignoring letter case) OR New condo, tract or townhome construction includes the selected option condo conversions (ignoring letter case) OR New condo, tract or townhome construction includes the selected option tract housing (ignoring letter case) OR New condo, tract or townhome construction includes the selected option townhomes (ignoring letter case) OR Operations outside drywall contains more than 50% of work on new construction (ignoring letter case))

New and repair work by property type

For each property type where you work, enter the percent that is new construction and the percent that is repair or remodel. Each used row should total 100%.

Control: tract-grid
Response needed when shown: Yes when shown
Shown when: (New residential / tract / apartments starts with Yes OR New multi-family / tract work starts with Yes OR New developments starts with Yes OR New condo, tract or townhome construction includes the selected option condominiums (ignoring letter case) OR New condo, tract or townhome construction includes the selected option condo conversions (ignoring letter case) OR New condo, tract or townhome construction includes the selected option tract housing (ignoring letter case) OR New condo, tract or townhome construction includes the selected option townhomes (ignoring letter case) OR Operations outside drywall contains more than 50% of work on new construction (ignoring letter case))

Contracting role mix

What percent of your work is as a general contractor, subcontractor, and construction manager? The total should be 100%.

Control: percentage mix
Response needed when shown: Yes when shown
Shown when: (New residential / tract / apartments starts with Yes OR New multi-family / tract work starts with Yes OR New developments starts with Yes OR New condo, tract or townhome construction includes the selected option condominiums (ignoring letter case) OR New condo, tract or townhome construction includes the selected option condo conversions (ignoring letter case) OR New condo, tract or townhome construction includes the selected option tract housing (ignoring letter case) OR New condo, tract or townhome construction includes the selected option townhomes (ignoring letter case) OR Operations outside drywall contains more than 50% of work on new construction (ignoring letter case))
Options: General contractor; Subcontractor; Construction manager

Interior and exterior work

What percent of your work is interior and what percent is exterior? The total should be 100%.

Control: percentage mix
Response needed when shown: Yes when shown
Shown when: (New residential / tract / apartments starts with Yes OR New multi-family / tract work starts with Yes OR New developments starts with Yes OR New condo, tract or townhome construction includes the selected option condominiums (ignoring letter case) OR New condo, tract or townhome construction includes the selected option condo conversions (ignoring letter case) OR New condo, tract or townhome construction includes the selected option tract housing (ignoring letter case) OR New condo, tract or townhome construction includes the selected option townhomes (ignoring letter case) OR Operations outside drywall contains more than 50% of work on new construction (ignoring letter case))
Options: Interior; Exterior

Trades performed

Select every trade you perform and enter the percent performed by your own crew and the percent subcontracted. Each selected trade should total 100%.

Control: tract-trades
Response needed when shown: Yes when shown
Shown when: (New residential / tract / apartments starts with Yes OR New multi-family / tract work starts with Yes OR New developments starts with Yes OR New condo, tract or townhome construction includes the selected option condominiums (ignoring letter case) OR New condo, tract or townhome construction includes the selected option condo conversions (ignoring letter case) OR New condo, tract or townhome construction includes the selected option tract housing (ignoring letter case) OR New condo, tract or townhome construction includes the selected option townhomes (ignoring letter case) OR Operations outside drywall contains more than 50% of work on new construction (ignoring letter case))
Options: Airport runways; Grading; Asbestos abatement; HVAC; Blasting; Insulation; Bridges; Masonry; Carpentry; Mechanical; Cell towers; Mold remediation; Concrete; Painting; Conduits; Paving; Crane operations; Pile driving; Dams; Plastering; Demolition; Plumbing; Doors and windows; Power lines; Drilling; Roofing; Drywall; Sewer and water mains; EIFS; Steel erection; Electrical; Street and road work; Excavation; Stucco and siding; Fire sprinklers; Swimming pools; Foundations; Traffic control; Gas mains; Waterproofing

Three largest completed projects

List the three largest projects completed in the past three years, with a description and contract value for each.

Control: tract-grid
Response needed when shown: Yes when shown
Shown when: (New residential / tract / apartments starts with Yes OR New multi-family / tract work starts with Yes OR New developments starts with Yes OR New condo, tract or townhome construction includes the selected option condominiums (ignoring letter case) OR New condo, tract or townhome construction includes the selected option condo conversions (ignoring letter case) OR New condo, tract or townhome construction includes the selected option tract housing (ignoring letter case) OR New condo, tract or townhome construction includes the selected option townhomes (ignoring letter case) OR Operations outside drywall contains more than 50% of work on new construction (ignoring letter case))

Three largest planned projects

List the three largest projects planned for the next 12 months, with a description and contract value for each.

Control: tract-grid
Response needed when shown: Yes when shown
Shown when: (New residential / tract / apartments starts with Yes OR New multi-family / tract work starts with Yes OR New developments starts with Yes OR New condo, tract or townhome construction includes the selected option condominiums (ignoring letter case) OR New condo, tract or townhome construction includes the selected option condo conversions (ignoring letter case) OR New condo, tract or townhome construction includes the selected option tract housing (ignoring letter case) OR New condo, tract or townhome construction includes the selected option townhomes (ignoring letter case) OR Operations outside drywall contains more than 50% of work on new construction (ignoring letter case))

Cranes

Will any work involve cranes? (Yes / No) If yes, describe who owns and operates them and the largest capacity.

Control: yesno
Response needed when shown: Yes when shown
Shown when: (New residential / tract / apartments starts with Yes OR New multi-family / tract work starts with Yes OR New developments starts with Yes OR New condo, tract or townhome construction includes the selected option condominiums (ignoring letter case) OR New condo, tract or townhome construction includes the selected option condo conversions (ignoring letter case) OR New condo, tract or townhome construction includes the selected option tract housing (ignoring letter case) OR New condo, tract or townhome construction includes the selected option townhomes (ignoring letter case) OR Operations outside drywall contains more than 50% of work on new construction (ignoring letter case))
Options: Yes; No

Scaffolding

Will any work involve scaffolding? (Yes / No) If yes, describe the type, maximum height, and who erects it.

Control: yesno
Response needed when shown: Yes when shown
Shown when: (New residential / tract / apartments starts with Yes OR New multi-family / tract work starts with Yes OR New developments starts with Yes OR New condo, tract or townhome construction includes the selected option condominiums (ignoring letter case) OR New condo, tract or townhome construction includes the selected option condo conversions (ignoring letter case) OR New condo, tract or townhome construction includes the selected option tract housing (ignoring letter case) OR New condo, tract or townhome construction includes the selected option townhomes (ignoring letter case) OR Operations outside drywall contains more than 50% of work on new construction (ignoring letter case))
Options: Yes; No

Subsidence

Have you built, or will you build, on areas with recent subsidence activity? (Yes / No) If yes, describe it.

Control: yesno
Response needed when shown: Yes when shown
Shown when: (New residential / tract / apartments starts with Yes OR New multi-family / tract work starts with Yes OR New developments starts with Yes OR New condo, tract or townhome construction includes the selected option condominiums (ignoring letter case) OR New condo, tract or townhome construction includes the selected option condo conversions (ignoring letter case) OR New condo, tract or townhome construction includes the selected option tract housing (ignoring letter case) OR New condo, tract or townhome construction includes the selected option townhomes (ignoring letter case) OR Operations outside drywall contains more than 50% of work on new construction (ignoring letter case))
Options: Yes; No

Work above two stories

Will any exterior work be above two stories? (Yes / No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: (New residential / tract / apartments starts with Yes OR New multi-family / tract work starts with Yes OR New developments starts with Yes OR New condo, tract or townhome construction includes the selected option condominiums (ignoring letter case) OR New condo, tract or townhome construction includes the selected option condo conversions (ignoring letter case) OR New condo, tract or townhome construction includes the selected option tract housing (ignoring letter case) OR New condo, tract or townhome construction includes the selected option townhomes (ignoring letter case) OR Operations outside drywall contains more than 50% of work on new construction (ignoring letter case))
Options: Yes; No

Work above two stories, percent

What percent of your exterior work will be above two stories?

Control: textarea
Response needed when shown: Yes when shown
Shown when: ((New residential / tract / apartments starts with Yes OR New multi-family / tract work starts with Yes OR New developments starts with Yes OR New condo, tract or townhome construction includes the selected option condominiums (ignoring letter case) OR New condo, tract or townhome construction includes the selected option condo conversions (ignoring letter case) OR New condo, tract or townhome construction includes the selected option tract housing (ignoring letter case) OR New condo, tract or townhome construction includes the selected option townhomes (ignoring letter case) OR Operations outside drywall contains more than 50% of work on new construction (ignoring letter case)) AND Work above two stories starts with Yes)

Maximum work height

What is the maximum exterior-work height?

Control: textarea
Response needed when shown: Yes when shown
Shown when: ((New residential / tract / apartments starts with Yes OR New multi-family / tract work starts with Yes OR New developments starts with Yes OR New condo, tract or townhome construction includes the selected option condominiums (ignoring letter case) OR New condo, tract or townhome construction includes the selected option condo conversions (ignoring letter case) OR New condo, tract or townhome construction includes the selected option tract housing (ignoring letter case) OR New condo, tract or townhome construction includes the selected option townhomes (ignoring letter case) OR Operations outside drywall contains more than 50% of work on new construction (ignoring letter case)) AND Work above two stories starts with Yes)

Work below grade

Will you work below grade? (Yes / No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: (New residential / tract / apartments starts with Yes OR New multi-family / tract work starts with Yes OR New developments starts with Yes OR New condo, tract or townhome construction includes the selected option condominiums (ignoring letter case) OR New condo, tract or townhome construction includes the selected option condo conversions (ignoring letter case) OR New condo, tract or townhome construction includes the selected option tract housing (ignoring letter case) OR New condo, tract or townhome construction includes the selected option townhomes (ignoring letter case) OR Operations outside drywall contains more than 50% of work on new construction (ignoring letter case))
Options: Yes; No

Work below grade, percent

What percent of your work will be below grade?

Control: textarea
Response needed when shown: Yes when shown
Shown when: ((New residential / tract / apartments starts with Yes OR New multi-family / tract work starts with Yes OR New developments starts with Yes OR New condo, tract or townhome construction includes the selected option condominiums (ignoring letter case) OR New condo, tract or townhome construction includes the selected option condo conversions (ignoring letter case) OR New condo, tract or townhome construction includes the selected option tract housing (ignoring letter case) OR New condo, tract or townhome construction includes the selected option townhomes (ignoring letter case) OR Operations outside drywall contains more than 50% of work on new construction (ignoring letter case)) AND Work below grade starts with Yes)

Maximum work depth

What is the maximum depth below grade?

Control: textarea
Response needed when shown: Yes when shown
Shown when: ((New residential / tract / apartments starts with Yes OR New multi-family / tract work starts with Yes OR New developments starts with Yes OR New condo, tract or townhome construction includes the selected option condominiums (ignoring letter case) OR New condo, tract or townhome construction includes the selected option condo conversions (ignoring letter case) OR New condo, tract or townhome construction includes the selected option tract housing (ignoring letter case) OR New condo, tract or townhome construction includes the selected option townhomes (ignoring letter case) OR Operations outside drywall contains more than 50% of work on new construction (ignoring letter case)) AND Work below grade starts with Yes)

Ground-up homes

Will you build ground-up homes? (Yes / No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: (New residential / tract / apartments starts with Yes OR New multi-family / tract work starts with Yes OR New developments starts with Yes OR New condo, tract or townhome construction includes the selected option condominiums (ignoring letter case) OR New condo, tract or townhome construction includes the selected option condo conversions (ignoring letter case) OR New condo, tract or townhome construction includes the selected option tract housing (ignoring letter case) OR New condo, tract or townhome construction includes the selected option townhomes (ignoring letter case) OR Operations outside drywall contains more than 50% of work on new construction (ignoring letter case))
Options: Yes; No

Ground-up homes per year

What is the maximum number of ground-up homes you will build in one year?

Control: textarea
Response needed when shown: Yes when shown
Shown when: ((New residential / tract / apartments starts with Yes OR New multi-family / tract work starts with Yes OR New developments starts with Yes OR New condo, tract or townhome construction includes the selected option condominiums (ignoring letter case) OR New condo, tract or townhome construction includes the selected option condo conversions (ignoring letter case) OR New condo, tract or townhome construction includes the selected option tract housing (ignoring letter case) OR New condo, tract or townhome construction includes the selected option townhomes (ignoring letter case) OR Operations outside drywall contains more than 50% of work on new construction (ignoring letter case)) AND Ground-up homes starts with Yes)

Ground-up homes per tract

What is the maximum number of homes in any one tract or development?

Control: textarea
Response needed when shown: Yes when shown
Shown when: ((New residential / tract / apartments starts with Yes OR New multi-family / tract work starts with Yes OR New developments starts with Yes OR New condo, tract or townhome construction includes the selected option condominiums (ignoring letter case) OR New condo, tract or townhome construction includes the selected option condo conversions (ignoring letter case) OR New condo, tract or townhome construction includes the selected option tract housing (ignoring letter case) OR New condo, tract or townhome construction includes the selected option townhomes (ignoring letter case) OR Operations outside drywall contains more than 50% of work on new construction (ignoring letter case)) AND Ground-up homes starts with Yes)

Hazardous activities

Select every activity that applies: blasting; EIFS; hazardous-material work; cofferdam or caisson work; shoring or underpinning; mold remediation; none of these.

Control: multichips
Response needed when shown: Yes when shown
Shown when: (New residential / tract / apartments starts with Yes OR New multi-family / tract work starts with Yes OR New developments starts with Yes OR New condo, tract or townhome construction includes the selected option condominiums (ignoring letter case) OR New condo, tract or townhome construction includes the selected option condo conversions (ignoring letter case) OR New condo, tract or townhome construction includes the selected option tract housing (ignoring letter case) OR New condo, tract or townhome construction includes the selected option townhomes (ignoring letter case) OR Operations outside drywall contains more than 50% of work on new construction (ignoring letter case))
Options: Blasting; EIFS; Hazardous-material work; Cofferdam or caisson work; Shoring or underpinning; Mold remediation; None of these

Regular subcontractors

Do you regularly use the same subcontractors? (Yes / No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: (New residential / tract / apartments starts with Yes OR New multi-family / tract work starts with Yes OR New developments starts with Yes OR New condo, tract or townhome construction includes the selected option condominiums (ignoring letter case) OR New condo, tract or townhome construction includes the selected option condo conversions (ignoring letter case) OR New condo, tract or townhome construction includes the selected option tract housing (ignoring letter case) OR New condo, tract or townhome construction includes the selected option townhomes (ignoring letter case) OR Operations outside drywall contains more than 50% of work on new construction (ignoring letter case))
Options: Yes; No

Written subcontract agreements

Do all subcontractors have written contracts? (Yes / No)

Control: textarea
Response needed when shown: Yes when shown
Shown when: (New residential / tract / apartments starts with Yes OR New multi-family / tract work starts with Yes OR New developments starts with Yes OR New condo, tract or townhome construction includes the selected option condominiums (ignoring letter case) OR New condo, tract or townhome construction includes the selected option condo conversions (ignoring letter case) OR New condo, tract or townhome construction includes the selected option tract housing (ignoring letter case) OR New condo, tract or townhome construction includes the selected option townhomes (ignoring letter case) OR Operations outside drywall contains more than 50% of work on new construction (ignoring letter case))

Waiver of subrogation

Do subcontract agreements require a waiver of subrogation in your favor? (Yes / No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: (New residential / tract / apartments starts with Yes OR New multi-family / tract work starts with Yes OR New developments starts with Yes OR New condo, tract or townhome construction includes the selected option condominiums (ignoring letter case) OR New condo, tract or townhome construction includes the selected option condo conversions (ignoring letter case) OR New condo, tract or townhome construction includes the selected option tract housing (ignoring letter case) OR New condo, tract or townhome construction includes the selected option townhomes (ignoring letter case) OR Operations outside drywall contains more than 50% of work on new construction (ignoring letter case))
Options: Yes; No

Uninsured subcontractors

Will any subcontractor work without its own liability and workers compensation insurance? If yes, describe the work and estimated annual cost.

Control: yesno
Response needed when shown: Yes when shown
Shown when: (New residential / tract / apartments starts with Yes OR New multi-family / tract work starts with Yes OR New developments starts with Yes OR New condo, tract or townhome construction includes the selected option condominiums (ignoring letter case) OR New condo, tract or townhome construction includes the selected option condo conversions (ignoring letter case) OR New condo, tract or townhome construction includes the selected option tract housing (ignoring letter case) OR New condo, tract or townhome construction includes the selected option townhomes (ignoring letter case) OR Operations outside drywall contains more than 50% of work on new construction (ignoring letter case))
Options: Yes; No

Formal safety program

Do you have a formal written safety program? (Yes / No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: (New residential / tract / apartments starts with Yes OR New multi-family / tract work starts with Yes OR New developments starts with Yes OR New condo, tract or townhome construction includes the selected option condominiums (ignoring letter case) OR New condo, tract or townhome construction includes the selected option condo conversions (ignoring letter case) OR New condo, tract or townhome construction includes the selected option tract housing (ignoring letter case) OR New condo, tract or townhome construction includes the selected option townhomes (ignoring letter case) OR Operations outside drywall contains more than 50% of work on new construction (ignoring letter case))
Options: Yes; No

Faulty-construction accusations

In the past five years, have you been accused of faulty construction or defective workmanship? (Yes / No) If yes, describe the allegation and outcome.

Control: yesno
Response needed when shown: Yes when shown
Shown when: (New residential / tract / apartments starts with Yes OR New multi-family / tract work starts with Yes OR New developments starts with Yes OR New condo, tract or townhome construction includes the selected option condominiums (ignoring letter case) OR New condo, tract or townhome construction includes the selected option condo conversions (ignoring letter case) OR New condo, tract or townhome construction includes the selected option tract housing (ignoring letter case) OR New condo, tract or townhome construction includes the selected option townhomes (ignoring letter case) OR Operations outside drywall contains more than 50% of work on new construction (ignoring letter case))
Options: Yes; No

Other operations

Do you perform any operations not described elsewhere in this application? (Yes / No) If yes, describe them.

Control: yesno
Response needed when shown: Yes when shown
Shown when: (New residential / tract / apartments starts with Yes OR New multi-family / tract work starts with Yes OR New developments starts with Yes OR New condo, tract or townhome construction includes the selected option condominiums (ignoring letter case) OR New condo, tract or townhome construction includes the selected option condo conversions (ignoring letter case) OR New condo, tract or townhome construction includes the selected option tract housing (ignoring letter case) OR New condo, tract or townhome construction includes the selected option townhomes (ignoring letter case) OR Operations outside drywall contains more than 50% of work on new construction (ignoring letter case))
Options: Yes; No

Roofing property mix

What percent of roofing work is residential and what percent is commercial or industrial? The total should be 100%.

Control: percentage mix
Response needed when shown: Yes when shown
Shown when: ((New residential / tract / apartments starts with Yes OR New multi-family / tract work starts with Yes OR New developments starts with Yes OR New condo, tract or townhome construction includes the selected option condominiums (ignoring letter case) OR New condo, tract or townhome construction includes the selected option condo conversions (ignoring letter case) OR New condo, tract or townhome construction includes the selected option tract housing (ignoring letter case) OR New condo, tract or townhome construction includes the selected option townhomes (ignoring letter case) OR Operations outside drywall contains more than 50% of work on new construction (ignoring letter case)) AND New multi-family / tract work starts with Yes)
Options: Residential; Commercial or industrial

Roofing project mix

What percent of roofing work is replacement and what percent is new construction? The total should be 100%.

Control: percentage mix
Response needed when shown: Yes when shown
Shown when: ((New residential / tract / apartments starts with Yes OR New multi-family / tract work starts with Yes OR New developments starts with Yes OR New condo, tract or townhome construction includes the selected option condominiums (ignoring letter case) OR New condo, tract or townhome construction includes the selected option condo conversions (ignoring letter case) OR New condo, tract or townhome construction includes the selected option tract housing (ignoring letter case) OR New condo, tract or townhome construction includes the selected option townhomes (ignoring letter case) OR Operations outside drywall contains more than 50% of work on new construction (ignoring letter case)) AND New multi-family / tract work starts with Yes)
Options: Replacement; New construction

Roofing product mix

What percent of roofing work uses hot tar, built-up roofing, modified bitumen, and EPDM? The total should be 100%.

Control: percentage mix
Response needed when shown: Yes when shown
Shown when: ((New residential / tract / apartments starts with Yes OR New multi-family / tract work starts with Yes OR New developments starts with Yes OR New condo, tract or townhome construction includes the selected option condominiums (ignoring letter case) OR New condo, tract or townhome construction includes the selected option condo conversions (ignoring letter case) OR New condo, tract or townhome construction includes the selected option tract housing (ignoring letter case) OR New condo, tract or townhome construction includes the selected option townhomes (ignoring letter case) OR Operations outside drywall contains more than 50% of work on new construction (ignoring letter case)) AND New multi-family / tract work starts with Yes)
Options: Hot tar; Built-up roofing; Modified bitumen; EPDM

Roofing systems installed

Enter the percent of work for each roofing system you install. The used rows should total 100%.

Control: tract-grid
Response needed when shown: Yes when shown
Shown when: ((New residential / tract / apartments starts with Yes OR New multi-family / tract work starts with Yes OR New developments starts with Yes OR New condo, tract or townhome construction includes the selected option condominiums (ignoring letter case) OR New condo, tract or townhome construction includes the selected option condo conversions (ignoring letter case) OR New condo, tract or townhome construction includes the selected option tract housing (ignoring letter case) OR New condo, tract or townhome construction includes the selected option townhomes (ignoring letter case) OR Operations outside drywall contains more than 50% of work on new construction (ignoring letter case)) AND New multi-family / tract work starts with Yes)

Tar or asphalt heating equipment

Do you use tar or asphalt heating equipment? (Yes / No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: ((New residential / tract / apartments starts with Yes OR New multi-family / tract work starts with Yes OR New developments starts with Yes OR New condo, tract or townhome construction includes the selected option condominiums (ignoring letter case) OR New condo, tract or townhome construction includes the selected option condo conversions (ignoring letter case) OR New condo, tract or townhome construction includes the selected option tract housing (ignoring letter case) OR New condo, tract or townhome construction includes the selected option townhomes (ignoring letter case) OR Operations outside drywall contains more than 50% of work on new construction (ignoring letter case)) AND New multi-family / tract work starts with Yes)
Options: Yes; No

Heating-equipment controls

Select every control that applies: All kettles or heat processing equipment are placed at ground level; Barriers are present which prohibit the general public from entering the jobsite; 15 lb. or larger charged ABC extinguishers are present at all jobsites; Personnel remain at jobsite for at least 30 minutes after equipment has been shut off or removed.

Control: multichips
Response needed when shown: Yes when shown
Shown when: (((New residential / tract / apartments starts with Yes OR New multi-family / tract work starts with Yes OR New developments starts with Yes OR New condo, tract or townhome construction includes the selected option condominiums (ignoring letter case) OR New condo, tract or townhome construction includes the selected option condo conversions (ignoring letter case) OR New condo, tract or townhome construction includes the selected option tract housing (ignoring letter case) OR New condo, tract or townhome construction includes the selected option townhomes (ignoring letter case) OR Operations outside drywall contains more than 50% of work on new construction (ignoring letter case)) AND New multi-family / tract work starts with Yes) AND Tar or asphalt heating equipment starts with Yes)
Options: All kettles or heat processing equipment are placed at ground level; Barriers are present which prohibit the general public from entering the jobsite; 15 lb. or larger charged ABC extinguishers are present at all jobsites; Personnel remain at jobsite for at least 30 minutes after equipment has been shut off or removed

Torch-applied roofing

Do you perform torch-applied roofing? (Yes / No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: ((New residential / tract / apartments starts with Yes OR New multi-family / tract work starts with Yes OR New developments starts with Yes OR New condo, tract or townhome construction includes the selected option condominiums (ignoring letter case) OR New condo, tract or townhome construction includes the selected option condo conversions (ignoring letter case) OR New condo, tract or townhome construction includes the selected option tract housing (ignoring letter case) OR New condo, tract or townhome construction includes the selected option townhomes (ignoring letter case) OR Operations outside drywall contains more than 50% of work on new construction (ignoring letter case)) AND New multi-family / tract work starts with Yes)
Options: Yes; No

Torch-applied work, percent

What percent of roofing work is torch applied?

Control: textarea
Response needed when shown: Yes when shown
Shown when: (((New residential / tract / apartments starts with Yes OR New multi-family / tract work starts with Yes OR New developments starts with Yes OR New condo, tract or townhome construction includes the selected option condominiums (ignoring letter case) OR New condo, tract or townhome construction includes the selected option condo conversions (ignoring letter case) OR New condo, tract or townhome construction includes the selected option tract housing (ignoring letter case) OR New condo, tract or townhome construction includes the selected option townhomes (ignoring letter case) OR Operations outside drywall contains more than 50% of work on new construction (ignoring letter case)) AND New multi-family / tract work starts with Yes) AND Torch-applied roofing starts with Yes)

CERTA training

Are torch operators CERTA trained? (Yes / No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: (((New residential / tract / apartments starts with Yes OR New multi-family / tract work starts with Yes OR New developments starts with Yes OR New condo, tract or townhome construction includes the selected option condominiums (ignoring letter case) OR New condo, tract or townhome construction includes the selected option condo conversions (ignoring letter case) OR New condo, tract or townhome construction includes the selected option tract housing (ignoring letter case) OR New condo, tract or townhome construction includes the selected option townhomes (ignoring letter case) OR Operations outside drywall contains more than 50% of work on new construction (ignoring letter case)) AND New multi-family / tract work starts with Yes) AND Torch-applied roofing starts with Yes)
Options: Yes; No

Spray applications

Do you perform spray-applied roofing or coatings? (Yes / No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: ((New residential / tract / apartments starts with Yes OR New multi-family / tract work starts with Yes OR New developments starts with Yes OR New condo, tract or townhome construction includes the selected option condominiums (ignoring letter case) OR New condo, tract or townhome construction includes the selected option condo conversions (ignoring letter case) OR New condo, tract or townhome construction includes the selected option tract housing (ignoring letter case) OR New condo, tract or townhome construction includes the selected option townhomes (ignoring letter case) OR Operations outside drywall contains more than 50% of work on new construction (ignoring letter case)) AND New multi-family / tract work starts with Yes)
Options: Yes; No

Flammable spray materials

Are any spray materials flammable? (Yes / No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: (((New residential / tract / apartments starts with Yes OR New multi-family / tract work starts with Yes OR New developments starts with Yes OR New condo, tract or townhome construction includes the selected option condominiums (ignoring letter case) OR New condo, tract or townhome construction includes the selected option condo conversions (ignoring letter case) OR New condo, tract or townhome construction includes the selected option tract housing (ignoring letter case) OR New condo, tract or townhome construction includes the selected option townhomes (ignoring letter case) OR Operations outside drywall contains more than 50% of work on new construction (ignoring letter case)) AND New multi-family / tract work starts with Yes) AND Spray applications starts with Yes)
Options: Yes; No

Spray process

Describe the spray materials, application process, ventilation, and ignition controls.

Control: textarea
Response needed when shown: Yes when shown
Shown when: (((New residential / tract / apartments starts with Yes OR New multi-family / tract work starts with Yes OR New developments starts with Yes OR New condo, tract or townhome construction includes the selected option condominiums (ignoring letter case) OR New condo, tract or townhome construction includes the selected option condo conversions (ignoring letter case) OR New condo, tract or townhome construction includes the selected option tract housing (ignoring letter case) OR New condo, tract or townhome construction includes the selected option townhomes (ignoring letter case) OR Operations outside drywall contains more than 50% of work on new construction (ignoring letter case)) AND New multi-family / tract work starts with Yes) AND Spray applications starts with Yes)

Drone Operation: Drone Operation (1 questions)

Other coverage besides drones

Besides drone coverage, would you like us to quote any other business insurance for you? General liability covers third-party bodily injury or property damage claims, commercial auto covers vehicles you use for the business, and business property covers your gear and workspace. (Yes, quote other coverage too / No, I only need drone coverage)

If you only need drone coverage you can buy it directly through SkyWatch in a few minutes. If you'd also like other business coverage, a short questionnaire follows so Lee can shop it for you.

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes, quote other coverage too; No, I only need drone coverage

Pest Control Specific Questions: Pest Control Specific Questions (2 questions)

Special operations

Please indicate if any of the following apply: commercial heat treatment for bedbug control; use of firearms (other than pellet guns or air rifles) for wildlife control; work on farms, crops, or other agriculture-related industry; more than 25% of revenue in repair work (wildlife and termite repair).

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Commercial heat treatment (bedbugs); Firearms for wildlife control; Farm / crop / agriculture work; Over 25% revenue in repair work; None of these

Service lines and revenue

For each service below, indicate Yes/No and the revenue you anticipate this coming year: general household pest control; bed bug treatment; fumigation; wildlife control; termite treatment; wood-destroying insect inspections; lawn care services; tree spraying/trimming services; pesticide retail sales.

Control: counts
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Equine Specific Questions: Equine Specific Questions (17 questions)

Operations check

Do any of the following apply to your operations? (Yes/No each): rental of saddle animals hired by the hour or day to the general public (including hay rides, carriage rides, sleigh rides, trail and endurance rides, pack trips); trainers, instructors, or clinicians under age 18 conducting business on your premises; stallions used for riding instruction that are not owned or leased by the student; managing and/or conducting rodeos; pony rides as primary operations or held off premises; processing or slaughtering animals for meat on premises; housing or breeding exotic animals; facility primarily used for veterinary services and rehabilitation.

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Saddle animals rented to the public; Instructors under 18; Stallions used for instruction; Rodeos; Pony rides off-premises; On-site slaughter / processing; Exotic animals; Primarily veterinary / rehab; None of these

Associations

Are you a member of any associations? If so, which one(s)?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Property responsibility

Do you own, lease, or have legal responsibility for the property where your owned horses are kept and/or where you run your equine operations? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Primary operations

Which of the following primary operations apply? (Yes/No each): boarding of others' equines; breeding; farrier services for non-owned equines; leasing horses to others; pleasure (own horses); riding instruction to students; teaching clinics; training of others' equines.

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Boarding others' horses; Breeding; Farrier services; Leasing horses out; Pleasure (own horses); Riding instruction; Teaching clinics; Training others' horses; None of these

School horses per lesson

Do you use more than 5 school horses at any one time during a lesson? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Safety gear

Do you require all riders to wear appropriate safety gear customary to their discipline? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Secondary operations

Which of the following secondary operations apply? (Yes/No each): day or overnight camp; equine rescue; hay rides / sleigh rides; hosting shows or clinics; leasing equines to camps or resorts; parades; pony rides; racehorse training; sale of hay, tack, food, or clothing; sale of equines; therapeutic equine activities (including equine-assisted psychotherapy or learning).

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Day / overnight camp; Equine rescue; Hay / sleigh rides; Hosting shows or clinics; Leasing to camps / resorts; Parades; Pony rides; Racehorse training; Sale of hay / tack / food; Sale of horses; Therapeutic activities; None of these

Primary manager

Who is the primary manager of your operations?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Recreational vehicles

Do you use any recreational vehicles for your operations? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Instructors, trainers, and clinicians

How many total instructors, trainers, and clinicians work at your facility (including yourself, employees, and independents)? For each, please provide: full name; whether the person is 18 years or older (Yes/No); and whether the person has more than 5 years of experience as a riding instructor or equine trainer (Yes/No).

Control: rows
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Uninsured independents

Of that total, how many independents working for you do not carry their own liability insurance?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Lessons taught

Do you, an employee, and/or an independent teach lessons? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Student-horse receipts

Annual gross receipts for instruction given on student-owned horses:

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Owned horses per lesson

In a single lesson, how many owned/leased school horses, assigned by an instructor, may be used at one time?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Non-owned horses per lesson

In a single lesson, how many non-owned school horses, assigned by an instructor, may be used at one time?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Equine liability law

Do you abide by the equine liability law in your state and post state statutory signs where applicable? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Waiver/release

Do you require a signed waiver/release for all equine activities? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Car Dealership Specific Questions: Car Dealership Specific Questions (67 questions)

Vehicles sold

What cars will you be selling (for example used vehicles only, passenger cars, SUVs)?

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Inventory

How many vehicles will you have at a time?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Typical value per unit

Typical value per unit:

Control: money
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Max total lot value

Maximum total lot value at one time:

Control: money
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Titles

Which title types do you handle (for example clean, salvage)? (Select all that apply.)

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Clean; Salvage; Rebuilt / reconstructed; Other

Consignment

Will you sell on consignment? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Financing

Will you offer financing? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Building square footage

Building square footage:

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Storage

Storage (indoors or outdoors):

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Indoors; Outdoors; Both

Lot security

How is the lot secured? (Select all that apply.)

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: None; Fence & gate; Post & cable; Inside a building; Other

Secondary storage

Secondary storage location address, if applicable:

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Test drives

Will you allow test drives? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Who drives / transports vehicles

How are newly acquired vehicles driven or transported to your lot? (Select all that apply.)

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Owner or employees drive them; Transported by trailer / tow; Transporter service; Contract drivers

Known drivers

For any known employee or owner drivers now, please provide full name, date of birth, driver's license number, and the state that issued it.

Control: driver_rows
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Dealer plates

Will you use dealer plates, and if so how many?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Personal use

Personal use of inventory? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Sales channels

Roughly what percent of your vehicle sales are retail, broker, and wholesale? (should total 100%)

Control: percentage mix
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Retail; Broker; Wholesale

Inventory mix

Roughly what percent of your inventory is each vehicle type? (should total 100%)

Control: percentage mix
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Private passenger autos (cars, SUVs, pickups, vans); Antique / classic; Commercial vehicles; Motorcycles & off-road; RVs / motorhomes; Salvage titles; Other

Service / repair work

Do you do any service or repair work for customers (not just prepping your own inventory)? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Services performed

Which services do you perform? (Select all that apply.)

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Airbags / safety systems; Air conditioning; Alignment; Antique / classic restoration; Batteries; Brakes; Diagnostics; Car wash / detailing; Customization / fabrication; Driver assist technology (ADAS); Lift kits; Paint & body; Performance enhancement; Self-park parking / charging stations; Tires (sales or service); Other

Key security

How are vehicle keys secured? (Select all that apply. Applies during business hours and after closing.)

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Key cabinet in office; In or on the vehicle; Vehicle-mounted lockbox; Taken home; Other

Loaner / rental vehicles

Do you ever loan or rent vehicles to customers? If yes: is there a signed agreement, do you copy the driver's license and verify their auto insurance, and what is the minimum age?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Household drivers

Have all household members and anyone who might drive your vehicles (including children away at college) been disclosed?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Other exposures

Do any of these apply to your operation? (Select all that apply.)

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Racing / exhibition exposure; Auto auction operations; Auto pawn; Towing for hire; Importing or exporting vehicles; Leasing plates to others; None of these

Off-site / street parking

Do you ever park customer or inventory vehicles on the street, or store or display vehicles anywhere other than your lot?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Years in business

If the business is already operating: how many years has the business been operating?

Control: years
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: New venture; In business for…

Years of dealer experience

How many years of experience do you personally have as a dealer?

Control: years
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Gross receipts: service

What are your estimated annual gross receipts from service/repair work?

Control: money
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Gross receipts: sales

What are your estimated annual gross receipts from vehicle sales?

Control: money
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Prior coverage cancelled/declined

Has any prior garage or dealer insurance policy ever been cancelled, declined, or non-renewed?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Other businesses at this location

Is any other business operated at this location (besides the dealership)?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Rents space to others

Do you rent or lease any part of your premises to another business?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Firearms on premises

Are firearms kept on the premises?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Transporter plates

Do you use transporter plates? If so, how many?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Drivers licensed 2+ years

Have all drivers held a valid license for at least 2 years?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Unlisted drivers

Is anyone who isn't listed as a driver ever permitted to drive dealership vehicles?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Dealer license

Do you hold a valid dealer license?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Transporter COI

If you use a transporter service, do you obtain a certificate of insurance from them?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Transport distance

How far do vehicles typically travel when being transported to or from your lot?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Delivers vehicles to customers

Do you ever deliver a vehicle to a customer's home or business?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Repairs salvage/rebuilt vehicles

Do you repair salvage or rebuilt vehicles before reselling them?

Salvage-title repair work is a materially different exposure than selling clean-title vehicles, so carriers price it separately.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Salvage repair mix

Of that salvage/rebuilt repair work, roughly what percent is structural, mechanical, and cosmetic? (should total 100%)

Control: percentage mix
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Structural; Mechanical; Cosmetic

Titles transferred promptly

Are vehicle titles transferred promptly after each sale?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Buy-here-pay-here financing

Do you offer buy-here-pay-here (in-house) financing?

BHPH dealers carry their own financing risk and often retain the vehicle title, which changes how the policy needs to be structured.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

BHPH lienholder on title

For buy-here-pay-here sales, is the dealership listed as lienholder on the title?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Self-repossession

Do you ever repossess vehicles yourself, rather than using a repossession company?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Supervised test drives

Are test drives supervised (an employee rides along)?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Verify license before test drive

Do you verify a customer's driver's license before allowing a test drive?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Overnight test drives

Are customers ever allowed to take a vehicle on an overnight test drive?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Rideshare/delivery use

Is any inventory ever used for rideshare or delivery-app driving before it's sold?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Subcontractor COI

If you use subcontractors, do you obtain a certificate of insurance from each of them?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Liability signs posted

Are signs posted restricting customers from work/service areas?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Sells gasoline

Do you sell gasoline on-site?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Gasoline service type

If you sell gasoline, what type of service is it?

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Self-Service; Full Service

Gasoline gallons sold

Roughly how many gallons of gasoline do you sell per year?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Sells propane/LPG

Do you sell propane or LPG on-site?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Pickup/delivery service

Do you offer a vehicle pickup or delivery service for service customers?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

ADAS calibration level

For driver-assist technology work, which level applies?

Calibrating advanced driver-assist or self-driving systems is a distinct, higher liability exposure than routine mechanical work.

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Assists driver, requires intervention; Fully self-driving, no human attention

Lift kits over 6 inches

Do you ever install lift kits that raise the vehicle more than 6 inches?

Lift kits over 6 inches change a vehicle's handling enough that some carriers restrict or exclude the work.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Lift kit work mix

Of your lift kit work, roughly what percent is body lifts vs. suspension lifts? (should total 100%)

Control: percentage mix
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Body lifts; Suspension lifts

Paint booth

Do you have a dedicated paint booth?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Flammables storage cabinet

Are flammable materials stored in an approved fire-rated cabinet?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Performance work: street legal

For performance-enhancement work, do all vehicles remain street legal afterward?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

EV charging stations

Do you have EV charging stations on-site?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Tire quality control

Do you inspect and torque-check wheels after tire work?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Racing tires / recaps

Do you sell or install racing tires or recapped/retreaded tires?

Recapped or racing tires carry a higher failure and liability risk than standard passenger tires.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Tire work performed

Which tire services do you perform? (Select all that apply.)

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Fixing flats; Tire rotation; Tire siping; Comp cutting; Other

Assisted Living Specific Questions: Assisted Living Specific Questions (27 questions)

Licensed beds

How many licensed beds does the facility have?

Licensed bed capacity is the main size and rating basis for a residential care facility, and carriers and supplemental applications generally ask for it before anything else.

Control: countslider
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: None

Current residents

How many residents currently live at the facility (occupied beds)?

Occupancy against licensed capacity tells an underwriter how full the facility runs, which is read differently from the licensed number alone.

Control: countslider
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: None

Own or lease the building

Who owns the building the facility operates in?

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: We own it (directly or through a company I control); We lease from a third-party landlord; Not sure

Landlord insurance requirements

Does your lease require you to carry specific limits, or to name the landlord as an additional insured (a certificate of insurance)?

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No; Not sure

Security in place

What security do you have in place? (Select all that apply.)

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Security cameras; Keypad or badge access; Door and exit alarms; Wander-management system; 24/7 on-site staff; None

Medication handling

How are residents' medications handled?

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: We administer medications; We remind residents to take them; Residents self-administer

Medication staff

Who manages medications? (Select all that apply.)

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: RNs; LPNs; Med techs; Caregivers; None of these

Agency / 1099 staff

Do you use any agency or 1099 staff?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Employee screening

What screening do you run on prospective employees? (Select all that apply.)

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Criminal background checks; Drug testing; Abuse-registry checks; Reference checks; None

Staff training

What training do your staff receive? (Select all that apply.)

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: CPR / First aid; De-escalation; Dementia care; Lift and transfer; Infection control; None of these

Resident transportation

Do you transport residents, and in what vehicles?

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: We don't transport residents; Owned vehicle(s); Hired or non-owned vehicles; Both owned and hired

Driver requirements

For resident transportation, what driver controls do you have in place? (Select all that apply.)

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: MVR checks; Driver training; Trip logs; Wheelchair lifts; None of these

Resident vehicles

Do any residents keep their own cars at the facility?

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: No resident vehicles; Yes, with parking controls or valet; Yes, no special controls

Pre-admission assessment

Do you conduct an in-person pre-admission assessment for every new resident?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

What the assessment checks

When you assess a new resident, which of these do you check for? (Select all that apply.)

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Skin breakdown or ulcers; Mobility limitations; Prior injuries or falls; Need for assistance; Disorientation; Current medications; Wandering risk; Cognitive ability; None of these

Who completes assessments

Who completes the pre-admission assessments? (title / role)

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Denied admissions

Have you denied any admissions due to high acuity in the last two years?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Reassessment frequency

How often do you reassess residents?

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: On change of condition; Monthly; Quarterly; Every 6 months; Annually

Transfer to higher care

How do you decide when a resident needs to move to a higher level of care (for example a nursing home)?

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Attending physician

Do residents have their own attending physician?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Wheelchair / bedridden residents

How many residents are in a wheelchair most of the day, or bedridden?

Control: countslider
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: None

Residents by Alzheimer's / dementia stage

How many residents fall into each stage?

Control: counts
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Ground-floor placement

Are all non-ambulatory and dementia residents housed on the ground floor?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Dementia care policy

Does your facility have a written policy identifying which types of dementia or Alzheimer's residents your staff can care for?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Wandering controls

Are all exit doors alarmed, with a secured unit for residents prone to wandering?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Elopements

How many residents have eloped (wandered off) from the facility in the last three years?

Control: countslider
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: None

Medication system

Is a unit-dose medication system used?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Home Care Specific Questions: Home Care Specific Questions (5 questions)

Medical services

Are any services you provide medical, skilled, clinical, or physician-directed? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Non-medical only

Are your services limited solely to non-medical help with daily living and household tasks? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Client transportation

Will you transport any clients in a vehicle? (Yes/No) If yes, will you ever transport clients in your own vehicle (Yes/No), and will you ever transport clients in the client's vehicle (Yes/No)? Note: coverage for transporting clients in your own vehicle can be very difficult to obtain and, when available, is often very expensive under hired and non-owned auto coverage.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Single owner, no employees

Is the business a single owner with no employees and no 1099 caregivers working for you? (Yes/No)

A one-caregiver operation and an agency with staff are generally written on different programs, so this points to the programs that fit.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Owner's date of birth

If you are the sole owner with no employees and no 1099 caregivers, what is your date of birth?

Programs written for a one-caregiver home care operation generally rate on the owner as an individual, so the carrier's application asks for the owner's date of birth.

Control: date
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Handyman Specific Questions: Handyman Specific Questions (10 questions)

Floor staining

Do you perform floor staining work? (Yes/No)

Stains and their rags are a spontaneous-combustion fire exposure, and several handyman programs exclude the work outright.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Exterior work

Do you perform work on the exterior of buildings/homes? (Yes/No) If yes, what is the maximum number of stories you will work on the outside of a building (1, 2, 3, or more than 3)?

Exterior work is where the fall exposure lives, and most handyman programs set a story limit above which they stop writing.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No; 1; 2; 3; More than 3

Industrial sites

Will you perform any work at industrial sites like factories or warehouses? (Yes/No)

Factories and warehouses carry exposures a residential handyman class does not contemplate, so a carrier that writes one may not write the other.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Hazardous work

Do you perform any of the following or use these materials or infrastructure: asbestos, lead, or mold evaluation or abatement; blasting; cranes, lifts, or bucket trucks; demolition; emergency systems; fire suppression; foundations; hazardous material or waste removal; hydraulic fracturing (fracking); retaining walls; scaffolding operation; work at landfills (not including dropping off waste or debris); or any other similarly hazardous projects or materials? (Yes/No) Note: a Yes answer will make this risk much harder to place, and insurance costs will be significantly higher.

Each item on this list is separately excluded by most handyman programs. Naming the ones that apply lets us start with a carrier that can write them rather than waiting on a declination.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Multi-unit locations

Will you perform the same type of work in more than 15 units at a multi-unit location? (Yes/No)

Repeating the same work across many units multiplies one mistake into many claims, which is the construction-defect pattern carriers watch for.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

New developments

Will you perform work in new developments or tracts where there will be more than 10 units? (Yes/No)

New tract development carries the defect exposure carriers underwrite hardest, and many handyman programs exclude it entirely.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Furniture

Will you mass-produce furniture or produce children's furniture? (Yes/No)

Manufacturing furniture, and children's furniture in particular, is a products-liability exposure rather than a services one, and it is generally rated and placed separately.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Roofing work

Will you perform any roofing work, including patch repairs or power washing / soft washing a roof? (Yes/No) Note: if yes, the insurance will be significantly more expensive.

Roofing is one of the hardest trades to place, and most handyman programs exclude it even when it is only an occasional patch.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Hospitals

Will you perform work in any hospitals? (Yes/No)

Hospital work brings a professional and bodily-injury exposure well above ordinary handyman work, and carriers screen for it directly.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Permit / licensed-scope work

Does any of your work require a building permit, a city or county inspection, or a contractor license - for example electrical, plumbing, HVAC, structural changes, or room additions?

The quick online policy is built for small handyman jobs. Permit- or license-scope work isn't a fit for it, so Lee can quote that work through a different market instead - this doesn't disqualify you from coverage.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Quick Eligibility Check: Quick Eligibility Check (1 questions)

Excluded venues and practices

Do any of these apply: you own or operate a bar, tavern, restaurant, or club venue; service past 2:00 am; BYOB, drinking games, all-you-can-drink specials, or self-service; staff drinking during work hours; you promote or sponsor the entertainment at events; or retail package liquor sales?

The online general plus liquor liability policy is built for mobile bartenders, caterers, and concessionaires working events. Fixed venues and high-risk service practices are declined, so Lee can shop those separately.

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: We own/operate a bar, tavern, restaurant, or club; Service past 2:00 am; BYOB, drinking games, all-you-can-drink, or self-service; Staff drink during work hours; We promote/sponsor the entertainment at events; Retail package liquor sales; None of these

Liquor Liability Specific Questions: Liquor Liability Specific Questions (45 questions)

Financial history

Are there past, pending, or planned foreclosures, bankruptcies, or judgments for unpaid taxes against the named insured or any officer, partner, member, or owner within the last five years? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Off-premises alcohol

Is alcohol ever sold or served away from the premises? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Franchisor

Will or has the establishment acted as a franchisor? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Owner solvency

Have all owners and principals with a controlling interest been financially solvent for the last 12 months? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Liquor license

Is a valid liquor license maintained if required by ordinance or law? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Alcohol percentage

Sale of alcoholic beverages is what percentage of total annual food and liquor receipts?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Cooking equipment

Are there grills, deep-fat frying equipment, or woks on the premises? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Deep fryer

Is there a deep-fat fryer on premises? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Last alcohol service time

What is the latest time the establishment will cease the sale, service, or furnishing of alcohol?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Daily cease of service

Does the establishment cease the sale, service, or furnishing of alcohol daily? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

ID scanner

Does the establishment use an identification scanner on all patrons, regardless of age? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Server training

Are all alcohol-serving employees certified in a formal alcohol training course not mandated by the state? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Closing time

What is the latest time the establishment will close and all patrons will be vacated from the premises?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Security staff

Are bouncers, security, or doorpersons ever employed? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Lowest beer price

What is the lowest beer or malt beverage price offered, including happy hours and specials?

Control: money
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Lowest wine/liquor price

What is the lowest price offered for a glass of wine or liquor, including happy hours or specials?

Control: money
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Banquet facilities

Are facilities available for banquets, receptions, or private affairs? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Banquet entertainment frequency

How often does entertainment for banquets or receptions occur at this location annually?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Major entertainment nights

How many nights of major entertainment?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Entertainment type

What is the entertainment frequency type?

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Open 24 hours

Is the establishment open 24 hours? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

BYOB

Does the establishment permit BYOB? (Yes/No) If so, what percentage of patrons bring their own bottle?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Sole occupant

Is the establishment the sole occupant of the building? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Bar seating

Is there a bar with seating? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Building upkeep

Is the applicant the building owner or responsible by lease for upkeep of the building, sidewalk, or parking area, including snow and ice removal? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Smoke/heat detectors

Do all public areas, occupancies, and/or habitational units have functioning and operational smoke and/or heat detectors? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Multiple levels

Does the public access multiple levels within the establishment? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Fire extinguishers

Are there functioning and operational fire extinguishers readily available? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Pyrotechnics/foam

Are there pyrotechnics or foam machines on the premises? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Oxygen/hookah

Is there inhalation of oxygen gas from tanks or hookah smoking on the premises? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Fire suppression on cooking

Do all grills, deep-fat frying equipment, and woks have a functioning automatic fire-extinguishing system compliant with NFPA 96? (Yes/No) Does that system have an in-force cleaning contract? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Authorized servers

Are only the establishment's authorized employees or members permitted to sell, serve, or furnish alcohol at all events? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Off-season security

Is the location locked and secured during the closed season? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Seasonal operation

Is this a seasonal operation? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Elevated deck

Do you have a deck attached to your establishment with patron access that is elevated 8 feet or more above ground level, or on the roof of the building? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Kava products

Are any Kava products offered? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Karaoke

Does the establishment offer karaoke entertainment? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Staff drinking

Is anyone acting within the scope of their employment permitted to consume alcohol during their hours of employment or service if their duties involve selling, serving, or furnishing alcohol; providing security, premises entry, and/or age verification; or providing management or supervisory services? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Late specials

Are drink specials or happy hours offered after 9:00 PM? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Complimentary drinks

Are patrons offered more than two complimentary drinks in one day? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

All-you-can-drink

Are all-you-can-drink, bottomless drinks, or open-bar specials offered? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Bottle service

Are whole bottles of liquor sold, served, or furnished for bottle service with set-ups, or are BYOB liquor set-ups offered? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Drinking games

Are drinking games offered or permitted? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Means of egress

Are there at least two means of egress for every floor with public access? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Hazardous features

Are there any pyrotechnics, foam machines, mosh pits, trampolines, or swimming pools on the premises? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Restaurant Details: Restaurant Details (14 questions)

Service style

Which best describes your restaurant? Quick service / fast food; Fast casual; Full-service casual dining; Fine dining; Cafe, coffee, or bakery; Bar or brewpub with a full kitchen; Wine bar or tasting room (little or no cooking); Other.

Your service style is how carriers class a restaurant, and it drives both your pricing and which markets will quote you.

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Quick service / fast food; Fast casual; Full-service casual dining; Fine dining; Cafe, coffee, or bakery; Bar or brewpub with a full kitchen; Wine bar or tasting room (little or no cooking); Other

Seating capacity

About how many guests can you seat at once, indoors and outdoors combined? (Enter 0 if you're take-out or delivery only.)

Seating capacity is a core rating factor and tells carriers how large your operation is.

Control: countslider
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: None

Latest hours

On your busiest night, what is the latest you stay open? We close by 10pm; Between 10pm and midnight; Between midnight and 2am; After 2am; Open 24 hours.

Late-night hours, especially with alcohol, are one of the biggest factors in how a restaurant is priced and who will quote it.

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: We close by 10pm; Between 10pm and midnight; Between midnight and 2am; After 2am; Open 24 hours

Alcohol share of sales

Roughly what share of your sales comes from alcohol? We don't serve alcohol; Under 10%; 10% to 25%; 25% to 50%; More than 50%.

The more of your revenue that comes from alcohol, the more liquor-liability exposure carriers see, so this helps us match you to the right market and limits.

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: We don't serve alcohol; Under 10%; 10% to 25%; 25% to 50%; More than 50%

Cooking methods

Which cooking methods do you use? Select all that apply: deep frying; grilling or flat-top; charbroiling or open flame; solid-fuel cooking (wood or charcoal); wok cooking; flambe or flaming dishes; no commercial cooking (microwave or warming only).

Grease-producing and open-flame cooking is the leading cause of restaurant fires, so carriers ask exactly how you cook.

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Deep frying; Grilling or flat-top; Charbroiling or open flame; Solid-fuel cooking (wood or charcoal); Wok cooking; Flambe or flaming dishes; No commercial cooking (microwave or warming only)

Hood cleaning schedule

How often is your kitchen exhaust hood and duct system professionally cleaned? Monthly; Quarterly; Twice a year; Once a year; Only as needed; Never; We have no commercial cooking.

Regular hood and duct cleaning by a certified company is the single most important restaurant fire-safety control, and most carriers require it on a set schedule.

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Monthly; Quarterly; Twice a year; Once a year; Only as needed; Never; We have no commercial cooking

Cooking-line fire suppression

Is there an automatic fire-suppression system over the cooking line, serviced under a current contract? (If you have no commercial cooking, answer No.) (Yes/No)

A serviced hood-suppression system, often called an Ansul system, is required by most carriers wherever there is commercial cooking.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Entertainment features

Do you have any of these features or activities? Select all that apply: live music, DJ, or a dance floor; door staff or security / bouncers; late-night alcohol service (after midnight); drink specials or happy hour after 9pm; hookah; amusement features (mechanical bull, axe throwing, arcade, etc.); adult entertainment; hosting outside events (festivals, block parties); ATM on site; none of these.

Entertainment and nightlife features change a restaurant's risk profile and which carriers can quote it, so it is better to flag them up front.

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Live music, DJ, or a dance floor; Door staff or security / bouncers; Late-night alcohol service (after midnight); Drink specials or happy hour after 9pm; Hookah; Amusement features (mechanical bull, axe throwing, arcade, etc.); Adult entertainment; Hosting outside events (festivals, block parties); ATM on site; None of these

Off-premises operations

Besides your dining room, do you also do any of these? Select all that apply: off-site catering or private events; a food truck or cart; temporary stands or booths at events; a ghost kitchen (renting kitchen space to others); delivery-only or virtual brands run from this kitchen; none of these.

These off-premises operations usually need coverage your dining-room policy does not include, so we want to capture them now.

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Off-site catering or private events; A food truck or cart; Temporary stands or booths at events; A ghost kitchen (renting kitchen space to others); Delivery-only or virtual brands run from this kitchen; None of these

Delivery

How do customers get delivery, if you offer it? We don't offer delivery; Third-party apps only (Uber Eats, DoorDash, etc.); Our own employees deliver; Both our own drivers and third-party apps.

If your own employees make deliveries, you likely need hired and non-owned or commercial auto coverage, which changes your quote.

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: We don't offer delivery; Third-party apps only (Uber Eats, DoorDash, etc.); Our own employees deliver; Both our own drivers and third-party apps

Building setting

Where is your restaurant located? Standalone building; Strip mall or shopping center; Enclosed shopping mall; Attached to apartments or condos (mixed-use); Inside a food hall or shared kitchen; Other.

Whether you share walls with homes or other tenants affects fire-separation requirements and how carriers rate the building.

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Standalone building; Strip mall or shopping center; Enclosed shopping mall; Attached to apartments or condos (mixed-use); Inside a food hall or shared kitchen; Other

Parking / outdoor areas

Are you responsible for a parking lot, sidewalk, or outdoor seating area that customers use? (Yes/No)

Outdoor areas the public uses add slip, trip, and fall exposure that carriers factor into your liability coverage.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Safety programs

Which of these does your restaurant have in place? Select all that apply: a certified food-safety manager (ServSafe or equivalent); a written employee training program and handbook; a formal preventative-maintenance program; security cameras; monitored fire and burglar alarms; a grease-trap or hood-cleaning service contract; none of these yet.

These programs lower your risk and can earn credits that reduce your premium, so it helps to list everything you already do.

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: A certified food-safety manager (ServSafe or equivalent); A written employee training program and handbook; A formal preventative-maintenance program; Security cameras; Monitored fire and burglar alarms; A grease-trap or hood-cleaning service contract; None of these yet

Franchise

Is your restaurant part of a franchise? (Yes/No) If yes, which brand?

Franchise brands often have their own insurance requirements and preferred programs we can tap into.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Vacant Land Specific Questions: Vacant Land Specific Questions (16 questions)

Property address / parcel

What is the address of the property? If there is no address, provide the county and parcel number.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Deed holder

What is the name of the deed holder?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Property type

Is the property residential or commercial?

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Residential; Commercial

Number of acres

How many acres is the property?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Preferred policy term

What policy term would you prefer: 3 months, 6 months, or 12 months?

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: 3 months; 6 months; 12 months

Financial history

Have you had a foreclosure, repossession, or bankruptcy in the past 5 years? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Water features

Is there a pool, pond, lake, or hot tub on any of the premises? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Nuisance hazards

Are there any nuisance hazards on any of the properties (swing sets, vehicles, debris, trampoline, fuel tanks, underground tanks, etc.)? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Arson / fraud history

In the past 5 years, have you been convicted or indicted for arson, fraud, bribery, or any other arson-related crime? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Buildings on the land

Are there any building(s) on the land? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Hunting activities

Are there any hunting activities conducted on the land? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Sporting activities

Are there any sporting activities conducted on the land? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Agriculture / livestock

Are there agriculture and/or livestock activities conducted on the land? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Growing operations

Are there any growing operations conducted on the land? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Land development

Is there any development of the land, including grading, roads, or substructure installation (utilities, drainage, etc.)? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Property checked regularly

Does someone check on the property on a regular basis? If yes, by whom and how often? (If no, the quote will likely be declined by the carrier.)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Vacant Building Specific Questions: Vacant Building Specific Questions (47 questions)

Buying or already own this building

Are you buying this building now, or do you already own it?

Carriers often ask whether a building is a new purchase or one you already own, and the answer can change which of their questions apply.

Control: pillset
Response needed when shown: Optional
Shown when: When this step is shown in the live form.
Options: Buying it now (under contract / closing soon); I already own it

Proposed policy term

What policy term do you want: 3 months, 6 months, 9 months, or Annual Term?

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: 3 months; 6 months; 9 months; Annual Term

Proposed effective date

What date do you want the policy to take effect?

Control: date
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Relationship to the building

What is the applicant's relationship to the building? (The legal entity type is taken from your earlier answer.)

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Building Owner; Tenant; Mortgagee; Other

Prior occupancy

What was the building used for before it became vacant? Choose one: Office; Retail; Warehouse or storage; Manufacturing; Restaurant; Residential; Never occupied; Other.

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Office; Retail; Warehouse or storage; Manufacturing; Restaurant; Residential; Never occupied; Other

Reason for vacancy

Why is the building vacant right now? Choose one: For sale; Between tenants; Under renovation; Awaiting demolition; Seasonal closure; Condemned or unsafe; Other.

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: For sale; Between tenants; Under renovation; Awaiting demolition; Seasonal closure; Condemned or unsafe; Other

Vacancy duration

How long has the building been vacant?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Completely vacant?

Is the building completely vacant? If not, what percent is occupied and by whom?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Tenants evicted?

Have any tenants been evicted from the premises within the past 60 days?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Intended disposition

What do you intend to do with the building?

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Sell; Lease; Occupy; Demolish; Other

Vacant building year built

What year was the building built?

Control: countslider
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Vacant building square footage

About how many square feet is the building?

Control: countslider
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Vacant building stories

How many stories is the building?

Control: countslider
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Vacant building construction type

What is the building's construction type?

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Frame (wood); Masonry / brick; Concrete block; Steel / metal; Fire resistive (concrete); Mixed: part masonry, part frame; Other / not sure

Vacant building roof work

Has the roof been replaced, and if so was it a full or partial job?

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Full replacement; Partial repair or replacement; Not replaced, or not sure

Year of roof work (approximate is fine)

About what year was that roof work done? An approximate year is fine.

Control: countslider
Response needed when shown: Yes when shown
Shown when: Vacant building roof work is one of: Full replacement; Partial repair or replacement

Vacant building plumbing work

Has the plumbing been updated, and if so was it a full or partial update?

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Full update; Partial update; Not updated, or not sure

Year of plumbing work (approximate is fine)

About what year was the plumbing work done? An approximate year is fine.

Control: countslider
Response needed when shown: Yes when shown
Shown when: Vacant building plumbing work is one of: Full update; Partial update

Vacant building electrical work

Has the wiring been updated, and if so was it a full or partial update?

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Full update; Partial update; Not updated, or not sure

Year of electrical work (approximate is fine)

About what year was the electrical work done? An approximate year is fine.

Control: countslider
Response needed when shown: Yes when shown
Shown when: Vacant building electrical work is one of: Full update; Partial update

Vacant building heating / cooling work

Has the heating or cooling system been updated, and if so was it a full or partial update?

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Full update; Partial update; Not updated, or not sure

Year of heating / cooling work (approximate is fine)

About what year was the heating or cooling work done? An approximate year is fine.

Control: countslider
Response needed when shown: Yes when shown
Shown when: Vacant building heating / cooling work is one of: Full update; Partial update

Condemned?

Has the building been condemned?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Existing damage?

Is there any existing damage to the building or premises? If yes, please describe it.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

General condition

How would you describe the building's general condition and housekeeping: Poor, Fair, or Good?

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Poor; Fair; Good

Utilities operational

Which utilities are currently operational: Gas, Electric, Water, or None? (select all that apply)

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Gas; Electric; Water; None

Security measures

What security measures are in place: Boarded, Locked, Fenced, 24 Hr Security, and/or Monitored Central Station Alarms? (select all that apply)

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Boarded; Locked; Fenced; 24 Hr Security; Monitored Central Station Alarms; None of these

Check-in frequency

How often is the building checked on? Choose one: Daily; Several times a week; Weekly; Every two weeks; Monthly; Less often than monthly.

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Daily; Several times a week; Weekly; Every two weeks; Monthly; Less often than monthly

Neighborhood type

What type of neighborhood is the building in: Residential, Commercial, Industrial, Rural, or Remote?

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Residential; Commercial; Industrial; Rural; Remote

Adjacent exposures

Describe the properties or exposures adjacent to the building.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Attractive nuisances?

Are there any attractive nuisances on the property (e.g., pool, playground equipment)? If yes, describe.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Back taxes / liens?

Are there any back taxes owed or tax liens on the property?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Arson conviction?

Has the applicant ever been convicted of the felony of arson?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Renovations planned?

Are any renovations planned for the building? If yes, please describe them.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Renovation work started

Has any renovation work started? (Yes / No)

Control: pillset
Response needed when shown: Yes when shown
Shown when: Renovations planned? starts with Yes
Options: Yes; No

Renovation percent complete

About how much of the renovation work is finished? (Not started / Under 10% / 10% to 50% / Over 50%)

Control: pillset
Response needed when shown: Yes when shown
Shown when: Renovations planned? starts with Yes
Options: Not started; Under 10%; 10% to 50%; Over 50%

Value of existing building

What is the value of the existing building?

Control: money
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Cost of renovations

What is the estimated cost of the planned renovations?

Control: money
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Renovation completion date

When do you expect the renovations to be completed?

Control: date
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Who performs renovations

Who is performing the renovations: Insured, Insured's sub-contractors, or General Contractor?

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Insured; Insured's sub-contractors; General Contractor

Sub-Contractor Hold-Harmless Contracts

If acting as GC on renovations, do you get written sub-contracts with hold-harmless/indemnification in your favor?

Protects you if a sub causes a loss.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Sub-Contractors' Additional Insured Status

Are you named as additional insured on all sub-contractors' GL policies?

Extends the sub's coverage to you.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Parking lot

Does the property include a parking lot? (Yes / No / Not sure)

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No; Not sure

Parking lot size

About how many square feet is the parking lot? (optional)

Control: line
Response needed when shown: Optional
Shown when: Parking lot is Yes

Parking spaces

About how many parking spaces are in the lot? (optional)

Control: line
Response needed when shown: Optional
Shown when: Parking lot is Yes

Shared parking lot

Is the parking lot shared with other tenants or properties? (Yes / No)

Control: yesno
Response needed when shown: Optional
Shown when: Parking lot is Yes
Options: Yes; No

Special events

Will the parking lot be used for any special events? (Yes / No)

Control: yesno
Response needed when shown: Optional
Shown when: Parking lot is Yes
Options: Yes; No

Mining Specific Questions: Mining Specific Questions (86 questions)

Operation Type(s)

Which of these describe the applicant's mining operation(s)? (Select all that apply.)

Carriers rate the risk very differently depending on whether the applicant operates the mine directly, contracts it out, or just leases the land.

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Operates mine; Operated by contract miner; Contract miner under; Staffing firm; Landowner; Prep plant; Tipple; Inactive mine; Other operation

Subsidiary of Another Entity

Is the applicant a subsidiary of, or owned/controlled by, another entity?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Gross Projected Annual Sales

What is the gross projected annual sales for all requested named insureds?

Control: money
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Projected Mining Payroll

What is the projected mining payroll for all requested named insureds?

Control: money
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Owns Other Unlisted Entities

Does the applicant own or control any entities not presented in this application?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Leases/Loans Equipment

Does the applicant lease or loan any equipment to others?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Mine Name

What is the name of the mine?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Mine Location

What is the location/directions to the mine (include county & state)?

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

MSHA ID Number(s)

What is/are the MSHA ID number(s) for this mine?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

State Mine Permit Number(s)

What is/are the state mine permit number(s)?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Surface vs. Underground Mine

Is this a surface mine? (Answer No if it is an underground mine.)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

What Is Mined

What material is being mined (e.g. coal, limestone, sand & gravel, aggregate, etc.)?

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Annual Raw Tons

What is the annual production from this mine in raw tons?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Annual Clean Tons

What is the annual production from this mine in clean tons?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Total Acreage

What is the total acreage associated with this mine?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Oil/Gas Pipelines on Property

Does the property have any oil or gas pipelines?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Uses Leased/Contract Labor

Is any work associated with this mine performed by leased workers or contract labor?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Blasting Present

Is there any blasting (excluding cut & shoot underground) associated with this mine?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Processing Facility Present

Is there a processing facility (crush, clean, size, blend, etc.) associated with this mine?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Waste Treatment Ponds

Are there any waste treatment ponds associated with this mine?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Impoundments With a Dam

Are there any impoundments with a dam associated with this mine?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Waste/Gob/Tailings Piles

Are there any waste, gob, or tailings piles associated with this mine?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Ever Closed by a Regulatory Body

Has this mine ever been closed by any regulatory body?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Contractors Hired by Applicant

Does the applicant hire any contractors (hauling, drilling, blasting, security, auger, highwall mining, reclamation, etc.)?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Pollution Coverage Ever Canceled/Declined

Has pollution or similar coverage ever been canceled or refused to the applicant?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Cited for Environmental Violation

During the last five years, has the applicant been cited or prosecuted for any violation of a standard or law relating to the release of a substance into the environment?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Sued Over a Pollution Incident

Has the applicant ever been sued, or asked to pay damages or investigate/remediate, in connection with any actual or alleged pollution incident?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Emissions Exceeded Permissible Levels

Have there been any emissions, discharges, releases, or escapes of pollutants above permissible levels at any site covered by this application?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Currently Environmentally Compliant

Is the applicant currently in compliance with federal, state, and local environmental laws and permits?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Lessees Operating on Property

List any lessees who are conducting mining operations on the applicant's property, if any.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Subsidiary Relationship Detail

If the applicant is a subsidiary, name the other entity and describe the relationship.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Year Business Established

If the business is already operating: what year was this mining business established?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

New Entity for This Application

Is the applicant a newly-formed entity for the mine being applied for?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Expected Mine Development Start Date

If a new entity, what is the expected start date for mine development?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Expected Production Start Date

If a new entity, what is the expected start date for production?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Prior Mining Companies Owned/Operated

If other mining companies were owned or operated in the past, provide their names.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Other Payroll Description

Is any payroll left over that does not fit the categories above? Briefly describe what it covers, or write None.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Other Owned Entities Detail

If the applicant owns/controls other entities not presented in this application, name them, describe their operations, and note their current insurance coverage.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Leased/Loaned Equipment Detail

If the applicant leases or loans equipment to others, describe the equipment and to whom.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Applicant Works as a Subcontractor

Does the applicant ever work as a subcontractor for another mining company?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Subcontracted Work Detail

If yes, describe the subcontracted work and approximate receipts from it.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Owns Employee Dwellings

Does the applicant own or provide dwellings/housing for employees?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Owns Recreational Facilities

Does the applicant own or provide recreational facilities for employees?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Provides Employee Transportation

Does the applicant provide transportation for employees to/from the mine?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Life Expectancy of Mine

What is the estimated remaining life expectancy of the mine (in years)?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Surface Mining Method(s)

Which surface mining method(s) are used? (Select all that apply.)

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Mountain top; Open pit; Contour; Auger; Highwall; Other

Other Surface Method

If 'other' surface method, please describe.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Underground Mining Method(s)

Which underground mining method(s) are used? (Select all that apply.)

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Drift; Slope; Shaft; Longwall; Shortwall; Advancing; Retreating; Continuous; Conventional; Other

Other Underground Method

If 'other' underground method, please describe.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Pipeline Owner

If there are oil/gas pipelines on the property, who owns them?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Pipeline/Surrounding Area Condition

What is the condition of the surrounding area (any landslide or subsidence issues)?

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Leased/Contract Labor Annual Cost

If leased workers or contract labor are used, what is the annual cost paid for them?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Leased/Contract Labor Work Description

Fully describe the work performed by leased workers or contract labor.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Blasting Subcontracted

Is blasting work subcontracted to another company?

Blasting exposure is priced very differently depending on who actually performs it.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Blasting Performed by Applicant

Is blasting performed directly by the applicant's own employees?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Pre-Blast Surveys Conducted

Are pre-blast surveys of nearby structures conducted before blasting?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Pre-Blast Surveys by Third Party

If pre-blast surveys are conducted, are they performed by a third-party contractor?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Pre-Blast Survey Contractors

If yes, provide the names of those contractors.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Seismographic Recordings Made

Are seismographic recordings made during blasting?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Seismographic Recordings by Third Party

If seismographic recordings are made, are they made by a third-party contractor?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Seismographic Recording Contractors

If yes, provide the names of those contractors.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Distance to Nearest Third-Party Structure

What is the distance from the blast site to the closest third-party structure?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Processing Facility MSHA ID

If there is a processing facility, what is its MSHA ID number?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Facility Output From Owned/Controlled Mines

What share of the facility's output is from raw materials mined at owned or controlled mines?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Facility Output From Other Mines

What share of the facility's output is from raw materials mined at other (non-owned) mines?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Mine Has a Security Gate

Does the mine have a security gate controlling access?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Security Gate Type

What type of gate is it (fence gate, cable gate, or other)?

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Fence gate; Cable gate; Other

Other Gate Type

If 'other' gate type, please describe.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Security Gate Locked Schedule

Is the gate locked 24/7, only when the mine is off/closed, or never locked?

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Locked 24/7; Locked only when mine is off/closed; Never locked

Other Security Measures

Describe any other security measures at the mine.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Mining Engineer on Staff/Retainer

Does the applicant employ or retain a mining engineer?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Mine Closure Details

If this mine has ever been closed by a regulatory body, provide details.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Contractors Hired by Others on Applicant's Operation

Do other companies ever hire contractors to perform services associated with the applicant's mining operation (for example, coal haulers hired by a permit holder)?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Contractors-by-Others Detail

If yes, describe the services and who hires them.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Time-Element Pollution Coverage Declined

Has time-element pollution coverage ever been declined for the applicant? (Answer yes to skip the remaining pollution questions.)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Environmental Management Department

Does the applicant have a dedicated environmental management department or staff?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Aware of Potential Pollution Claim

Is the applicant aware of any circumstance that could give rise to a pollution claim?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Pollution Loss Description

Briefly describe any pollution-related losses.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Mine Info B: Mine Name

For the additional mine (Mine Info B section), what is its name?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Mine Info B: Closed/Abandoned

Is this additional mine closed or abandoned?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Mine Info B: How Long Closed

If closed/abandoned, how long has it been closed?

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Mine Info B: Prior Operations

Were there prior mining operations at this site before the applicant?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Mine Info B: Prior Operations Detail

If yes, provide details on the dates and operations formerly performed at this site.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Mine Info B: Landfill/Waste Disposal

Is this site used for landfill or offsite waste disposal?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Mine Info B: Waste Detail

If yes, describe the type of waste, quantities, and source of the materials.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Mine Info B: Site Owned/Controlled by Another

Is this site owned or controlled by another person or company?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Inflatable Rental Specific Questions: Inflatable Rental Specific Questions (24 questions)

Business Structure

What is the business's legal structure?

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Corporation; Individual / sole prop; Partnership; LLC / other

Years in Business

If the business is already operating: how many years has the business been operating?

Control: years
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: New venture; In business for…

Years of Experience

How many years of experience does the business have specifically with inflatables?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

IIP&GA Member

Is the business a member of the International Inflatable Products and Games Association (IIP&GA)? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Equipment List

For each inflatable you rent, list: Manufacturer, Type, Age (years), Size/Dimensions, Capacity (max people), and Height of side walls. One unit per line. List all of them; if you have more than 5, a continuation page is added automatically.

Carriers underwrite per unit. The manufacturer, age, size, capacity, and wall height of each inflatable all affect the rate.

Control: rows
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Rental inventory value

Approximate total replacement value of your inflatables and other rental inventory?

This helps size coverage for your rental equipment if you choose to insure it. What a policy covers depends on its wording.

Control: money
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Other Items Rented

Do you rent any other items (e.g. tents, chairs, snow cone machines)? If so, list them.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Other Operations

Do you run any other operations (e.g. concessions, games)? If so, describe them.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Prior Coverage Declined

Has any policy or coverage ever been declined, cancelled, or non-renewed? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Coverage Purchased Before

Has the proposed coverage been purchased before? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Current GL Carrier

Who is the current general liability carrier?

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Current GL Limit

If currently insured: what is the current limit of liability on the general liability policy?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Rental Agreement Required

Do you require the renter to sign a rental agreement? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Hold Harmless Clause

Does the rental agreement include a hold harmless clause? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Business Sets Up Equipment

Does the business set up the equipment itself? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Equipment Tethered/Secured

Is the equipment tethered or secured during use? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Supervision Provided

Is supervision provided during rental use? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Rules/Capacity Posted

Are the rules and capacity limitations clearly posted on the equipment? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Age/Height Requirements Posted

Are age and height requirements clearly posted? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Equipment Inspected After Use

Is the equipment inspected after each use? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Inspection Records Maintained

If inspected after each use, are inspection records maintained? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Records Note Date/Time of Inspection

If you keep post-use inspection records, do they note the date and time of each inspection (not just a yes/no)?

A dated log proves diligence if a claim is ever disputed.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Prior Coverage History

If you've purchased this coverage before, list each prior policy: Year, Renewal Date, Carrier, Limit/Deductible, Premium. One per line, up to 3.

Your placement history helps carriers price the account.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Losses/Incidents (3 yr)

Any inflatable-specific losses in the last 3 years? List: Date, Description, Amount. One per line, up to 3. Skip if none.

Carriers rate on inflatable-specific loss history.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Crane & Rigging Specific Questions: Crane & Rigging Specific Questions (66 questions)

Business Entity Type

What type of entity is the applicant?

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Individual; Partnership; Corporation; Joint Venture; Other

Years in Business

If the business is already operating: how many years has the business been in operation?

Control: years
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: New venture; In business for…

Geographic Area of Operation

What is the geographic area of operation (e.g. cities/counties/states served)?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Equipment Description

Provide a detailed description of all equipment used in operations (e.g. forklift, crane, etc.).

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Last 5 Jobs (Description & Cost)

Provide a detailed description, including cost, of the last 5 jobs performed. If you are a new venture without completed jobs yet, list any jobs you have lined up or are bidding on instead.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Specializes in a Particular Field/Industry

Do you specialize in any particular field of operation or for any one specific industry?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Specialization Details

If yes, provide complete details of the field/industry specialization.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Welding/Electrical Hookup Involved

Is welding or electrical hook up involved with the operations?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Rents Equipment to Others

Do you rent any equipment to others?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Rented Equipment Description & Sales

If yes, describe the equipment rented to others, including gross sales.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Formal Written Safety Program

Is there a formal written loss control or safety program?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Employee Responsible for Safety Program

Is one employee responsible for your safety program?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Safety Officer Name

If yes, what is the name of the individual responsible for the safety program?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Regular Safety Meetings

Do you hold regular safety meetings with all employees on a regular basis?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Operator Screening/Reference Checks

Do you have screening and/or reference procedures for all new operators?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Random Drug/Alcohol Testing

Are random drug or alcohol testing procedures outlined in a written manual provided to all employees?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Written Scheduled Maintenance Program

Do you keep a written scheduled maintenance program of all equipment?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Formal Accident/Injury Report Process

Do you have a formal report to be filed on all accidents or injuries?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Certificates of Insurance on Crane Rentals

Do you obtain certificates of insurance on all crane rentals?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

MVRs Obtained on All Drivers

Do you obtain MVR's (motor vehicle records) on all drivers?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

All Cranes Inspected/Certified

Are all cranes inspected or certified?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Commercial Auto Liability on Road Units

Do you maintain Commercial Automobile Liability coverage on all units driven over the road?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Performs Dual Lifts/Personnel Lifts/High-Rise Work

Do you perform any of the following services: dual lifts, personnel lift or placement, or work in excess of three stories?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Dual Lifts

Do you perform dual lifts?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Personnel Lift or Placement

Do you perform personnel lift or placement?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Work in Excess of Three Stories

Do you perform work in excess of three stories?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Maximum Work Height

What is the maximum height of work performed?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Crane w/ Operator: Payroll

Estimated annual payroll for crane rental WITH your operator:

The carrier prices each type of crane work separately. A best estimate for the next 12 months is fine.

Control: money
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Crane w/ Operator: Gross Sales

Estimated annual gross sales for crane rental WITH your operator:

Gross sales means total receipts for this category before expenses. Estimates are fine. Carriers audit at year end.

Control: money
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Bare Rental: Payroll

Estimated annual payroll for bare crane rental (no operator):

Bare rental = you rent the crane out and the customer supplies the operator.

Control: money
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Bare Rental: Gross Sales

Estimated annual gross sales for bare crane rental (no operator):

Bare rental = you rent the crane out and the customer supplies the operator.

Control: money
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Heavy Haul: Payroll

Estimated annual payroll for heavy haul / heavy hauling work:

Heavy haul covers oversized-load transport work. Enter 0 if you don’t do this.

Control: money
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Heavy Haul: Gross Sales

Estimated annual gross sales for heavy haul work:

Enter 0 if you don’t do this.

Control: money
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Millwright: Payroll

Estimated annual payroll for millwright work:

Millwright work = moving, installing, or dismantling industrial machinery. Enter 0 if not applicable.

Control: money
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Millwright: Gross Sales

Estimated annual gross sales for millwright work:

Enter 0 if you don’t do this.

Control: money
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Installation/Repair: Payroll

Estimated annual payroll for installation or repair work:

Covers installation, service, or repair jobs done apart from crane lifts. Enter 0 if not applicable.

Control: money
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Installation/Repair: Gross Sales

Estimated annual gross sales for installation or repair work:

Enter 0 if you don’t do this.

Control: money
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Rigging: Payroll

Estimated annual payroll for rigging work:

Rigging = attaching, securing, and moving loads. Enter 0 if not applicable.

Control: money
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Rigging: Gross Sales

Estimated annual gross sales for rigging work:

Enter 0 if you don’t do this.

Control: money
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Miscellaneous: Payroll

Estimated annual payroll for any other/miscellaneous operations:

Anything that doesn’t fit the categories above. Enter 0 if not applicable.

Control: money
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Miscellaneous: Gross Sales

Estimated annual gross sales for any other/miscellaneous operations:

Enter 0 if you don’t do this.

Control: money
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Youngest Operator Age

What is the age of your youngest crane operator?

Carriers check operator experience; very young operators can affect eligibility and price.

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Oldest Operator Age

What is the age of your oldest crane operator?

Just the age of your most senior operator. It rounds out the operator profile the carrier asks for.

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Union Operators (count)

How many UNION crane/equipment operators do you employ?

The carrier asks for staffing split by union and non-union. Enter 0 where it doesn’t apply.

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Non-Union Operators (count)

How many NON-UNION crane/equipment operators do you employ?

Enter 0 if none.

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Union Technicians (count)

How many UNION technicians or maintenance personnel do you employ?

Enter 0 if none.

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Non-Union Technicians (count)

How many NON-UNION technicians or maintenance personnel do you employ?

Enter 0 if none.

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Union Leased Workers (count)

How many UNION leased or temporary workers do you use?

Leased/temporary workers come from a staffing or labor-leasing firm. Enter 0 if none.

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Non-Union Leased Workers (count)

How many NON-UNION leased or temporary workers do you use?

Enter 0 if none.

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Cranes Not Inspected: Details

You answered that not all cranes are inspected/certified. Please explain (which units, and why).

Uninspected cranes are a key underwriting concern; a clear explanation keeps your application moving.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

No Commercial Auto: Details

You answered No to Commercial Auto Liability on road units. Please explain how road units are insured.

If units travel over the road without commercial auto coverage, the carrier needs to know how that exposure is handled.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Commercial Auto: Carrier, Limits & Term

Please provide your Commercial Auto carrier, limits, and policy term (e.g. Progressive, $1M CSL, 3/1/26-3/1/27).

This shows the carrier your over-the-road exposure is already covered, which helps the liability quote.

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Rigging Jobs per Year

Estimated number of rigging jobs performed annually for others:

A rough count is fine.

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Typical Rigging Job Duration

Estimated duration of each rigging job (e.g. 2 days, 1 week):

A typical or average duration is fine.

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Jobs In Progress: Max

Maximum number of rigging jobs in progress at any one time:

The carrier looks at how many simultaneous jobs you run at peak.

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Jobs In Progress: Min

Minimum number of rigging jobs in progress at any one time:

Use 0 if you sometimes have none running.

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Jobs In Progress: Average

Average number of rigging jobs in progress at any one time:

Your typical workload. A best estimate is fine.

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Rigging Job Cost: Max

Maximum cost (value) of a single rigging job:

The contract value of your largest typical job.

Control: money
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Rigging Job Cost: Min

Minimum cost (value) of a single rigging job:

The contract value of your smallest typical job.

Control: money
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Rigging Job Cost: Average

Average cost (value) of a rigging job:

Your typical job value. A best estimate is fine.

Control: money
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Equipment List

List your equipment below (make, model, year, serial, and value), or attach a complete list instead.

The carrier requires an equipment list before quoting. Enter each unit below, or attach a list you already have, whichever is easier.

Control: rows
Response needed when shown: Optional
Shown when: When this step is shown in the live form.

Financial Statement (attachment)

Attach your most recent financial statement.

Required by the carrier before a quote can be released. If you are a new venture without a financial statement yet, say so and Lee can let the carrier know. You can also send it later by email.

Control: upload
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: I'll send it later; New venture — no financial statement yet

Rental Agreement (attachment)

Attach a copy of your standard crane rental agreement/contract.

The carrier reviews your hold-harmless and insurance wording. If you do not rent equipment to others, choose Not applicable. Otherwise you can send it later if it is not handy.

Control: upload
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: I'll send it later; Not applicable — I don't rent equipment to others

Accident Report Form (attachment)

Attach a copy of your accident/incident report form.

Part of the carrier’s required safety documentation. Send later if needed.

Control: upload
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: I'll send it later

Daily Inspection Report (attachment)

Attach a copy of your daily crane inspection report/checklist.

Part of the carrier’s required safety documentation. Send later if needed.

Control: upload
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: I'll send it later

Safety / Loss Control Plan (attachment)

Attach your written safety or loss-control program.

Required before a quote. If you don’t have a written program, tell us and Lee can point you to templates.

Control: upload
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: I'll send it later

Tree Trimming Specific Questions: Tree Trimming Specific Questions (39 questions)

License Number

What is the applicant's contractor/business license number, if applicable?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Owner Payroll

What is the annual payroll for the owner(s)?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Employee Payroll

What is the annual payroll for employees (excluding owners)?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Subcontractor Costs

What is the annual cost paid to subcontractors?

Control: money
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Years in Business

If the business is already operating: how long has the applicant been in business?

Control: years
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: New venture; In business for…

Years of Experience

How many years of experience does the applicant have in tree trimming/arborist work?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Workers' Compensation Coverage

Does the applicant carry Workers' Compensation coverage? (Yes/No; include carrier name if known.)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Properly Licensed

Is the applicant properly licensed where required by law?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Tree Trimming or Cutting

Does the applicant perform tree trimming or cutting?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Tree Removal

Does the applicant perform tree removal?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Tree Chipping

Does the applicant perform tree chipping?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Stump Removal

Does the applicant perform stump removal?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Tree/Shrub Planting

Does the applicant perform tree or shrub planting?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Landscaping

Does the applicant perform landscaping?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Lawn Service

Does the applicant perform lawn service (mowing, fertilizing, etc.)?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Snow Plowing

Does the applicant perform snow plowing?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Controlled Burns

Does the applicant perform controlled burns?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Subcontracts Work

Does the applicant subcontract work to others?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Written Contract with Subcontractors

Does the applicant use a written contract with subcontractors?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Subcontract Requires Coverage

If so, does that contract require subcontractors to carry general liability (limits of at least $1M/$2M), workers' comp, and auto coverage; name the applicant as an additional insured; and include indemnity/hold-harmless wording in the applicant's favor?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

COI Before Job Site Access

Does the applicant obtain certificates of insurance from all subcontractors before allowing them on the job site?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Written Contract with Customers

Does the applicant use a written contract with all customers?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Written Contract Exception

If not, please explain when a written contract isn't required.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Fumigation/Crop Dusting/Aerial Spraying

Does the applicant do any fumigation, crop dusting, or aerial spraying?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Cranes/Cherry Pickers/Lifts

Does the applicant use cranes, cherry pickers, or lifts?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Max Height (Cranes/Lifts)

If yes, what is the maximum height reached using cranes/cherry pickers/lifts?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Regular Equipment Service Schedule

Does the applicant have a regular service schedule for all equipment?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Applies Herbicides/Pesticides

Does the applicant apply any herbicides or pesticides?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Licensed Herbicide/Pesticide Applicator

Is the applicant a licensed herbicide/pesticide applicator?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Chemicals Used

List all chemicals used, if any.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Works on Interstates

Does the applicant work on interstates?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Pre-Job Survey for Wires

Does the applicant perform pre-job surveys to locate wires (e.g., power lines)?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Percentage of Work Near Utilities

What percentage of the applicant's work is performed near utilities (e.g., power lines)?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Railroad Right-of-Way Work

Does the applicant do any work on railroad right of way?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Works for Utilities

Does the applicant work for any utilities?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Utility Clients List

If yes, please list which utilities the applicant works for.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Additional Details

Provide any additional details relevant to the 'yes' answers above (e.g., crane height, chemicals used, work near utilities/railroads).

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Subcontractor Trades Used

List each subcontractor trade with annual cost and % of operations, one per line (e.g. 'Stump grinding - $8,000 - 15%').

The carrier wants a cost/% breakdown by trade.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Equipment Owned or Leased

List major equipment (chippers, bucket trucks, cranes) and whether each is owned or leased, one per line.

Equipment type/ownership = exposure/maintenance the carrier prices.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Truck Repair Specific Questions: Truck Repair Specific Questions (52 questions)

Additional Shop Location

Do you operate out of more than one location? If so, what is the address of your primary additional shop location?

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Mechanic Experience

How many years of experience do your mechanics have, on average?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Supervisor Experience

How many years of experience do your shop supervisors have?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Manager Experience

How many years of experience do your shop managers have?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Subcontractor COI Required

If you use subcontractors, do you require them to provide Certificates of Insurance?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Private Passenger Vehicles %

What percentage of the vehicles you service are private passenger vehicles? (The vehicle-type percentages should total 100%.)

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Light Trucks %

What percentage are light trucks (up to 10,000 lbs)?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Medium Trucks %

What percentage are medium trucks (10,001-20,000 lbs)?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Heavy Truck Work %

What percentage of the vehicles you service are heavy trucks (20,001-45,000 lbs)?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Truck-Tractor Work %

What percentage of the vehicles you service are truck-tractors (up to 45,000 lbs)?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Semi-Trailers %

What percentage are semi-trailers?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Trailers %

What percentage are other (non-semi) trailers?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Service/Utility Trailers %

What percentage are service or utility trailers?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Equipment %

What percentage is heavy equipment (not a truck or trailer)?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Equipment Description

Please describe the equipment you service (make/model/type).

The carrier wants a general idea of what kinds of equipment come through your shop.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Other Vehicle Type %

What percentage of vehicles you service don't fit the categories above?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Other Vehicle Type Detail

If you have an 'other' vehicle-type percentage, please describe what it is.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Alignment/Steering/Front-End Suspension %

What percentage of your business is alignment, steering, or front-end suspension work?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Alignment/Steering: Sub-Contracted %

Of that alignment/steering/suspension work, what percentage is sub-contracted out?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Brake Work %

What percentage of your business is brake work (drums, rotors, hydraulic)?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Brake Work: Sub-Contracted %

Of that brake work, what percentage is sub-contracted out?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Minor Engine Work %

What percentage of your business is minor engine repair/tune-ups?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Minor Engine Work: Sub-Contracted %

Of that minor engine work, what percentage is sub-contracted out?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Extensive Engine Work %

What percentage of your business is extensive engine repair (overhauls, out-of-frame work)?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Extensive Engine Work: Sub-Contracted %

Of that extensive engine work, what percentage is sub-contracted out?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Fabricating Work %

What percentage of your business is metal fabricating work?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Fabricating Work: Sub-Contracted %

Of that fabricating work, what percentage is sub-contracted out?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Chassis Conversion/Lift Kit Work %

What percentage of your business involves installing kits to convert truck chassis (hydraulic dumps, lift mechanisms, cranes, loaders, concrete mixers)?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Chassis Conversion/Lift Kit: Sub-Contracted %

Of that conversion/lift-kit work, what percentage is sub-contracted out?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Hitch Work %

What percentage of your business is trailer hitch installation/repair?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Hitch Work: Sub-Contracted %

Of that hitch work, what percentage is sub-contracted out?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Hydraulic Work %

What percentage of your business is hydraulic work (other than conversion kits)?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Hydraulic Work: Sub-Contracted %

Of that hydraulic work, what percentage is sub-contracted out?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Refrigeration Work %

What percentage of your business is refrigeration (reefer) unit work?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Refrigeration Work: Sub-Contracted %

Of that refrigeration work, what percentage is sub-contracted out?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Tanker Work %

What percentage of your business is tanker work?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Tanker Work: Sub-Contracted %

Of that tanker work, what percentage is sub-contracted out?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

New Tire Work %

What percentage of your business is new tire sales/installation?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

New Tire Work: Sub-Contracted %

Of that new-tire work, what percentage is sub-contracted out?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Used Tire Work %

What percentage of your business is used tire sales/installation?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Used Tire Work: Sub-Contracted %

Of that used-tire work, what percentage is sub-contracted out?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Tire Retreading %

What percentage of your business is tire retreading?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Tire Retreading: Sub-Contracted %

Of that retreading work, what percentage is sub-contracted out?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Trailer Repair %

What percentage of your business is trailer repair?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Trailer Repair: Sub-Contracted %

Of that trailer-repair work, what percentage is sub-contracted out?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Other Repair Type %

What percentage of your business is repair work that doesn't fit the categories above?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Other Repair Type: Sub-Contracted %

Of that other repair work, what percentage is sub-contracted out?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Repair Type Detail

For any fabricating, refrigeration, or "other" repair work above, please briefly describe what it involves.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Work Done In-Shop %

What percentage of your work is performed at your shop only (as opposed to at a customer's location)?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Mobile/Away-From-Shop Work %

What percentage of your work is performed away from your premises (e.g., at a customer's location)?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Away-From-Shop Work Detail

Please briefly describe the work you perform away from your shop and where it typically takes place.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Traffic Diversion Required

Does any of the work you perform away from the shop require traffic diversion or road closures?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Auto Repair Specific Questions: Auto Repair Specific Questions (27 questions)

Business Type

What type of auto repair/service operation do you run? If 'other,' please describe.

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Repair Shop; Body Shop; Gas Station; Parking Facility; Other

Years of Experience

How many years of experience do you have in the auto repair/service business?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Autos Owned

How many autos does the business own (company vehicles, service vans, tow vehicles, etc.)?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Autos Stored Indoors

Are customer or business autos stored inside a building overnight?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Building Fire Protection

If autos are stored inside a building, does the building have sprinklers and/or a fire/burglar alarm?

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Sprinklers; Alarm; None of these

Building Construction

What is the building made of? Choose one: Frame; Joisted masonry; Non-combustible; Masonry non-combustible; Modified fire resistive; Fire resistive; Not sure.

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Frame; Joisted masonry; Non-combustible; Masonry non-combustible; Modified fire resistive; Fire resistive; Not sure

Protection Class

How close is the nearest fire protection? Choose one: Inside city limits with hydrants; Within 5 road miles of a fire station; More than 5 road miles from a fire station; Not sure.

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Inside city limits with hydrants; Within 5 road miles of a fire station; More than 5 road miles from a fire station; Not sure

Outdoor Lot Type

If autos are stored outside, is the lot a standard fenced lot, a non-standard lot, or unfenced?

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Standard fenced; Non-Standard; Un-Fenced

Customer Auto Security

How are customers' vehicles protected from theft and vandalism while in your care? Select all that apply: Fenced or walled lot; Locked gate after hours; Security lighting; Video cameras; Monitored alarm; Vehicles kept inside overnight; No overnight storage.

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Fenced or walled lot; Locked gate after hours; Security lighting; Video cameras; Monitored alarm; Vehicles kept inside overnight; No overnight storage

Tools Security

How are employees' tools protected from theft? Select all that apply: Locked toolboxes; Locked tool room or cage; Building alarm; Video cameras; Tools taken home nightly; No precautions in place.

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Locked toolboxes; Locked tool room or cage; Building alarm; Video cameras; Tools taken home nightly; No precautions in place

Rag Storage

Are used/oily rags stored in a covered metal container and picked up daily?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

No Smoking Policy

Please confirm that a 'no smoking' policy is enforced in the shop.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Paint Storage

Please confirm that all paint and flammable materials are stored in approved metal cabinets.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Liability Sign

Is a sign posted in the customer reception/waiting area stating you assume no liability for items left inside vehicles?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Key Security

How are customer vehicle keys secured? Select all that apply: Locked key box or cabinet; Key tags or tracking system; Access limited to named staff; Keys held at the front counter; Keys left in the vehicle.

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Locked key box or cabinet; Key tags or tracking system; Access limited to named staff; Keys held at the front counter; Keys left in the vehicle

Work Orders

Do you use a standard automotive work order for every vehicle serviced?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Commercial Auto Coverage

Do you carry commercial auto insurance covering all owned, non-owned, and hired vehicles?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Frame Work

Do you perform structural alterations or frame straightening on vehicles?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Dismantling/Salvage

Do you engage in auto dismantling or salvage operations?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Tank/Heavy Trucks

Do you own or operate any tank trucks or other heavy trucks as part of the business?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Loaner Vehicles Provided

Do you rent, lease, or loan vehicles, machinery, or equipment to others (e.g. loaner cars for customers)?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Vehicles Borrowed

Do you rent, lease, or borrow vehicles, machinery, or equipment from others?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Mechanical Repair: % Sales

Of your auto mechanical repair operations, what percentage is parts/vehicle sales?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Mechanical Repair: % Repair

Of your auto mechanical repair operations, what percentage is repair labor?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Tools Description

Describe the miscellaneous shop tools you want covered (each valued at $1,500 or less).

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Tools Value/Limit

What per-item limit do you need for miscellaneous tools coverage (maximum policy limit $10,000)?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Additional Operations

Do you do any of the following? Select all that apply (leave blank if none apply).

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Use dealer plates or transfer tags; Hold a dealer's license; Post signs restricting customers from work areas; Perform split rim work; Provide security guards; Keep guard dogs; Have underground storage tanks; Install or repair trailer hitches; Modify vehicles for performance; Repossess vehicles; Sell used parts; Sell butane, propane or gas; Sell recaps; Sell used tires; Sponsor or own race cars; Sponsor sporting or social events; Special hazards on premises; Tow truck service for hire; Valet parking; Storage or impound lot; Perform other operations not described above

Welding Specific Questions: Welding Specific Questions (15 questions)

Welding processes

What welding processes do you use? For example resistance, plasma, gas/oxy-fuel, laser, MIG, TIG, or stick.

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Type of welding & materials

Explain in detail the type of welding you do, what you weld on (for example structural, manufacturing, pipe, repair), and the materials you weld (steel, stainless, aluminum, and so on).

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Shop vs field split

Roughly what percent of your welding is done at your own shop versus at customer job sites (field/mobile)? (should total 100%)

Field and mobile welding carries a different fire and liability exposure than shop work, so carriers rate the two differently.

Control: percentage mix
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Shop (on premises); Field / mobile (off premises)

Trailer hitches welded

Do you weld any trailer hitches? (Yes/No)

Welded trailer hitches carry a product-liability exposure carriers ask about directly.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Products fabricated

Do you fabricate or manufacture any products (not just weld or repair)? (Yes/No) If yes, describe what you make.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

AWS certification

Do all of your welders hold American Welding Society (AWS) certification? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Fire protection & hot-work precautions

What fire protection and hot-work precautions do you have in place at job sites? For example fire extinguishers, a fire watch, and hot-work permits.

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Metal erection

Are you involved in any metal erection (erecting structural steel or metal framing)? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Structural welding over 3 stories

Do you do any structural welding on buildings over 3 stories? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Higher-hazard welding environments

Do you do any welding in or on the following? (Select all that apply.) Over the hole, drilling derricks, or rigs; Oil or gas tanks, lines, or pipes; Refineries or chemical plants; Grain bins, silos, or elevators; Aircraft or aerospace; Bridges; Pressure vessels (boilers, tanks).

These environments are much higher-hazard welding exposures, and some carriers exclude them, so we flag them up front to place you with the right market.

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Over the hole, drilling derricks, or rigs; Oil or gas tanks, lines, or pipes; Refineries or chemical plants; Grain bins, silos, or elevators; Aircraft or aerospace; Bridges; Pressure vessels (boilers, tanks); None of these

Industries served

What industries do you provide welding services to?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Size of fabricated products

If you fabricate products, what is the typical size of the equipment or products you make?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

End use of fabricated products

If you fabricate products, what is their end use?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Certified welder inspects work

Does a certified welder inspect completed work? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Machinery welded on

Do you fabricate, repair, or weld on any of these types of machinery? (Select all that apply.) Conveyors; Cranes; Forklifts; Farm equipment.

Welding on powered machinery adds a completed-operations exposure carriers price separately.

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Conveyors; Cranes; Forklifts; Farm equipment; None of these

Swimming Pool Contractor Specific Questions: Swimming Pool Contractor Specific Questions (29 questions)

Construction vs Remodel Mix

Roughly what percent of your work is new pool construction versus remodeling or renovating existing pools? (should total 100%)

New in-ground construction and remodel/repair of existing pools are rated very differently, so the split drives your classification.

Control: percentage mix
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: New construction; Remodel / renovation

In-Ground or Above-Ground

Do you build or install in-ground pools, above-ground pools, or both? (Select all that apply.)

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: In-ground; Above-ground; Neither (service / repair only)

In-Ground Construction Method

For in-ground pools, which construction methods do you use: gunite/shotcrete, fiberglass shell, or vinyl liner? (Select all that apply.)

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Gunite / shotcrete; Fiberglass shell; Vinyl liner; Not applicable (no in-ground work)

Residential vs Commercial

Roughly what percent of your work is residential versus commercial or public pools? (should total 100%)

Commercial and public pools carry a higher liability exposure than backyard residential pools.

Control: percentage mix
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Residential; Commercial / public

Service / Cleaning / Maintenance Work

Do you also do pool service, cleaning, or maintenance? If yes, roughly what percent of your revenue is service work versus construction and installation?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Years in Business (Pool)

How many years has the business been operating?

Control: countslider
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: None

Years of Experience (Pool)

How many years of experience do you personally have building or installing pools?

Control: countslider
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: None

Contractor License Number

What is your contractor's license number?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Contractor License Type

What type of contractor's license do you hold (for example the ROC classification)?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Owner Payroll (Pool)

What is the annual payroll for owners who actively work in the field?

Control: money
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Retail Employees

How many retail or counter employees do you have? Please note how many are full-time and how many are part-time.

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Retail Payroll

What is the total annual payroll for your retail or counter employees?

Control: money
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Installation Crew

How many installation or construction crew employees do you have? Please note how many are full-time and how many are part-time.

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Installation Payroll

What is the total annual payroll for your installation or construction crew?

Control: money
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Annual Retail Sales

What are your estimated annual retail sales (supplies, equipment, and spas sold over the counter)?

Control: money
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Annual Installation Sales

What are your estimated annual pool installation and construction sales?

Control: money
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Subcontractor Annual Cost

What is your total estimated annual cost paid to independent contractors and subcontractors?

Control: money
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Subsurface / Utility Study

Before any digging, do you study the subsurface and identify existing utility pipes and lines (for example calling 811 / Blue Stake)? (Yes/No)

Hitting a buried gas, water, or power line is one of the biggest excavation claims, so carriers want to know you locate utilities first.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Heavy Equipment Owned or Rented

Is the heavy equipment you use (excavators, skid steers, and similar) owned or rented? (If rented, we will need the rental company certificate of insurance.)

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Owned; Rented; No heavy equipment

Rents Out Portable Spas

Do you rent out portable spas or hot tubs? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Subcontractor COI Each Project

Do you require certificates of insurance from your subcontractors before the start of every project? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Subcontractor Lower Limits

Do any of your subcontractors carry coverage or limits lower than yours? (Yes/No; if yes, what minimum limits do you accept?)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Written Subcontractor Contracts

Do you get written contracts with a hold-harmless and indemnification clause in your favor from all subcontractors? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Named Additional Insured on Sub Policy

Are you named as an additional insured on your subcontractors' policies? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

COI Retention Period

How long do you keep certificates of insurance on file?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Own-Label Products

Do you manufacture or sell any products under your own label or brand? (Yes/No)

Selling products under your own label adds a products-liability exposure carriers underwrite separately, so it is flagged up front.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Installs Diving Boards / Slides

Do you install diving boards, slides, or similar accessories? (Yes/No)

Diving boards and slides are a leading source of serious pool injury claims, so carriers rate them closely.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Diving Board / Slide & Accessory Detail

If you install diving boards, slides, or other accessories, roughly how many per year, are any over 10 feet tall, and what other accessories (waterfalls, lighting, and similar) do you install?

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Written Warranty

Do you warranty your work in writing? (Yes/No; if yes, for how long?)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Plumbing Specific Questions: Plumbing Specific Questions (10 questions)

Heavy civil, infrastructure or industrial sites

Does the business perform any work related to the following? Select all that apply: underground utility or tunneling; airport or railroad construction; street, road, bridge or dam construction; installing or erecting playground equipment, bleachers or stages; equipment rented or leased to others; blasting operations; work at industrial, petroleum, chemical or mining facilities; none of these.

These are the operations plumbing programs most often exclude outright. Telling us exactly which ones apply, rather than just that something does, is what lets us go straight to a carrier that can write it instead of waiting a week on a declination.

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Underground utility or tunneling; Airport or railroad construction; Street, road, bridge or dam construction; Installing or erecting playground equipment, bleachers or stages; Equipment rented or leased to others; Blasting operations; Work at industrial, petroleum, chemical or mining facilities; None of these

Street, traffic or scaffolding work

Does the business perform any work related to the following? Select all that apply: snow plowing or street cleaning; traffic diversion, road closure or traffic safety; public street or road work; security operations; scaffolding; none of these.

Working in live traffic and working off scaffolding both add exposures a standard plumbing class does not contemplate, so carriers screen for them separately.

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Snow plowing or street cleaning; Traffic diversion, road closure or traffic safety; Public street or road work; Security operations; Scaffolding; None of these

Sprinkler, drilling, solar or waterproofing work

Does the business perform any work related to the following? Select all that apply: fire sprinkler work; oil or gas drilling; contractor equipment rental; solar or windmill installation; waterproofing; clearing brush or trees for wildfire control or vegetation management; none of these.

Each of these is its own class code. Doing any of them alongside plumbing changes which carriers can write the whole account rather than only part of it.

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Fire sprinkler work; Oil or gas drilling; Contractor equipment rental; Solar or windmill installation; Waterproofing; Clearing brush or trees for wildfire control or vegetation management; None of these

Excavation, sensitive occupancies or remediation

Does the business perform any work related to the following? Select all that apply: grading or excavation on slopes greater than 30 degrees; retaining walls over 6 feet high; work at hospitals, senior housing, assisted living or schools; grain elevators, traffic lights, underground storage tanks, skylights or EIFS; remediation of smoke, fire, water or earthquake damage; hazardous material abatement or environmental remediation; none of these.

Slope and retaining-wall work, sensitive occupancies like hospitals and schools, and anything touching contamination are each rated well above ordinary plumbing, and they go to different carriers. A selection here does not disqualify you; it tells us which market to approach first.

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Grading or excavation on slopes greater than 30 degrees; Retaining walls over 6 feet high; Work at hospitals, senior housing, assisted living or schools; Grain elevators, traffic lights, underground storage tanks, skylights or EIFS; Remediation of smoke, fire, water or earthquake damage; Hazardous material abatement or environmental remediation; None of these

Roofing installation or repair

Does the business perform any roofing installation or repair? (Yes / No)

Roofing is one of the hardest trades to place and most plumbing programs exclude it, even when it is only the occasional patch after a vent or drain job.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Exterior work above three stories

Does the business perform EXTERIOR work on dwellings over three stories? (Yes / No)

Height drives the fall exposure carriers rate hardest, so exterior work above three stories moves a plumbing risk into a different class with most programs.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

New condo, tract or townhome construction

Does the business perform new construction of any of the following? Select all that apply: condominiums; condo conversions; tract housing; townhomes; none of these.

New multi-unit and tract residential carries the construction-defect exposure carriers underwrite hardest, and many plumbing programs exclude it entirely. This is a knockout question on nearly every contractor supplement.

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Condominiums; Condo conversions; Tract housing; Townhomes; None of these

Custom home construction

Is the business involved in constructing custom homes? (Yes / No)

Custom homes are underwritten differently from tract housing. They are one-off rather than repeated across a development, so the defect exposure is usually smaller, but carriers still want it identified separately.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Boilers, sprinklers, LPG or multi-story units

Do you or your direct employees perform any of the following, NOT including work you subcontract to others? Select all that apply: boilers or pressure vessels other than water heaters; building sprinklers or fire suppression systems; LPG (liquefied petroleum gas); apartments or condominium units over two stories; backflow testing or high pressure steam pipe work; none of these.

Carriers separate what your own crew does from what you hand to a subcontractor, because your policy is rated on your payroll. These five are the plumbing operations most often carved out of a standard program, and they are not carved out equally, so which ones you do matters.

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Boilers or pressure vessels other than water heaters; Building sprinklers or fire suppression systems; LPG (liquefied petroleum gas); Apartments or condominium units over two stories; Backflow testing or high pressure steam pipe work; None of these

Process piping or industrial plant work

Do you or your direct employees perform any of the following, NOT including work you subcontract to others? Select all that apply: process piping; work at industrial facilities; work at petrochemical facilities; aerospace work; none of these.

Process piping and industrial plant work are rated well above residential and light commercial plumbing, so if your own crew does it, it needs to be on the application from the start rather than surfacing at audit.

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Process piping; Work at industrial facilities; Work at petrochemical facilities; Aerospace work; None of these

Drywall Specific Questions: Drywall Specific Questions (7 questions)

Operations outside drywall

Does the business do any of the following? Select all that apply: general contracting; more than 50% of work on new construction, including multi-unit (20 or more) residential condos, town houses, tract homes or housing developments; asbestos, lead or mold abatement, remediation, pollution clean up or environmental services; handyman operations; demolition that is not performed in conjunction with your own trade work; infrastructure work such as utilities, highways, bridges or dams; millwrighting, meaning installing, servicing or repairing machinery or boilers in industrial settings; none of the above.

Every one of these sits in a different class code than drywall, and most drywall programs either exclude them or rate them separately. Naming the specific ones that apply, rather than just that something does, is what lets us go straight to a carrier that can write the whole account instead of waiting a week on a declination.

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: General contracting; More than 50% of work on new construction, including multi-unit (20 or more) residential condos, town houses, tract homes or housing developments; Asbestos, lead or mold abatement, remediation, pollution clean up or environmental services; Handyman operations; Demolition that is not performed in conjunction with your own trade work; Infrastructure work such as utilities, highways, bridges or dams; Millwrighting, meaning installing, servicing or repairing machinery or boilers in industrial settings; None of the above

Carpentry work performed

Does the business perform any of the following carpentry work? Select all that apply: structural framing; home building; installing windows, skylights or exterior doors when that work is not in conjunction with and incidental to interior trade work; roofing, gutters, siding, EIFS or building envelope work; constructing items that are not buildings, such as pools, playground equipment, bleachers, piers or docks; none of the above.

Interior drywall and finish carpentry are among the easier trades to place. Structural framing and anything on the building envelope carry the construction-defect and water-intrusion exposure carriers underwrite hardest, which moves the risk into a different class and often a different market, so it gets screened up front rather than at audit.

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Structural framing; Home building; Installing windows, skylights or exterior doors when that work is not in conjunction with and incidental to interior trade work; Roofing, gutters, siding, EIFS or building envelope work; Constructing items that are not buildings, such as pools, playground equipment, bleachers, piers or docks; None of the above

Maximum working height

What is the maximum height you or your crew will work at? (0 to 6 feet / 7 to 15 feet / 16 to 30 feet / more than 30 feet)

Falls are the most common serious injury in the trade, so height is one of the few answers that changes both the carrier and the price. Interior drywall that stays under 6 feet is rated very differently from work off scaffolding or a lift.

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: 0 to 6 feet; 7 to 15 feet; 16 to 30 feet; More than 30 feet

Equipment used at heights

If you work above 6 feet: which equipment do you use when working at heights? Select all that apply: ladders; scaffolding; aerial lift equipment including pump jacks and scissor lifts; cherry pickers, booms or cranes; other equipment.

Ladders and scaffolding are expected in the trade. Lifts, booms and cranes add an equipment exposure of their own, and several programs need them identified before they will quote at all.

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Ladders; Scaffolding; Aerial lift equipment including pump jacks and scissor lifts; Cherry pickers, booms or cranes; Other equipment

OSHA standards at heights

If you work above 6 feet: does the business follow the required OSHA standards for working at heights? (Yes / No)

A documented fall-protection practice is what several carriers use to decide whether a height exposure is acceptable at all, and with some of them it also earns a credit on the premium.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Rooftop work

If you work above 6 feet: what rooftop work does the business do? Select all that apply: no rooftop work; flat roof work; pitched roof work.

Any time spent on a roof is underwritten separately from interior work, and a pitched roof is rated above a flat one. Answering no rooftop work keeps the risk in the ordinary drywall class.

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: No rooftop work; Flat roof work; Pitched roof work

Experience in the trade

Which of the following have you already done in this trade? Select all that apply: negotiated contracts with clients; bid on jobs; performed job site supervision; supervised subcontractors; hired employees; none of the above.

A brand-new business has no loss history for a carrier to look at, so the owner's hands-on experience is what gets underwritten instead. The more of these you have already done, the more markets will look at a first-year contractor.

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Negotiated contracts with clients; Bid on jobs; Performed job site supervision; Supervised subcontractors; Hired employees; None of the above

Child Care Specific Questions: Child Care Specific Questions (58 questions)

Type of Operation

What type of child care operation is this? (e.g. Day Care Center, Drop-off Center, Before/After School Program, In-Home Day Care, Sick-Child Day Care, Foster Care, or Part of an Organization)

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Day Care Center; Drop-Off Center; Before/After School; Sick-Child Day Care; In-Home Day Care; Foster Care; Organization

Years in Business

If the business is already operating: how long has the applicant been in business (as a day care/child care operation)?

Control: years
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: New venture; In business for…

Overnight Care?

Is overnight care provided to any children?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Special-Needs Care?

Is care provided for autistic or special-needs children (mentally or physically impaired)?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Open 24 Hours?

Is the facility open twenty-four (24) hours a day?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Drop-off at Mall/Retail?

If this is a drop-off center, is it located at a shopping mall or other retail establishment?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Provides Nannies Off-Site?

Does the applicant provide nannies or similar services away from the premises address?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Abuse Coverage Limit

What sexual/physical abuse coverage limit is being requested? State whether it's for a Day Care Center or In-Home Day Care, and the limit (e.g. 'Day Care Centers: $100,000 Per Claim/$300,000 Aggregate' or 'In-Home Day Care: $25,000 Per Claim/$50,000 Aggregate').

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Day Care Centers: $ 25,000; Day Care Centers: $100,000; Day Care Centers: $250,000; In-Home Day Care: $ 25,000; In-Home Day Care: $ 50,000; In-Home Day Care: $100,000

Licensed/Registered?

Is the applicant licensed, registered, and/or in compliance with state child-care regulations?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

License Number

What is the applicant's license number (if applicable)?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Max Children Permitted by License

What is the maximum number of children permitted by the applicant's license/regulations?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Max Children On Premises

What is the maximum number of children on the premises at any one time?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Average Daily Attendance

What is the average daily attendance (number of children)?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Background Checks?

Are criminal background checks completed on employees?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Prior Abuse Allegations?

Are there any previous or pending allegations of sexual or physical abuse against the applicant?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Trampolines?

Are there any trampolines on the premises?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Inflatables?

Are there any inflatables, such as moon bounces or slides, rented or owned?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Play Area Fenced?

Is the play area fully fenced?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Pools/Wading Pools?

Are there any swimming or wading pools on the premises?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Pool Self-Latching Gate?

If there are pools, is the pool area fenced with a self-latching gate?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Lifeguard Present?

If there are pools, is a certified lifeguard or CPR-certified attendant present at all times?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Natural Bodies of Water?

Are there any natural bodies of water (lakes, rivers, streams, etc.) on the property?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Animals On Premises?

Are there any animals on the premises?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Transports Children?

Does the applicant transport children to and from home and/or school (owned or hired vehicles)?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

15+ Passenger Vehicles?

Are any vehicles with a seating capacity exceeding fifteen (15) passengers utilized?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Organization Description

If the day care is part of a larger organization (church, school district, employer, etc.), what is the name of that organization?

Carriers underwrite differently when a day care operates under a parent organization's umbrella.

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Children by Age Group

For each age group, how many children are typically enrolled?

Age mix drives both staffing ratios and the injury exposure carriers price for. Best estimates are fine.

Control: counts
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Attendants by Age Group

For each of those same age groups, how many attendants/staff are typically assigned?

Staff-to-child ratios by age group are a core underwriting factor for day cares.

Control: counts
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Building Description

Briefly describe the building: approximate age, construction type, and number of exits.

Building age and construction type affect both property rating and life-safety underwriting.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Bottle Warmers/Cooking Appliances Accessible?

Are there any bottle warmers or cooking appliances located in areas children can access?

Burn hazards within reach of children are a specific carrier concern. "No" is the answer they hope to see.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Pools Over 18" Deep

How many pools deeper than eighteen (18) inches are on the premises? (0 if none)

Pool depth determines which safety rules apply; 18 inches is the carrier’s dividing line.

Control: countslider
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: None

Wading Pools (18" or Less)

How many wading pools eighteen (18) inches deep or less are on the premises? (0 if none)

Shallow wading pools are rated differently from full swimming pools.

Control: countslider
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: None

Pool Location

Are the swimming pools located above-ground or in-ground?

Above-ground and in-ground pools carry different access and injury profiles for the carrier.

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Above-ground; In-ground

Pool Slides/Diving Boards?

Are there any swimming pool slides or diving boards?

Slides and diving boards add injury exposure carriers price separately.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Slide/Diving Board Height

If there are pool slides or diving boards, what is the height?

Height is the main factor in how risky the carrier considers a slide or board.

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Poolside Life Safety Equipment?

Is life safety equipment (e.g. a rescue hook, ring buoy) kept at poolside?

Basic rescue equipment at poolside is a standard carrier requirement.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Pool Rules Posted?

Are pool rules posted at the pool area?

Posted rules demonstrate active supervision practices to the carrier.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Attendant-to-Child Ratio While Swimming

What is the ratio of attendants to children while swimming (e.g. "1 to 6")?

This supervision ratio is a key factor carriers use to price pool-related liability.

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

VGB Pool & Spa Safety Act Compliant?

Are all swimming pools, wading pools, hot tubs, and spas in compliance with the federal Virginia Graeme Baker Pool and Spa Safety Act?

VGB compliance (anti-entrapment drain covers) is a standard carrier requirement for any pool exposure.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Animals Description

If there are animals on the premises, please describe them (type and number).

Carriers mainly watch for dogs and exotic animals around children.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Dogs Kept Away From Children?

Are dogs kept away from the children at all times?

Dog bites are one of the most common day-care claims, so carriers ask this directly.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Other Premises Hazards

Are there any other notable hazards or features on the premises not already covered above? Please describe.

A catch-all so nothing surprises the underwriter at inspection time.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Handling Injuries/Illnesses

Briefly describe how injuries and illnesses among the children are handled.

A clear first-aid and notification procedure reassures the carrier.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Special Classes Taught?

Are any special classes taught (e.g. dance, gymnastics, martial arts)? If yes, please describe.

Higher-risk activity classes (gymnastics, martial arts) can affect pricing and which carriers will write the risk.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Auto Liability Carrier (if Transporting)

If currently insured and you transport children to and/or from home or school: who is your auto liability insurance carrier?

The carrier confirms the transport exposure is insured on an auto policy, not this one.

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Large-Vehicle Use Explained

If any vehicle seating more than fifteen (15) passengers is used, please explain.

Buses and large vans are a distinct exposure the carrier reviews individually.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Field Trips

Describe the nature of any field trips: how many trips per year, and who provides the transportation?

Off-premises activities and transport arrangements change the liability picture.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Drivers Required to Carry Auto Liability?

Do you require any drivers (other than the business itself) to carry their own auto liability insurance?

Requiring proof of insurance from parents/volunteers who drive protects your policy from their accidents.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Medication Dispensed?

Is any medication dispensed to children? If yes, please describe.

Dispensing medication raises a distinct liability exposure that some carriers price or exclude separately.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Accident & Health Policy on Students?

Do you carry an accident and health policy covering the students/children?

A student A&H policy pays small injury claims first, which keeps them off your liability policy.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

A&H Carrier

If currently insured: who is the accident & health carrier?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

A&H Policy Number

If currently insured: what is the accident & health policy number?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

A&H Policy Term

If yes, what is the accident & health policy term?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Released Only to Custodial Parent/Guardian?

Are children released only to the custodial parent or legal guardian?

Release controls are central to abuse/abduction underwriting.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Release Authorization Procedure

If children are NOT released only to the custodial parent/guardian, describe the authorization procedure used to release a child to anyone else.

The carrier wants to see a written authorization process for anyone else picking up a child.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Power Generation?

Does the business engage in generating power (other than emergency back-up power) for its own use or for sale to power companies? If yes, please describe.

An unusual exposure for a day care: solar arrays that sell power back count, and need separate review.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Other Business Ventures?

Does the applicant have any other business ventures for which coverage is not being requested here? If yes, please explain and advise where each is insured.

Carriers need to know about related ventures to confirm they aren't inadvertently covered, or excluded, by this policy.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Field trips / outings

Do you take the children on field trips or outings away from the premises?

The quick online policy excludes field trips. If outings are part of your program, Lee can quote a market that covers them instead - nothing here disqualifies you from coverage.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Pilot Car Specific Questions: Pilot Car Specific Questions (41 questions)

Years in Business/Experience

How many years has the business been operating pilot car / escort vehicle services?

Control: years
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: New venture; In business for…

States/Area of Operation

In which states or geographic area does the business operate?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Total # of Pilot Cars

How many pilot car / escort vehicle units does the business run?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Description of Operations

Please describe all pilot car / escort vehicle operations performed.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Auto Insurance Carried on Pilot Car

Is auto liability insurance currently carried on the pilot car(s), or being quoted out now? (Carriers typically decline if not.)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Tillerman/Steering Services Provided

Does the business provide any tillerman or rear-steering services on escorted loads? (Carriers typically decline if yes.)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

No Prior Losses/Claims

Has the business had zero prior losses or claims in its pilot car operations? (If there ARE losses to report, leave unchecked and provide loss details separately.)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Subcontracted Work % of Receipts

What percentage of total annual receipts is subcontracted work?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Certificates of Insurance from Subcontractors

Does the business obtain certificates of insurance from all subcontractors?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Written Contract with Subcontractors

Does the business use a written contract with subcontractors?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Additional Insured on Subs' Policies

Is the business added as an additional insured on subcontractors' liability policies?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Directs Traffic Through Intersections

Does the risk direct traffic through intersections while escorting loads?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Open Communication Pilot Car/Load

Is there an open line of communication maintained between the pilot car and the load being piloted?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Routes Researched/Pre-Planned

Are routes researched and pre-planned prior to travel?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Route Pre-Planning Methods

How do you plan a route before the move? Select all that apply: State permit office route; Written route survey; GPS or mapping software with height data; Physical pre-drive of the route; Route supplied by the customer; Height pole check on the day.

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: State permit office route; Written route survey; GPS or mapping software with height data; Physical pre-drive of the route; Route supplied by the customer; Height pole check on the day

Avoids Overhead Hazards

Does the risk map out routes to avoid overhead powerlines, underpasses, and railroad crossings?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Uses Height Poles

Does the risk use any height poles?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Height Poles Telescoping

If height poles are used, are they telescoping?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Height Pole Twist-Type Fittings

Do the height poles use twist-type compression fittings?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Height Pole Bolt/Pin Fittings

Do the height poles use bolt/pin type fittings?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Height Poles Meet OSHA Standard

Do the height poles meet OSHA standards for live electric line tools (29 CFR Part 1910.269)?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Height Poles Attached Front, Clear View

Do the height poles always attach to the front of the pilot car vehicle in clear view of the driver?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Number of Owners/Partners

How many owners or partners work in the business?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Total Annual Payroll

What is the total annual payroll for the business?

Control: money
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Number of Trade Employees

How many employees work in the pilot car/escort trade (drivers, dispatchers, etc.)?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Prior Year Receipts

What were the business's receipts/sales for the prior year?

Control: money
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Receipts Two Years Ago

What were the business's receipts/sales two years ago?

Control: money
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Average Jobs per Month

On average, how many pilot car/escort jobs does the business run per month?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Other Business Ventures

Does the applicant own or operate any other business ventures?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Other Ventures Details

Please describe the other business venture(s), and confirm where each is insured.

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Additional Interest Name & Address

If a lienholder, lessor, or other party needs to be listed as an additional interest, provide their name and address (leave blank if none).

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Subcontracted Cost: Uninsured

What is the annual cost paid to subcontractors who do NOT carry their own insurance?

Control: money
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Subcontracted Cost: Insured

What is the annual cost paid to subcontractors who DO carry their own insurance?

Control: money
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Subcontracted Operations Description

Please describe the operations that are subcontracted out.

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Subcontractor Hold-Harmless Agreement

Do subcontractor agreements include a hold-harmless/indemnification clause in your favor?

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No; N/A

Subcontractor Minimum COI Limits

What are the minimum liability limits you require on subcontractor certificates of insurance?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Written Contract Exception

If you don't always use a written contract with subcontractors, please explain when one isn't used.

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Directing Traffic Details

Please describe how traffic is directed through intersections while escorting loads (e.g. flags, signage, training).

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

No Route Mapping: Explanation

Since routes aren't mapped to avoid overhead hazards, please explain how that risk is otherwise managed.

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Prior Insurance Carriers

If currently insured: list your prior insurance carrier(s), term, and premium, one per line (e.g. 'Progressive - 2023-2024 - $12,000'). Up to 2 will be recorded on the application.

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Auto Insurance Limits

What are the current auto liability limits on the pilot car(s), or the limits you're getting quoted for?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Courier / Delivery Specific Questions: Courier / Delivery Specific Questions (12 questions)

What you carry

What do you carry on a typical run? Select all that apply.

What is in the vehicle is the single biggest factor in which cargo or goods-in-transit market can write the account. Prescription medications, human tissue, and cash or negotiable instruments are each handled under their own rules by most carriers, so it matters which of these apply.

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Lab specimens, blood, or biological samples; Prescription medications or pharmaceuticals; Medical records, requisitions, or other documents; Medical equipment or supplies; Organs or tissue for transplant; General packages and parcels; Food or restaurant orders; Legal filings or court documents; Cash, checks, or other negotiable instruments; Something else

Value of one load

At your best estimate, what is the most one vehicle would be carrying at any one time?

Cargo limits are generally set per vehicle against the highest-value load you would carry at once, so this is the figure a limit gets quoted against. An estimate is fine and can be updated before anything is finalized.

Control: money
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Temperature-controlled runs

Do any of your runs have to stay at a set temperature, for example refrigerated specimens, vaccines, or anything shipped on dry ice?

A refrigeration or temperature failure that ruins a shipment is generally addressed by a separate spoilage or temperature-controlled cargo coverage rather than by standard cargo coverage, subject to the policy wording and carrier guidelines.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Specimen and biohazard handling

If you carry specimens, samples, or medical waste, which of these are part of how your drivers handle them? Select all that apply.

Underwriters on a medical courier account look for bloodborne pathogen training and proper containment. If some of these are not in place yet, it is fine to say so; it helps set expectations with the carrier up front.

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Bloodborne pathogen training for drivers; Leak-proof secondary containment or approved specimen bags; Biohazard labelling on containers; A spill kit carried in every vehicle; Written handling and spill procedures; Not applicable, I don't carry specimens or medical waste; None of these yet

Tracking a package

How do you track a package from pickup to delivery? Select all that apply.

A lost, damaged, or misdelivered item is the most common courier claim, and a documented chain of custody is what establishes where it went. It also affects how the account is priced.

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Signature capture at pickup and delivery; Barcode or QR scanning; Photo proof of delivery; GPS or app-based tracking; A paper manifest or log sheet; None of these yet

Patient records and privacy

Do you carry patient records, requisitions, or anything else holding protected health information, and have you signed a HIPAA business associate agreement with any client?

Records in transit are a privacy exposure rather than a cargo one, and a business associate agreement usually carries its own obligations. Knowing this up front helps identify whether a cyber or privacy coverage belongs in the quote alongside the auto and cargo.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

How drivers are classified

Will your drivers be W-2 employees, 1099 independent contractors, or a mix?

How drivers are classified affects how the policy is set up and whether workers compensation applies.

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Just me for now; W-2 employees; 1099 independent contractors; A mix of both

Drivers using their own cars

Will any driver ever use their own personal vehicle to make deliveries?

A personal auto policy generally excludes delivery work, so a personal vehicle used for the business changes how the policy needs to be set up. It is important to flag up front.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Typical run distance

How far do your runs typically go from your base?

Driving radius is one of the main rating factors on a commercial auto policy.

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Mostly local (within about 25 miles); Regional (up to about 100 miles); Statewide; Across state lines

When you run

When do your runs happen? Select all that apply.

Night and weekend driving is rated differently from a weekday route, and a scheduled route is a different exposure from on-demand dispatch.

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Scheduled daily or weekly routes; On-demand or dispatched calls; Overnight runs; Weekend runs; STAT or rush runs

Who you deliver for

Who do you deliver for, and do any of their contracts spell out insurance requirements such as limits or certificate wording? For example hospitals, reference labs, pharmacies, law firms, or a larger delivery network you contract to.

Client contracts usually specify the limits and certificate wording they require, so the underwriter can take those requirements into account when putting the quote together.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Packages left in a vehicle

Are packages ever left in an unattended vehicle, and where are the vehicles parked overnight?

Theft from an unattended vehicle is excluded or sharply limited on many cargo forms, and the overnight garaging location is listed for each vehicle on the application.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Medical Transport (NEMT) Specific Questions: Medical Transport (NEMT) Specific Questions (15 questions)

Transport service mix

Roughly what share of your trips falls into each category? Your best estimate is fine.

Carriers price wheelchair and stretcher trips differently than ambulatory trips because of the extra loading, securement, and passenger handling involved. An estimate is fine and can be updated before anything is finalized.

Control: percentage mix
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Ambulatory (passenger can walk; sedan or van); Wheelchair; Stretcher or gurney; Other or non-medical trips (school routes, shuttles, courier)

Care provided during transport

What level of care do you or your drivers provide during transport?

Carriers quote transport with medical staff or monitoring on board on a different basis, so it is important to know up front.

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Curb-to-curb only (no physical assistance); Door-to-door or door-through-door (help walking and getting in and out, no medical care); Medical care or monitoring on board (for example an EMT or nurse)

Emergency or 911 work

Will you do any emergency, 911, or lights-and-sirens response work?

Emergency response is rated and underwritten separately from scheduled non-emergency trips.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Vehicles by type

How many vehicles of each type will be on the policy? Enter 0 where none.

Lift-equipped and higher-seating vehicles are rated differently, and carriers ask for the count of each type.

Control: counts
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Trips in a typical week

Roughly how many one-way trips will you run in a typical week once you are up and running?

Trip volume helps the underwriter gauge how much the vehicles are on the road. A best estimate is fine for a new venture.

Control: countslider
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: None

Typical trip distance

How far do your trips typically go from your base?

Driving radius is one of the main rating factors on a commercial auto policy.

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Mostly local (within about 25 miles); Regional (up to about 50 miles); Longer trips (more than 50 miles)

Out-of-state trips

Will any trips cross state lines, even occasionally?

Interstate trips can require federal filings and change how the policy is set up, so carriers ask even when the trips are rare.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Broker and facility contracts

Do you have, or are you applying for, contracts with transportation brokers or facilities (for example AHCCCS/Medicaid brokers, hospitals, nursing homes, dialysis centers, or behavioral health facilities)?

Broker and facility contracts usually specify the auto liability limit and certificate wording they require, so the underwriter can take those requirements into account when putting the quote together.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

How drivers are classified

Will your drivers be W-2 employees, 1099 independent contractors, or a mix?

Carriers ask how drivers are classified because it affects how the policy is set up and whether workers compensation applies.

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: W-2 employees; 1099 independent contractors; A mix of both; Just me for now

Driver screening and training

Which of these are part of hiring and managing your drivers? Select all that apply.

Underwriters look for basic driver screening on passenger transport risks. If some of these are not in place yet, that is fine to say; it helps set expectations with the carrier.

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Motor vehicle record (MVR) check before hire; MVR re-checks at least annually; Criminal background checks; Drug and alcohol screening; A written driver training program; None of these yet

Securement and passenger assistance training

Are drivers trained on wheelchair securement and safe passenger assistance?

Wheelchair securement is one of the most common sources of passenger injury claims in this business, so carriers ask specifically about training.

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; Not yet, training is planned; Not applicable, no wheelchair or stretcher passengers

Drivers using their own cars

Will any driver ever use their own personal vehicle to transport clients?

Carriers ask about personal vehicles used for client transport because it changes how the policy needs to be set up, so it is important to flag up front.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Rented or borrowed vehicles

Other than the vehicles you listed earlier, will you ever rent or borrow a vehicle for the business, for example a short-term rental while a van is in the shop?

Carriers ask separately about rented or borrowed vehicles, so the underwriter needs to know if this applies.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Overnight vehicle parking

Where will the vehicles be parked overnight?

The overnight garaging location is listed for each vehicle on the application and affects rating.

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: At the business address; At drivers' homes; A mix of both

Other people driving the vehicles

Will anyone other than your drivers, such as family members, ever drive the business vehicles?

Carriers ask who has access to the vehicles so every regular driver can be listed on the application.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Mobile Home Park / Campground Specific Questions: Mobile Home Park / Campground Specific Questions (40 questions)

Park / Campground Type

What type of operation is this? (Select all that apply.) Permanent / mobile home park; RV park; Campground / tent.

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Permanent / mobile home park; RV park; Campground / tent

Number of Permanent Spaces

How many permanent (mobile home / manufactured home) spaces are there?

Control: countslider
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: None

Number of RV / Camping Spaces

How many RV and tent / camping (tourist) spaces are there?

Control: countslider
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: None

Percentage Seasonal

What percentage of the spaces are seasonal (not occupied year-round)?

Control: countslider
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: None

Owner-Rented Units

Do you own any of the mobile homes or dwellings on the property and rent them to residents? (If yes, how many?)

Homes you own and rent out add a landlord/dwelling exposure the carrier rates separately from the ground lease.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Operating Season

What is your operating season? For example 'open year-round' or 'April to October'.

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Total Acres

What is the total acreage occupied by the park, RV park, or campground?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Amenities & Recreational Facilities

Which of the following are on the property? (Select all that apply.) Sports courts; Bathing beaches; Bicycle trails; Boat rentals; Boat docks; Boat ramps; Clubhouse; Convenience or grocery store; Garbage dump; Horse trails; Lake or pond; Lake or pond formed by a dam; Laundromat; Lodging or cabins; Parks or green space; Playgrounds; Private well; Riding arenas; Saddle animals; Saunas; Shooting range; Short-term special events; Spas or hot tubs; Stables; Swimming or wading pools; Ice skating rink; Recreational vehicle rentals; Vending machines; Propane sales; Waterworks; Former landfill; Primitive camping.

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Sports courts; Bathing beaches; Bicycle trails; Boat rentals; Boat docks; Boat ramps; Clubhouse; Convenience or grocery store; Garbage dump; Horse trails; Lake or pond; Lake or pond formed by a dam; Laundromat; Lodging or cabins; Parks or green space; Playgrounds; Private well; Riding arenas; Saddle animals; Saunas; Shooting range; Short-term special events; Spas or hot tubs; Stables; Swimming or wading pools; Ice skating rink; Recreational vehicle rentals; Vending machines; Propane sales; Waterworks; Former landfill; Primitive camping; None of these

Security Guards

Do you provide security guards at the property? (If yes: how many, are they armed or unarmed, and are they your own employees or an outside guard service?)

Armed guards are a materially different exposure, and using an outside service shifts whether we need a certificate of insurance from them.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Rental Units Have Smoke Detectors?

If you rent mobile homes or dwellings to residents, do those units have smoke detectors? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Average Monthly Lot Rent

What is the average monthly lot rental fee per permanent space?

Control: money
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

RV / Campground Space Rate

What is the average fee for a temporary RV / campground space (give the daily and/or weekly rate)?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Owned Mobile Home Rent

If you rent out mobile homes you own, what is the average monthly rent charged?

Control: money
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Owned Dwelling Rent

If you rent out dwellings you own, what is the average monthly rent charged?

Control: money
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Recreational Facility Details

Describe any recreational facilities or operations that need explanation (for example shooting range type, boats, horse / saddle operations, short-term special events, or equipment you rent to guests).

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Indoor Pools

If you have swimming or wading pools, how many are indoor?

Control: countslider
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: None

Outdoor Pools

If you have swimming or wading pools, how many are outdoor?

Control: countslider
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: None

Pool Construction

Are the pools in-ground or above-ground? (Select all that apply.)

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: In-ground; Above-ground; Not applicable (no pools)

Diving Boards / Slides

Are there any diving boards, slides, or diving platforms at the pool? (If yes, please describe.)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Pool Safety Features

Which pool safety features are in place? (Select all that apply.)

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Fenced with self-latching gate; Swimming rules posted; Life-safety / rescue equipment at poolside; Certified lifeguard on duty; None of these

Park Maintains Roads?

Is the park responsible for maintenance of the streets and roads on the property? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Outside Guard Service COI

If the security guards are provided by an outside service, are certificates of insurance required, and what minimum limits? (Leave blank if you employ your own guards or use none.)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Sewer Type

Is the park on city sewer or septic?

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: City sewer; Septic

Septic Maintenance

If on septic: who maintains and treats the system, and how often?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Septic Problems (5 yrs)

Any history of problems with the septic system in the past five years, such as backups? (If yes, please describe the problem and what was done to prevent it.)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Sewer Lift Station / Pump

Does the flow of sewage require a sewer lift station or pump? (If yes, what happens if that system fails?)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Own Sewer Treatment Plant?

Does the park have its own sewer treatment plant? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Disposal Facilities?

Are there sewage disposal facilities? (If yes, how often is the tank emptied, and who disposes of the sewage and where?)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Park Owns Gas Lines?

Are the gas lines owned by the park? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Gas System Compliance

If the park owns the gas lines, which of the following apply? (Select all that apply.)

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: In compliance with the Federal Pipeline Safety Act; Gas system maps available and used; Neither of these

Water Source

Is water supplied by the city or by a well on the premises?

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: City water; Well on premises

Park-Supplied Water Treated?

If water is supplied by the park, is it treated? (If yes, by whom and how often?)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

State Tests Water Annually?

Does the state test the water annually? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

On-Site Owner / Manager?

Is the owner or manager located on site? (If yes, what hours are they available to residents?)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Independent Management Company?

Is the park operated by an independent management company? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Leases & Rules to Residents

Which of the following do you provide to residents? (Select all that apply.)

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Signed leases available to residents; Written rules / regulations provided to residents; Neither of these

Animals Allowed?

Are renters or campers allowed to have animals? (If yes, what restrictions apply, for example breed or size limits?)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Ongoing / Planned Construction?

Is there any ongoing or planned future construction on the property? (If yes, please describe.)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Other Ventures Not Covered?

Do you have any other business ventures for which coverage is not being requested? (If yes, please explain and say where.)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Flood Exposure

Is any part of the property in a flood zone or subject to flooding from a nearby river, lake, or wash?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Property Management Specific Questions: Property Management Specific Questions (8 questions)

Types of property managed

What types of property do you manage? Select all that apply.

The mix of residential, commercial, and association property changes which carriers will write the risk and how it is rated.

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Residential (single-family or small multi-family); Apartment buildings; Condo or homeowners associations (HOA); Commercial (retail, office); Industrial or warehouse; Other

Units (doors) managed

Roughly how many units (doors) do you manage in total? Your best estimate is fine.

The number of doors under management is one of the main rating factors for a property manager's coverage.

Control: countslider
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: None

Real estate agent services

Does your business provide any real estate agent services? (Yes/No)

Real estate brokerage is a separate professional exposure from property management, so carriers ask about it up front.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Other services provided

Does your business provide any of the following services? Select all that apply.

Some of these are higher-hazard or separately rated services, so flagging them helps match you to the right carrier.

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Construction or remodeling; General contracting; Home inspector; Insurance agent/broker; Janitorial or cleaning; Landscaping or lawn care; Mortgage banker/broker; Property developer or builder; Property preservation; Real estate appraiser; Title agent/abstractor; None of the above

Hotel or health care properties

Does your business manage any hotel properties or health care facilities? (Yes/No)

Hospitality and health care properties carry a materially higher liability exposure and are often quoted separately.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Construction / renovation projects

Does your business manage or implement any construction, renovation, or reconstruction projects on the properties you manage? This does not apply to oversight of routine maintenance. (Yes/No)

Overseeing construction or renovation adds a contracting exposure beyond routine property management, which changes how the policy is written.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Tenant credit checks

Does your business conduct credit checks on prospective tenants? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Tenant credit-check consent

Does your business obtain a consent form, or advise prospective tenants, that their credit will be checked? (Yes/No)

Getting tenant consent before pulling credit is a basic FCRA safeguard, so carriers ask about it when credit checks are run.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Lessor's Risk Specific Questions: Lessor's Risk Specific Questions (51 questions)

Own or purchasing

Do you already own this property, or are you purchasing it now (under contract or closing soon)?

A purchase is quoted to begin at closing, and questions about leases and tenant insurance are answered as what you'll require once you own it. A property you already own is quoted on its current tenants and practices.

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: I already own it; Purchasing now (under contract / closing soon)

Purchase closing date

When is the purchase expected to close?

The expected date helps identify your requested coverage start date. Your lender may have specific insurance requirements; submitting this form does not bind coverage.

Control: date
Response needed when shown: Yes when shown
Shown when: Own or purchasing starts with Purchasing

Primary named insured

What is the exact legal name that should appear on the policy as the primary named insured, that is, the entity that owns the property? If the property is held in a different entity than the business name you gave earlier (for example a separate property-holding LLC), enter that exact name here.

The named insured is who the policy protects. For a lessor's risk policy it should be the entity that holds title to the building, which is often a different LLC than any operating business.

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Other buildings or locations

Do you own other buildings or locations that need coverage, whether under this account or a separate policy? For each, list the address, the entity that holds title, and how tenants use the space. Write None if this is the only location.

Commercial landlords often hold several buildings across different entities, and each location is rated and scheduled separately, so listing them lets us sort each one to the policy and carrier that fits it.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Parking lot

Does the property include a parking lot? (Yes / No / Not sure)

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No; Not sure

Prior property claims

Has this rental property had any insurance claims or losses in the past 5 years? (Yes / No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Number of claims

If you reported claims or losses, how many were there? (1 / 2 / 3 / 4 or more)

Control: pillset
Response needed when shown: Yes when shown
Shown when: Prior property claims starts with Yes
Options: 1; 2; 3; 4 or more

Total amount paid for the claim

If there was one claim, about how much was paid on that claim in total? An estimate is fine.

Control: money
Response needed when shown: Yes when shown
Shown when: Number of claims is 1

Claim dates and amounts

If there were two or more claims, list each claim's date and about how much was paid. An estimate is fine for each amount.

Control: rows
Response needed when shown: Optional
Shown when: Number of claims is one of: 2; 3; 4 or more

Upload your loss runs (optional)

Control: upload
Response needed when shown: Yes when shown
Shown when: Prior property claims starts with Yes
Options: I'll send it later

Total Building Square Footage

What is the total building square footage at this location?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Parking Lot Square Footage

What is the total square footage of the parking lot?

Parking areas carry their own slip-and-fall and auto exposure that's rated separately from the building itself.

Control: line
Response needed when shown: Optional
Shown when: Parking lot is Yes

Number of Stories

How many stories does the building have?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Tenant Names & Operations

Please list the names of all tenants and the type of business each operates (e.g., retail, office).

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Applicant Occupies Premises?

Does the applicant (property owner) operate a business out of any part of the premises?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Applicant-Occupied Square Footage

If the applicant occupies part of the premises, how many square feet do they use?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Applicant Operations Description

Briefly describe the operations the applicant runs out of that space.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Connection to Tenant Operations?

Does the applicant have any ownership interest or other connection to any tenant's business operations?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Lease Agreement in Place?

Does the applicant have a written lease agreement (including a hold-harmless clause) with each commercial tenant? If you are purchasing the property, answer for what will be in place at closing.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Tenants Required to Carry CGL?

Does (or, if you are purchasing, will) the lease agreement require each tenant to maintain commercial general liability insurance, including coverage for damage to premises rented to them?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Tenant Names Applicant as AI?

Is the tenant required to name the applicant as an additional insured on the tenant's own policy? If you are purchasing, answer for what your leases will require.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Applicant Obtains COIs?

Does the applicant obtain certificates of insurance from tenants? If you are purchasing, answer whether you will require them once you own the property.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

COIs Kept on File?

Are the certificates of insurance kept on file, signed by the tenant? If you are purchasing, answer for the practice you will follow.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Maintenance Responsibility

Who maintains the premises? Choose one: The applicant; The tenants; Split between both; An outside management company.

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: The applicant; The tenants; Split between both; An outside management company

Snow/Ice Removal Responsibility

Who handles ice and snow removal? Choose one: The applicant; The tenants; An outside contractor; Not applicable in this climate.

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: The applicant; The tenants; An outside contractor; Not applicable in this climate

Subcontracted Maintenance Cost

If independent contractors handle maintenance or repairs, roughly how much do you pay them per year?

This shifts how the risk is rated, and it decides whether a certificate of insurance is needed from those contractors.

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Contractor COI Obtained?

If independent contractors are used for maintenance or repairs, is a certificate of insurance obtained from them?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Any Vacant Units?

Are any units at the property currently vacant?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Applicant Provides Security Guards?

Does the applicant provide security guards at the property?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Guard Employment Type

If security guards are provided, are they the applicant's employees or independent contractors?

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Employees; Independent Contractors

Guard Armed or Unarmed?

Are the security guards you provide armed or unarmed?

Armed guards are a materially different exposure, and some carriers decline to write them at all.

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Armed; Unarmed

Guard Contractor Names Applicant as AI?

If the guards are independent contractors, does their company name the applicant as an additional insured?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Guard Contractor COI Obtained?

If the guards are independent contractors, is a certificate of insurance obtained from their company?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Tenants Provide Security Guards?

Do any tenants provide their own security guards at the property?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Tenant Guard Armed or Unarmed?

If a tenant provides its own security guards, are they armed or unarmed?

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Armed; Unarmed

Tenants with Dangerous Exposure?

Do any tenants have an inherently dangerous exposure, such as storage or handling of explosive materials?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Tenants with Pollution Exposure?

Do any tenants have a pollution exposure, such as storage or handling of hazardous or toxic chemicals?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Tenants Involved in Cannabis?

Do any tenants' operations involve cannabis?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Cannabis Operation Type

If a tenant is involved in cannabis, what type of operation do they run?

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Grower/Cultivator; Manufacturer/Processor; Extractor; Retail/Dispensary; Other

Other Cannabis Operation Type

If you picked "Other" for the cannabis operation type, please describe it.

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Cannabis Tenant Licensed?

Is the cannabis tenant properly licensed for this type of operation?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Cannabis Consumption Permitted?

Is cannabis consumption permitted on the premises?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Tenants Involved in Crypto Mining?

Do any tenants' operations involve cryptocurrency mining?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Parking spaces

About how many parking spaces are in the lot? (optional)

Control: line
Response needed when shown: Optional
Shown when: Parking lot is Yes

Shared parking lot

Is the parking lot shared with other tenants or properties? (Yes / No)

Control: yesno
Response needed when shown: Optional
Shown when: Parking lot is Yes
Options: Yes; No

Special events

Will the parking lot be used for any special events? (Yes / No)

Control: yesno
Response needed when shown: Optional
Shown when: Parking lot is Yes
Options: Yes; No

Tenant occupancy types

Do any of your tenants (current or planned) fall into these categories: residential or mixed-use (apartments / condos); bar, tavern, or nightclub; auto repair or service; adult entertainment; bowling, billiards, trampoline park, or indoor entertainment; check cashing or pawn shop; convenience or grocery store; firearm sales; laundromat; tattoo parlor; theater; tobacco, smoke, vape, or CBD shop; manufacturing; or enclosed mall / large shopping center?

Some tenant types are rated differently or fall outside the quick online program. Nothing here disqualifies you from coverage. It just decides whether the instant online quote fits; if not, Lee can shop the building for you.

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Residential or mixed-use (apartments / condos); Bar, tavern, or nightclub; Auto repair or service; Adult entertainment; Bowling, billiards, trampoline park, or indoor entertainment; Check cashing or pawn shop; Convenience or grocery store; Firearm sales; Laundromat; Tattoo parlor; Theater; Tobacco, smoke, vape, or CBD shop; Manufacturing; Enclosed mall / large shopping center; None of these

Building value over $2 million

Do you expect to insure the building for more than $2 million in replacement cost (or is the total insured value, including rents, over $3 million)?

Larger buildings are quoted through Lee's full markets rather than the quick online program.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Vacancy over 30%

Is more than 30% of the building's rentable space currently vacant?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Roof / building systems age

Is the roof more than 30 years old; or, if the building was built more than 30 years ago, have the roof, wiring, plumbing, or heating and cooling gone more than 15 years without an update?

Every property carrier asks about roof and system updates; older, un-updated buildings are quoted through different markets.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Overnight tenant operations

Do any tenants operate between midnight and 6:00 AM?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Behavioral Health / Assisted Living Specific Questions: Behavioral Health / Assisted Living Specific Questions (101 questions)

Facility/Program Type

What type of facility do you operate: Independent Living Facility, Assisted Living Facility (elderly), Group Home for Developmentally Disabled Adults, Group Home for Mentally Ill Adults, or something else? If other, please describe.

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Independent Living; Assisted Living (elderly); Group Home for Developmentally Disabled Adults; Group Home for Mentally Ill Adults; Other

Licensed Beds

How many licensed beds does the facility have?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: None

Current Residents

How many residents currently live at the facility (occupied beds)?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: None

Admission/Readmission Assessment

Is an in-person assessment performed on all new residents before acceptance, and on returning residents after any absence such as hospitalization, by either you or a qualified third party?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Current Care Plan on File

Do all residents have a current care plan and physician evaluation on file, dated within the past 12 months?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Dementia/Alzheimer's Residents

Do any residents currently have, or are being evaluated for, dementia or Alzheimer's?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Licensed Without Restrictions

Are you currently licensed without conditions or restrictions?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

License Restriction Details

If not, please provide details about the licensing conditions or restrictions.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

License Number

What is the facility's license number(s)?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

License Refused/Suspended/Revoked

Has the applicant or any employee ever had a state professional license, or a license to prescribe/dispense narcotics, refused, suspended, revoked, had renewal refused, been accepted only on special terms, or been voluntarily surrendered?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Administrator Name

Who is the Administrator of the facility (please attach a resume)?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Staff-to-Resident Ratio

What is your typical staff-to-resident ratio (e.g., by shift)?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Medication Administration

Who administers medication to residents? Choose one: A licensed nurse on staff; Trained staff using a medication administration record; An outside agency or pharmacy service; Residents self-administer; We do not administer medication.

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: A licensed nurse on staff; Trained staff using a medication administration record; An outside agency or pharmacy service; Residents self-administer; We do not administer medication

Security/Wander Controls

What keeps residents from leaving unsupervised, and outsiders from getting in? Select all that apply: Alarmed doors; Keypad or badge locks; Perimeter fencing; Staff monitoring at exits; Video cameras; Wander-alert bracelets; None of these.

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Alarmed doors; Keypad or badge locks; Perimeter fencing; Staff monitoring at exits; Video cameras; Wander-alert bracelets; None of these

Elopement History

Have any residents eloped (left the premises without staff being aware) in the past 3 years?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Elopement Details

If yes, please provide the date(s) and details.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Transports Residents

Do you, your employees, contractors, or volunteers transport residents/patients (e.g., to appointments or outings)?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Annual Resident Transports

Approximately how many resident/patient transports have occurred in the past 12 months (adults)?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Estimated Adult Transports

Approximately how many resident/patient transports (adults) do you estimate for the next 12 months?

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Minor Transports (past 12 mo)

Approximately how many transports of minors (under age 18) occurred in the past 12 months? Enter 0 if you do not transport minors.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Estimated Minor Transports

Approximately how many transports of minors (under 18) do you estimate for the next 12 months? Enter 0 if none.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Driver MVR Checks

Do you obtain motor vehicle records (MVRs) on all drivers who transport residents, whether using owned, hired, or non-owned autos?

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Hired/Non-Owned Auto Claims

Has any hired & non-owned auto claim ever been made against the firm, its employees, contractors, or volunteers, or are you aware of circumstances that may result in one?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Criminal Background Checks

Do you obtain, review, verify, and keep on file criminal background checks as part of your hiring/screening process for employees, independent contractors, and volunteers?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Drug/HIV/Hepatitis Testing

Do you obtain, review, verify, and keep on file drug, HIV, or hepatitis testing results as part of your hiring/screening process?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Written Sexual Misconduct Policy

Do you have written guidelines regarding sexual misconduct, including an incident reporting policy and procedure, in place for all employees, independent contractors, and volunteers?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Agree to Implement Misconduct Guidelines

If you do not currently have written sexual-misconduct guidelines, do you agree to draw up and implement them within 30 days of binding coverage?

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Sexual Misconduct Training

Are all employees, independent contractors, and volunteers given initial training on these guidelines before client contact, and refresher training on a regular basis thereafter?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Agree to Implement Training Program

If you do not currently provide initial or refresher misconduct training, do you agree to implement such a training program within 30 days of binding coverage?

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Staff Alone with Minors

Are any employees, independent contractors, or volunteers ever alone with minors behind closed doors or in a private setting?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Abuse/Misconduct Claims History

Has any physical or sexual abuse/misconduct claim, or any other allegation of abuse, ever been made against the firm or its employees, contractors, or volunteers, or are you aware of circumstances that may result in one?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Professional/General Liability Claims

Has any claim ever been made against the firm or any of its employees?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Falls/Injuries on Premises

Have there been any falls or injuries on the premises in the past 3 years, under this or a prior owner/administrator?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Falls/Injuries Details

If yes, please provide the date(s) and details.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Screens for Prior Claims History

Do you question prospective employees or independent contractors about prior claims or lawsuits against them?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Written Incident Reporting Policy

Do you have a written incident/occurrence reporting policy and procedures?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Residents Age 0-17

How many current residents are age 0-17?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Residents Age 18-39

How many current residents are age 18-39?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Residents Age 40-65

How many current residents are age 40-65?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Residents Age 66+

How many current residents are age 66 or older?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Reason for Under-66 Residents

If you have residents under 66, briefly explain why they are in this level of care.

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Accepts Residents Under 18

Do you ever accept residents under age 18?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Business is a Startup

Is this a brand-new business with no operating history?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Recently Purchased Business

Did you recently purchase this business/facility from a prior owner?

The date of purchase affects how much operating history the carrier can underwrite on.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Purchase Date

What date did you purchase the business/facility?

Control: date
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Established Business

Has this business/facility been operating under your ownership for some time?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Years Operational

If the business is already operating: how many years has the facility been operating under your ownership?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Accepts Temporary/Emergency Placements

Do you ever accept residents on a temporary or emergency basis?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Temporary/Emergency Placement Details

If yes, please describe the circumstances.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Accepts Residents Outside Normal Scope

Do you ever accept residents whose care needs are outside your normal scope of services?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Out-of-Scope Acceptance Details

If yes, please describe.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Other Businesses at This Location

Do you operate any other business at this location?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Other Business Separately Insured

If so, is that other business separately insured?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Administrator's Weekly Hours

How many hours per week does the Administrator work on-site?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Screening: Employment Application

Does your hiring process include a signed employment application?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Screening: Licenses Verified

Do you verify professional licenses held by staff before hire?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Screening: Education/Training Verified

Do you verify staff education and training credentials before hire?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Screening: Multi-State Registry Check

Do you check a multi-state abuse/neglect registry as part of hiring?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Continuing Education Required

Is ongoing/continuing education required of your care staff?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Job Descriptions & Manuals

Do you maintain written job descriptions and policy/procedure manuals for staff?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Required Training Current

Is all staff required training currently up to date?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Resident Agreement Signed

Does every resident (or their representative) sign a resident agreement?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Assessment Kept on File

Is a completed pre-admission assessment kept on file for every resident?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Assessment Covers All Required Areas

Does your pre-admission assessment cover every area the carrier requires (medical, cognitive, behavioral, mobility, and care-needs history)?

If any area is missing, tell us which so we can flag it to the carrier rather than have it surface at claim time.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Missing Assessment Areas

If not, which area(s) does your assessment not cover?

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Prescreens for Combative Behavior

Do you screen for a history of combative or aggressive behavior before admission?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Accepts Combative Residents

Do you ever accept residents with a known history of combative behavior?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Combative-Resident Acceptance Details

If yes, please describe your safeguards.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

De-escalation Training

Is staff trained in de-escalation techniques?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Prescreens for Suicidal History

Do you screen for a history of suicidal ideation or attempts before admission?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Accepts Residents with Suicidal History

Do you ever accept residents with a known history of suicidal ideation or attempts?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Reassessment Frequency

How often are residents formally reassessed?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Residents by Dementia/Alzheimer's Stage

If any residents have dementia/Alzheimer's, how many are at each stage? Format: Stages 1-3: N, Stages 4-5: N, Stage 6: N, Stage 7: N.

Control: counts
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Residents with Wounds/Pressure Ulcers

Do any current residents have wounds or pressure ulcers?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Wound Stage Counts: Acquired Here

For wounds that developed while in your care, how many residents are at each stage? Format: Stage I: N, Stage II: N, Stage III: N, Stage IV: N.

Control: counts
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Wound Stage Counts: Present on Admission

For wounds already present when the resident was admitted, how many residents are at each stage? Format: Stage I: N, Stage II: N, Stage III: N, Stage IV: N.

Control: counts
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Wound Residents on Hospice

Are any residents with wounds currently on hospice care?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Wound Care by Separate Provider

Is wound care provided by a separate licensed provider (e.g. home health, wound-care nurse) rather than your own staff?

If your own staff perform wound care rather than an outside licensed provider, that's a materially different liability exposure.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Wound Care Arrangement Details

If not a separate provider, who on your staff provides wound care and what is their training?

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Residents with Legal/Financial Guardians

Do any residents have a court-appointed legal or financial guardian?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Guardian Details

If yes, please describe (how many residents, and how guardianship affects your operations).

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Smoke Detectors Installed

Are smoke detectors installed throughout the facility?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Fire Alarm System

Does the facility have a monitored fire alarm system?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Last State Inspection Date

What was the date of your most recent state licensing inspection?

Control: date
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Deficiencies Cited

How many deficiencies were cited at your last inspection? Enter 0 if none.

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Follow-Up Inspection Required

Did the last inspection require a follow-up inspection?

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No; N/A

Follow-Up Found New Citations

If a follow-up inspection occurred, did it result in any new citations?

Control: pillset
Response needed when shown: Yes when shown
Shown when: Follow-Up Inspection Required is Yes
Options: Yes; No; N/A

Corrective Action Plan Accepted

Was your corrective action plan accepted by the licensing agency?

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No; N/A

Complaints Filed (past year)

How many complaints have been filed against the facility in the past year? Enter 0 if none.

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Fines Assessed (past year)

How many fines have been assessed against the facility in the past year? Enter 0 if none.

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Disciplinary Proceedings

Is the applicant or any employee currently subject to a licensing disciplinary proceeding?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Criminal Conviction History

Has the applicant or any owner/officer ever been convicted of a felony related to resident care?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Professional Liability Declined/Cancelled

Has professional liability coverage ever been declined, cancelled, or non-renewed for this business?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Aware of Circumstances That May Result in a Claim

Are you aware of any circumstances, incidents, or complaints not already described that could result in a claim?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Resident Census by Care Need

How many residents currently need each of the following: wheelchair, 2-person/Hoyer lift transfer, bedridden (not hospice), bedridden + hospice, wander/elopement risk, fall risk, tube feeding, ventilator?

Control: counts
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Staffing by Shift

Roughly how many caregiving staff (employees and any independent contractors) do you have on each shift: day, evening, overnight?

Staffing ratios by shift are a key underwriting factor for resident-supervision risk.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Management Experience 3+ Years

Do you (or your management team) have at least 3 years of experience owning or managing this type of facility? (Yes/No)

The habitational carrier flags this as a must-answer eligibility item.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Number of Buildings

How many separate buildings make up the facility?

Control: countslider
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: None

Number of Dwelling Units

How many total dwelling units (apartments/rooms) are in the building(s)?

Control: countslider
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: None

Exterior Wall Covering

What is the exterior wall covering (e.g. brick veneer, stucco, wood/wood shake, EIFS/Dryvit, vinyl, aluminum)?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

On-Site Recreation Amenities

Which of these are on the property? (Select all that apply.) Swimming pool or spa; Playground; Fitness center; None of these.

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Swimming pool or spa; Playground; Fitness center; None of these

Social Services Specific Questions: Social Services Specific Questions (28 questions)

Programs & Populations Served

Which of these programs or client populations does your organization serve? (Select all that apply.) Alcohol/Drug Abuse Rehabilitation; Counseling; Day care; Developmentally Disabled; Head Start; Home Health Care; Mentally Challenged; Physically Disabled; Sheltered workshop; Senior programs; Youth programs.

This is the core of how the carrier classifies a social-services risk, so listing every program you run gets the quote to the right market the first time.

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Alcohol/Drug Abuse Rehabilitation; Counseling; Day care; Developmentally Disabled; Head Start; Home Health Care; Mentally Challenged; Physically Disabled; Sheltered workshop; Senior programs; Youth programs; None of these

Residential / In-Patient Beds

Is any part of your operation residential (clients stay overnight)? If yes, how many beds are licensed? Enter 0 if you are entirely non-residential (no overnight stays).

Residential care is a very different exposure than day/out-patient services, so the number of overnight beds (or zero) is one of the first things the underwriter needs.

Control: countslider
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: None

Client Ages

Roughly how many clients do you serve in each age band: under 18, 18-45, 46-65, and over 65? Enter 0 for any band you do not serve.

Serving minors changes both the abuse/molestation exposure and which carriers will write the risk, so the age mix matters up front.

Control: counts
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Serves Convicted Sexual Offenders

Does your facility provide treatment, care, or services for convicted sexual offenders? (Yes/No)

This is a hard eligibility question for the program; a Yes means this particular market cannot write the risk, so we would need to find a different one.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Transports Clients

Do employees or volunteers ever transport clients in their vehicles? (Yes/No. If yes, how often and how far?)

Transporting clients in personal vehicles is a hired & non-owned auto exposure that has to be set up deliberately on the policy, so we flag it early.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Background Checks on Staff & Volunteers

Do you run criminal background checks (including sexual-abuse and child-abuse offenses) on all employees and volunteers before they start? (Yes/No)

Background screening on everyone with client contact is one of the biggest factors abuse & molestation carriers look for.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

State Licensed

Is the operation licensed by the state (or another regulator)? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Non-Profit Organization

Is the organization a non-profit? (Yes/No; answer No if it is a for-profit business.) If you are interested in board liability, select "Not-for-profit directors & officers liability (D&O)" under Coverages to consider.

Non-profit and for-profit social-services organizations are underwritten and rated differently, so carriers need to know which you are up front.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Total Annual Expenditures

What are your total annual expenditures/expenses?

Social-services carriers often rate on total annual expenditures rather than revenue, so this is the sizing number they want.

Control: money
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Accredited

Is the facility accredited? (Yes/No. If yes, who granted the accreditation and on what date?)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Licensing-Board Complaints (12 mo)

In the past 12 months, have any complaints been filed with a licensing board against your facility? (Yes/No; if yes, please explain.)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

License Revoked/Suspended (3 yr)

In the last three years, have any of your licenses been revoked, suspended, or placed under probation? (Yes/No; if yes, please explain.)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Staff License Revoked/Suspended

Has any staff member ever had their professional license revoked or suspended? (Yes/No; if yes, give the staff member(s), the reason and date, and how long they have been with you.)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Annual Out-Patient Client Contacts

If you provide out-patient services (no overnight stays), roughly how many client contacts (client meetings) do you have per year?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Volunteers

Do you use volunteers? If so, roughly how many, and do any have direct, unsupervised contact with clients?

Volunteers with client contact carry the same abuse and injury exposure as staff, so carriers want them counted and screened like employees.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Sells/Rents Medical Equipment

Do you sell or rent medical equipment to others? (Yes/No; if yes, please explain and give the gross receipts from it.)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Employs a Medical Director

Do you employ a Medical Director? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Staff with Medical Training

Do any employees hold medical training or a medical degree? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Staff Act as Physician/Doctor

If any staff hold medical training, do they provide services in the capacity of a physician or doctor? (Yes/No)

If your staff act in the capacity of a physician, this program cannot provide the coverage, so a different market would be the fit instead.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Current Policy Includes Professional Liability

Does your present policy include professional liability? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Current Policy Includes Abuse & Molestation

Does your present policy provide abuse & molestation coverage? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Lawsuits/Settlements (5 yr)

Have you had any lawsuits, mediations, arbitrations, or negotiated settlements in the past five years? (Yes/No; if yes, please explain.)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Aware of Potential Claims

Are you aware of any circumstances that may give rise to a general-liability or professional-liability claim? (Yes/No; if yes, please explain.)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Verifies Employment References

Do you verify employment-related references on new hires? (Yes/No; if yes, how?)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Abuse & Molestation Covered at Orientation

At staff orientation, do you cover abuse and molestation: how to recognize the signs, and what to do if an individual reports being molested? (Yes/No)

Formal abuse-awareness training at orientation is a control abuse & molestation carriers specifically ask about.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Knowledge of a Potential Abuse Allegation

Do you have knowledge of any incident that could give rise to, or result in, an allegation of sexual abuse? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Prior Sexual-Abuse Allegation

Has there ever been an allegation of sexual abuse made against the insured? (Yes/No; if yes, please explain.)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Wants Abuse & Molestation Coverage

Would you like a quote to include abuse & molestation coverage? (Yes/No)

Abuse & molestation is the signature exposure for social-services work, so most organizations want it quoted; asking here makes it your call rather than an assumption.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Car Rental & Car Sharing Operations: Car Rental & Car Sharing Operations (21 questions)

Where you rent or share the vehicles

How do you rent or share out your vehicles? Select all that apply. (Turo / Getaround / HyreCar or a similar rideshare rental platform / Our own website or direct bookings / A rental counter, lot, or office / Other)

Each platform provides its own protection plan while a trip is active, and what that plan does generally decides what is left for your own policy to address. Terms vary by platform and by plan.

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Turo; Getaround; HyreCar or a similar rideshare rental platform; Our own website or direct bookings; A rental counter, lot, or office; Other

Platform protection plan

If you use a platform, which protection plan do you carry on it, and roughly what liability limit and physical damage terms does that plan provide? Write Not sure if you do not know.

Platform protection plans generally apply only while a trip is active, and the limits differ by plan tier. Knowing which plan you carry helps identify what is left between trips, subject to the platform's terms and the policy wording.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

What you would like quoted

What would you like quoted? (Coverage for the vehicles between rentals, when no trip is active / Coverage that applies both during and between rentals / General liability for the business as well / Not sure yet)

Between-rental coverage and full-time commercial auto are different products in different markets, so telling us which one you have in mind points the quote at the right carriers. If you are not sure, pick Not sure yet and Lee can go over the options with you.

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Coverage for the vehicles between rentals, when no trip is active; Coverage that applies both during and between rentals; General liability for the business as well; Not sure yet

Vehicles in the rental fleet

How many vehicles do you currently rent or share out, and how many do you expect to have in the next 12 months?

Fleet size is the main rating basis on this class, and it also decides whether the account fits a single-vehicle program or a fleet program.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

How long you have been renting

How long have you been renting or sharing vehicles, and roughly how many completed rentals have you had?

Operating history is one of the few track records an underwriter has on this class, so time in operation and completed trip count generally help the submission. A brand-new operation is still quotable; just say so.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Driving between rentals

What driving happens when a vehicle is NOT on an active rental? Select all that apply. (Cleaning or detailing / Fueling or charging / Maintenance, service, or inspection / Delivering the vehicle to a renter or picking it back up / Moving vehicles between parking or storage locations / Showing a vehicle to a prospective renter / None, the vehicle is not moved between rentals)

These trips generally fall outside a platform protection plan, which applies while a trip is active, so they are usually the reason this kind of policy is bought. Listing them is what lets the quote reflect the driving you actually do.

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Cleaning or detailing; Fueling or charging; Maintenance, service, or inspection; Delivering the vehicle to a renter or picking it back up; Moving vehicles between parking or storage locations; Showing a vehicle to a prospective renter; None, the vehicle is not moved between rentals

Who does that driving

Who does the between-rental driving? Select all that apply. (You or another owner, member, or partner / Employees / 1099 contractors or helpers / A detailing, cleaning, or transport vendor / Family members / Other)

Everyone who drives a business vehicle is a rated driver, and carriers order motor vehicle records on the drivers you list. An undisclosed driver is the most common reason a commercial auto claim gets questioned.

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: You or another owner, member, or partner; Employees; 1099 contractors or helpers; A detailing, cleaning, or transport vendor; Family members; Other

Delivery and pickup

Do you deliver vehicles to renters, for example to an airport, hotel, or home address, or is it pickup only? If you deliver, roughly how far and how often?

Delivery puts the miles on you rather than the renter, and airport delivery can also carry access or permit requirements. Distance and frequency are commercial auto rating factors.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Personal use of the rental vehicles

Are any of the rental vehicles also driven for personal or family use when they are not rented out? (Yes / No / Sometimes)

A vehicle that doubles as a personal car carries both a business and a personal exposure, and carriers handle that split differently. An accurate answer keeps the vehicle from being rated as something it is not.

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No; Sometimes

Where the vehicles are kept

Where are the vehicles kept between rentals, and how is that location secured? For example a private garage, a driveway, a fenced lot, or airport parking.

Where a vehicle sits overnight drives the comprehensive (theft and vandalism) part of the rate, and an enclosed or secured location generally rates better than street parking.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

How renters are screened

How are renters screened before they take a vehicle? Select all that apply. (The platform's screening only / We check the driver's license ourselves / We run or review a motor vehicle record / We verify the renter's own auto insurance / We require a security deposit or hold / We require a signed rental agreement / Other)

Renter screening is the main loss control an underwriter can see on this class, and controls beyond the platform's own check generally help the submission.

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: The platform's screening only; We check the driver's license ourselves; We run or review a motor vehicle record; We verify the renter's own auto insurance; We require a security deposit or hold; We require a signed rental agreement; Other

Youngest renter

What is the youngest age at which you allow someone to rent a vehicle? (18 to 20 / 21 to 24 / 25 or older / We use the platform's minimum / Not sure)

Young-driver exposure is rated heavily on rental and sharing accounts, and some programs will not write vehicles rented to drivers under 25.

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: 18 to 20; 21 to 24; 25 or older; We use the platform's minimum; Not sure

Renters who drive for rideshare or delivery

Do you rent or share vehicles to people who use them for rideshare or delivery work, for example Uber, Lyft, DoorDash, or Amazon Flex? (Yes / No / Not sure)

Renting to a commercial driver is a different exposure from renting to someone on vacation, and several programs exclude it. Knowing this up front keeps your submission out of a market that cannot write it.

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No; Not sure

Where renters may take the vehicles

Where are renters allowed to take the vehicles? (Arizona only / Arizona and neighboring states / Anywhere in the United States / Into Mexico or Canada as well / No stated limit)

Radius is a commercial auto rating factor, and travel into Mexico generally needs separate coverage because a United States auto policy is typically not recognized there.

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Arizona only; Arizona and neighboring states; Anywhere in the United States; Into Mexico or Canada as well; No stated limit

Lenders or lessors on the vehicles

Are any of the rental vehicles financed or leased? If so, list the lender or lessor for each one, exactly as it should appear on the policy. Write None if they are all owned outright.

A lender or lessor is generally listed on the policy as a loss payee or additional insured, and physical damage coverage may be required by your loan or lease for as long as it is open.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Tracking and cameras

Do the vehicles have GPS tracking, telematics, or dash cameras installed? (Yes, on all of them / Yes, on some / No / Planning to add them)

Tracking helps recover a stolen or unreturned vehicle, and some carriers price for it.

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes, on all of them; Yes, on some; No; Planning to add them

Who maintains the vehicles

Who performs maintenance and repairs on the vehicles: a licensed shop, a mobile mechanic, or you yourself?

Maintenance records are what a carrier looks at after a mechanical-failure claim, and work done by a licensed shop is generally viewed differently from work done in house.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

People coming to your location

Do renters, customers, or vendors ever come to a location you own or lease, for example to pick up a vehicle or to have one cleaned? (Yes / No)

People coming to your premises is what general liability generally responds to, subject to the policy wording, so this decides whether premises liability belongs in the quote.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Other services you provide

Besides renting your own vehicles out, do you do any of these? Select all that apply. (Detailing or cleaning other people's vehicles / Vehicle transport or delivery for others / Providing a driver or chauffeur with the vehicle / Selling vehicles / Managing or renting out vehicles owned by other people / None of these)

Providing a driver with the vehicle is livery rather than rental and is written in a different market. Each of the other services carries its own general liability or garage exposure, so the quote needs to reflect them.

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Detailing or cleaning other people's vehicles; Vehicle transport or delivery for others; Providing a driver or chauffeur with the vehicle; Selling vehicles; Managing or renting out vehicles owned by other people; None of these

Coverage anyone requires of you

Does a platform, lender, lessor, airport, or landlord require you to carry specific coverage or limits? If so, what do they ask for? Attach the requirement if you have it in writing.

Coverage limits may be required by your lease, contract, or lender, and matching them in the quote avoids a second round after the policy is issued.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Rental history from the platform

If you can export a summary of your rental history from the platform (trip count, ratings, any incidents or damage claims), attach it here. This is optional.

A rental history is the closest thing this class has to loss runs, and a clean one generally helps an underwriter price the account.

Control: upload
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: I'll send it later

Powersports Rental Operations: Powersports Rental Operations (23 questions)

Reservation / booking system

What reservation or booking system do you use to schedule rentals and excursions? (FareHarbor / Peek / Booking Central / Indexic / RMS / The Flybook / Waverez / No software - phone, email, or in person / Other)

The carrier asks which booking platform you run on. It helps them gauge how waivers, rental agreements, and scheduling controls are handled.

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: FareHarbor; Peek; Booking Central; Indexic; RMS; The Flybook; Waverez; No software - phone, email, or in person; Other

Youngest renter age

What is the youngest age at which you allow a renter to operate a unit? (15 or younger / 16 / 17 / 18 / 21 / 25 or older)

How young your youngest operator is directly drives the rate, and some units carry a manufacturer or state minimum operating age.

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: 15 or younger; 16; 17; 18; 21; 25 or older

Oldest renter age

Is there an oldest age at which you allow renters to operate, or no maximum? (Not applicable or no maximum / 50-84 / 85 or older)

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Not applicable or no maximum; 50-84; 85 or older

Average renter age

On average, how old are your renters? (18 to 44 / 45 or older)

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: 18 to 44; 45 or older

Months per year running excursions

During how many months per year do you actively run rentals or excursions?

Control: countslider
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: None

BRP Experiences status

Are you a part of BRP Experiences (the Can-Am / Sea-Doo dealer excursion program)? (Not a BRP dealer / BRP dealer, not enrolled in BRP Experiences / Enrolled - not Elite / Silver / Gold / Platinum / Not sure)

If you don't run the BRP Experiences program, just pick 'Not a BRP dealer.' Enrolled operators can qualify for program-specific pricing.

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Not a BRP dealer; BRP dealer, not enrolled in BRP Experiences; Enrolled - not Elite; Silver; Gold; Platinum; Not sure

Receipts from non-rental operations

Roughly what are your gross receipts from operations OTHER than rentals in the coming year (for example guided-tour fees, retail sales, food, or lodging)? Enter an amount, or None if rentals are your only source of income.

This is only the non-rental portion of your income. Your total projected revenue was captured earlier; this splits out the part that isn't unit rental.

Control: money
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Standard excursion length

On average, how long does a standard excursion last? (30 minutes / 1 hour / 2 hours / 3 hours / 4 hours / 5 to 9 hours, full day / Multi-day, 2 or more days)

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: 30 minutes; 1 hour; 2 hours; 3 hours; 4 hours; 5 to 9 hours, full day; Multi-day, 2 or more days

Excursions per week at peak

During peak season, approximately how many excursions do you run per week?

Control: countslider
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: None

Percent guided by staff

Approximately what percent of your excursions are guided by your staff? (0% - all unguided / 10% / 25% / 50% / 65% / 80% / 95% / 100% - all guided)

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: 0% - all unguided; 10%; 25%; 50%; 65%; 80%; 95%; 100% - all guided

Max units on a single excursion

At peak capacity, what is the maximum number of units on a single excursion? (1 / Up to 5 / Up to 10 / Up to 20 / Up to 50 / Up to 100)

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: 1; Up to 5; Up to 10; Up to 20; Up to 50; Up to 100

Max units supervised per guide

At peak capacity, what is the maximum number of units supervised by one guide? (Unguided / Up to 5 / 6 / 7 / Up to 10 / Up to 15 / Up to 20 / Up to 25)

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Unguided; Up to 5; 6; 7; Up to 10; Up to 15; Up to 20; Up to 25

Guide experience

On average, how many years of experience do your guides have? (Unguided / Less than 1 year / 1 year / 2 years / 3 years / 4 years / 5 or more years)

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Unguided; Less than 1 year; 1 year; 2 years; 3 years; 4 years; 5 or more years

Ride zone

Which best describes where excursions typically occur? (Guided by our employees / Telematics enforce the route or area / Direct trail access from our premises / Drive off and ride anywhere in an allowed area, such as dunes or public roads / Tow-away - customer trailers the units off-site)

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Guided by our employees; Telematics enforce the route or area; Direct trail access from our premises; Drive off and ride anywhere in an allowed area, such as dunes or public roads; Tow-away - customer trailers the units off-site

How customers access the units

How do customers access and operate the units? (Drive off from our address / We deliver the units to the renter / Customer tows from our address)

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Drive off from our address; We deliver the units to the renter; Customer tows from our address

Typical customer base

How would you describe your typical customer base? (Varies or not sure / Affluent or VIP guests / Families - mixed ages / Local residents / Adventure-focused guests)

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Varies or not sure; Affluent or VIP guests; Families - mixed ages; Local residents; Adventure-focused guests

Rental fleet

List each type of unit in your rental fleet. For every unit type, tell us the unit type, manufacturer, top speed, maximum passenger capacity, approximate value, the terrain it is used on, whether it has speed-limiter keys, GPS tracking, and telematics, and how many of that unit you operate.

This is your fleet schedule. Each unit type and its count is what the carrier rates the physical-damage and liability portions of the quote on.

Control: rows
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Trip schedule

List each distinct excursion or trip you offer. For each one, tell us the vehicle type used, the average number of passengers per unit, whether it is guided or unguided, how long it lasts start to finish, the environment it operates in, whether public roadways are used at any point, and the number of trips you run per year.

One row per distinct excursion type. If you only rent units and do not run set excursions, you can leave this empty.

Control: rows
Response needed when shown: Optional
Shown when: When this step is shown in the live form.

Upload a fleet schedule instead

Prefer to upload a fleet schedule instead of typing each unit? Attach a spreadsheet or PDF here (optional).

Control: upload
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: I'll send it later

Alcohol exposure

Do you serve, sell, or provide alcohol in connection with your operations or excursions? (Yes / No)

If alcohol is part of any excursion or event, a separate liquor-liability coverage is usually needed, so flagging it lets Lee build it into the quote.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Guest protection plan

Do you require guests to purchase a damage-protection or guest-protection plan at booking? (Yes - required at every booking / Required, with an optional upgrade / Not currently / Not sure)

A required guest-protection plan can lower your own loss costs, and some carriers price for it. Optional - skip if you're not sure.

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes - required at every booking; Required, with an optional upgrade; Not currently; Not sure

Preferred payment plan

If we quote this, which payment plan would you prefer? (Paid in full / Down payment plus monthly installments / Agency bill / No preference)

Just a preference so we can set the quote up the way you'd want to pay. Lee sets the final terms with the carrier.

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Paid in full; Down payment plus monthly installments; Agency bill; No preference

Loss runs (claims history)

If the business has carried insurance before, upload your loss runs (your carrier's claims-history report) here.

Loss runs are the official claims-history report from your prior carrier. Providing them up front lets the carrier finalize pricing without a delay.

Control: upload
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: I'll send it later

Rental Business Specific Questions: Rental Business Specific Questions (4 questions)

What you rent

What items do you rent out (for example tools, party equipment, tables/chairs, tents, generators)?

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Delivery & setup

Do you deliver, set up, or operate the equipment for customers, or is it pickup only?

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Delivery; Setup; We operate it for the customer; Pickup only

Equipment value

Approximate total replacement value of your rental inventory?

Control: money
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Rental agreement

Do customers sign a rental agreement with a liability waiver? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Financial Lending Specific Questions: Financial Lending Specific Questions (45 questions)

Loan types and mix

What types of loans or finance agreements does the business originate, broker, or service (for example residential mortgages, commercial mortgages, consumer installment loans, auto loans, hard-money or bridge loans, business loans)? Roughly what is the mix?

Underwriters price a lender's E&O by the kind of lending you do - a commercial bridge lender and a consumer auto lender carry very different exposures.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Loans originated per year

About how many loans do you originate yourself in a year, and what is the total dollar volume? (for example, 150 loans, $30,000,000)

Origination volume is the main size measure on a lender E&O application and sets the rate basis.

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Loans serviced per year

If you service loans yourself, about how many do you service and what is the total dollar volume? (Enter none if you do not service loans.)

Servicing carries its own errors-and-omissions and escrow-handling exposure, rated separately from origination.

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Lending licenses

Are all lending licenses required in the states where you operate currently in force? Please list the licenses you hold and your NMLS number if you have one.

Carriers confirm a lender is properly licensed everywhere it lends before offering E&O - an unlicensed loan is an uninsurable act.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Warehouse lines of credit

Do you use a warehouse line of credit or borrow from warehouse lenders to fund loans? If yes, list the warehouse lenders and any loss-payee requirements they impose.

Warehouse lenders usually require to be named as loss payee, and the arrangement changes both your fidelity-bond and E&O exposure.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Construction lending

Do you make or fund any construction loans? (Yes/No)

Construction lending is a materially higher-risk category with its own underwriting questions, so carriers need to know up front.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Fidelity bond / crime coverage

Along with professional liability (E&O), would you like a quote for a fidelity bond or crime coverage that protects against employee theft and social-engineering fraud? (Yes/No)

A fidelity bond covers money stolen by an employee or lost to a fraudulent funds-transfer scheme, which a professional liability policy does not.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Subsidiaries to cover

List any subsidiaries or affiliated companies you want included on the coverage.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Locations with underwriting authority

How many of your locations or branches have authority to underwrite or approve loans?

Control: countslider
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: None

Ownership / management change

Has there been any change in ownership or senior management in the past three years? (Yes/No; if yes, briefly describe.)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Principals owning 10% or more

List every principal, person, or entity that owns 10% or more of the company (and the parent company, if any), with the ownership percentage for each.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Professional associations

List any professional or industry associations the business belongs to.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

CPA-prepared financials

Are the business's financial statements prepared or audited by a CPA? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Working capital

Does the business have sufficient working capital for the next 12 months of operations? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Loans purchased or acquired

About how many loans or finance agreements do you purchase or acquire per year, and what dollar volume? (Enter none if not applicable.)

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Loans brokered

About how many loans or finance agreements do you broker to other lenders per year, and what dollar volume? (Enter none if not applicable.)

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Servicing 90+ days past due

Of the loans you service, what percentage is 90 days or more past due?

Delinquency in a servicing book drives foreclosure and loss-mitigation errors, a key E&O exposure.

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

New loan products

Have you introduced any new loan products in the past 12 months? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Average FICO score

What is the average borrower FICO score for your loans, if applicable?

A low average FICO signals sub-prime lending, which carriers rate as a higher E&O exposure.

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Source of funds

Where do the funds for your loans or finance agreements come from (for example your own capital, warehouse lines, investor funds, bank lines)?

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Quality-control procedures

Do you have formal written quality-control procedures in place? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Loans subject to QC review

What percentage of your loans or finance agreements are subject to a quality-control review?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

TRID applicability

Does the TILA-RESPA Integrated Disclosure rule (TRID) apply to your company? (Yes/No; if no, briefly explain.)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

TRID compliance

If TRID applies, is the business TRID compliant? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Lending-law violations

Do you know of, or have you had reported, any violations of consumer-lending or servicing laws (FDCPA, FCRA, TCPA, TILA, RESPA, ECOA, Dodd-Frank, TRID, or similar)? (Yes/No; if yes, describe the findings, any fines, and corrective measures taken.)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Outside compliance help

Have you used outside legal services or consultants to implement new regulatory compliance (Dodd-Frank, TRID, or similar)? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Regulatory investigation

Has the business been investigated, audited, or fined by any national or local regulatory agency? (Yes/No; if yes, name the agency, the result, and any corrective actions.)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Compliance officer

Do you have a compliance officer or similar role to confirm compliance with federal, state, and local laws? (Yes/No; if yes, give the person's name or title.)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Compliance software

Do you use regulatory compliance software? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Loan repurchase / indemnity

Have you ever been required to repurchase or indemnify any loans? (Yes/No; if yes, give the number of loans, dollar volume, details, and any corrective actions.)

A repurchase demand is a direct financial loss and a leading indicator of E&O claims for lenders.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

License investigation

Has the business had, or does it have ongoing, any licensing investigation from a state agency or other authority? (Yes/No; if yes, give full details and the outcome or status.)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Fraud detection service

Do you use a fraud detection service? (Yes/No; if yes, name the software or company.)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Borrower identity verification

Do you have a fraud-guard system or similar procedure to verify borrower identity (for example checking social security numbers)? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Dual controls

Do you have dual controls so that no single person can control the entire origination or underwriting process? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Commingling of funds

Do you commingle investor funds, or other funds that must be segregated by law or by a third party? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Bank reconciliation

Are bank accounts reconciled by someone who is not authorized to deposit or withdraw? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Check countersignature

Is countersignature of checks, including escrow accounts, required? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Monthly reconciliation

Are all cash, bank, and similar balances reconciled monthly? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Independent reconciliation

Are reconciliations prepared and supervised by someone with no responsibility for cash receipts or disbursements? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Large wire transfers

Roughly how many outgoing wire transfers above $5,000 do you make in a year?

Control: countslider
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: None

Officer review of reconciliations

Does an officer with no cash-handling responsibility review all reconciliations and question unusual items? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Out-of-band verification

Do you verify funds-transfer or payment requests using out-of-band authentication (confirming through a different channel, such as a callback to a known number)? (Yes/No)

Out-of-band verification is the single biggest control against social-engineering wire fraud, so crime underwriters weight it heavily.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Prior declination / cancellation

Has any insurance been declined or canceled in the past five years (not applicable in Missouri)? (Yes/No; if yes, please explain.)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Industry investigation / complaint

In the past five years, has the business (or any predecessor, partner, officer, director, or employee) been the subject of an investigation, reprimand, disciplinary action, criticism, or complaint by the FHA, VA, a PMI carrier, any investor, authority, or government agency? (Yes/No; if yes, please explain.)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Known circumstances

Are you aware of any circumstance, incident, or situation in the past five years that has resulted in, or may result in, a claim against the business or any partner, officer, director, or employee? (Yes/No; if yes, please explain.)

This is the standard E&O prior-knowledge question - anything known now is excluded from the new policy, so it must be disclosed.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Insurance Agency Specific Questions: Insurance Agency Specific Questions (10 questions)

Areas of practice

Which areas of insurance do you or your subcontractors place? Select all that apply: Life & Health; Financial Products; Property & Casualty; Other.

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Life & Health; Financial Products; Property & Casualty; Other

Other types of work

If you selected Other above, what other types of work do you perform?

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Specialty products placed

Do you sell or place any of these specialty products? Select all that apply: Long Haul Trucking; Medical Malpractice; Lawyers Professional Liability; Agribusiness or Crop; Aircraft or Aerospace; None of the above.

These lines carry higher E&O severity, so flagging them up front helps us match you to a carrier that will write them.

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Long Haul Trucking; Medical Malpractice; Lawyers Professional Liability; Agribusiness or Crop; Aircraft or Aerospace; None of the above

Specialized activities

Do you or your employees perform any of these activities (not counting work you subcontract to others)? Select all that apply: Acting as a countersigning agent for out-of-state agencies; Claims or third party administrator (TPA) work; Acting as a surplus lines broker; Employee benefits design or consulting (not general administration); Facilitating life settlements or other structured transactions; Advising on or managing retirement plans (IRA, 401(k), 403(b) and similar); Acting as a managing general agent (MGA) or in a similar underwriting capacity; None of the above.

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Countersigning agent for out-of-state agencies; Claims / third party administrator (TPA); Surplus lines broker; Employee benefits design or consulting (not general administration); Life settlements or structured transactions; Retirement plan advice or management (IRA, 401(k), 403(b)); Managing general agent (MGA) / underwriting; None of the above

Additional activities

Do you perform any of these activities? Select all that apply: Sell securities not registered with the SEC; Place business with excess and surplus lines carriers; Facilitate premium financing; Perform loss control or risk management consulting; Place business with carriers not rated B+ or better by AM Best or A or better by Demotech; Group benefits administration; None of the above.

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Sell securities not registered with the SEC; Place excess & surplus lines business; Facilitate premium financing; Loss control or risk management consulting; Place business with carriers below B+ (AM Best) or A (Demotech); Group benefits administration; None of the above

Current E&O policy

If currently insured: do you have an active Errors & Omissions (professional liability) policy?

E&O renewals are underwritten partly on your current carrier, limits, and retroactive date, so having those ready speeds up the quote and protects your prior-acts coverage.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Prior coverage canceled

In the last 3 years, has any commercial insurance coverage been canceled, revoked, or non-renewed (other than for non-payment or discontinuation of a program)?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Additional businesses

Do you or your employees run any additional businesses?

Other ventures can create exposures that need to be listed or insured separately, so underwriters ask about them up front.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Background disclosures

Has your business, or any of its officers, owners, or partners, had any of the following? Select all that apply: Convicted of a felony in the past 5 years; Declared bankruptcy in the past 3 years; Had business-related lawsuits, mediations, or arbitrations filed against them; None of the above.

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Convicted of a felony in the past 5 years; Declared bankruptcy in the past 3 years; Business-related lawsuits, mediations, or arbitrations filed against them; None of the above

Subcontractor payroll (next 12 months)

What is your expected subcontractor payroll for the next 12 months? Include payroll for all cash workers and 1099 contractors.

Uninsured subcontractor payroll is often added to your rating basis at audit, so estimating it now keeps your quote accurate.

Control: money
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Travel Agency Specific Questions: Travel Agency Specific Questions (18 questions)

Services you provide

What kinds of travel do you book or plan? (Select all that apply.)

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Leisure / vacation travel; Corporate or business travel; Cruises; Group tours; Destination weddings or honeymoons; Air-only ticketing; Hotel or resort bookings; Travel insurance; Other

Reward-point bookings, tours, and transportation

Does your business provide any of the following services? (Select all that apply.)

Booking travel on reward points the client did not obtain, and operating tours or transportation yourself, are both underwritten differently than a straight agent booking. Carriers ask about them separately.

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Book travel arrangements using travel reward points the client did not obtain (for example bookings made from points obtained through a travel reward broker); Tour operator or transportation; None of the above

Largest customer share of sales

During the next 12 months, what percentage of your expected gross sales will you earn from your largest customer?

Revenue concentrated in one customer is a standard professional-liability rating question: losing or being sued by that account affects the whole business, so carriers price it differently than a spread book.

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

International bookings

Roughly what percentage of your bookings are international travel?

International itineraries involve foreign suppliers and jurisdictions, which changes how a professional liability claim is handled.

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Host agency or consortium

Do you work under a host agency or consortium? If yes, which one?

Some host agencies extend errors and omissions coverage to their independent agents, so knowing the host can change what you actually need to buy.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Accreditation numbers

Which travel accreditations do you hold? (Select all that apply.)

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: IATA / IATAN; ARC; CLIA; I book under my host agency's accreditation; None of these

Seller of travel registration

Are you registered as a seller of travel in any state (for example California, Florida, Washington, Hawaii, or Iowa)? If yes, which states?

Several states license sellers of travel and some carriers require the registration to be in place before they will quote.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Client deposits and payments

Do you collect client deposits or payments into your own account before remitting them to the airline, cruise line, hotel, or tour operator? If yes, please describe how those funds are held.

Holding client money before it reaches the supplier creates a fidelity and fiduciary exposure on top of the professional liability, so carriers ask how it is handled.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Active E&O policy

If currently insured: do you have an active Errors & Omissions (professional liability) policy?

E&O is written on a claims-made basis, so your current carrier and retroactive date decide whether your prior work stays covered when you switch.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Tours you operate

If you operate tours, packages, or transportation yourself: please describe them, including the destinations and roughly how many travelers per year.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Escorting or leading trips

Do you or your staff accompany, escort, or lead clients on trips? If yes, please describe your role on the trip.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Vehicles used to carry clients

Do you own, lease, or hire any vehicles, boats, or aircraft used to transport clients? If yes, please describe them.

Carrying clients yourself is an auto or watercraft liability exposure that has to be insured separately from the agency's professional liability.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Adventure or high-hazard activities

Do the trips you arrange include adventure activities such as diving, climbing, skiing, safaris, or backcountry excursions? If yes, please describe.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Destinations under travel advisories

Do you book travel to any destinations currently under a government travel advisory or warning? If yes, which ones?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Written terms with clients

Do you use written terms and conditions or a client agreement that spells out supplier responsibility and cancellation terms?

A written agreement that makes clear you are booking with a supplier, not guaranteeing the supplier, is one of the main defenses in a travel agent claim.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Travel insurance offer documented

Do you offer travel insurance to every client and document it in writing when a client declines?

A documented decline is the single most common defense in travel agent E&O claims, so carriers ask about it directly.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Supplier vetting

How do you choose and vet the suppliers you book (airlines, cruise lines, tour operators, hotels)?

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Known complaints, losses, or claims

Are you aware of any complaints, incidents, losses, or claims that have happened, or that could lead to a claim under the policy? If yes, please describe.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Security Guard / Patrol Service Specific Questions: Security Guard / Patrol Service Specific Questions (18 questions)

Security services provided

Which services does the business provide? (Select all that apply.) Unarmed guard services; Armed guard services; Mobile / vehicle patrol; Alarm response; Private investigation / detective; Bodyguard / executive protection; Event / crowd security; K-9 units.

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Unarmed guard services; Armed guard services; Mobile / vehicle patrol; Alarm response; Private investigation / detective; Bodyguard / executive protection; Event / crowd security; K-9 units; None of these

Where guards work

Where do your guards or patrols work? (Select all that apply.) Bars / nightclubs; Construction sites; Retail stores; Apartments / residential; Hospitals / healthcare; Schools; Banks / financial; Government facilities; Special events / concerts; Shopping malls; Warehouses; Airports; Other.

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Bars / nightclubs; Construction sites; Retail stores; Apartments / residential; Hospitals / healthcare; Schools; Banks / financial; Government facilities; Special events / concerts; Shopping malls; Warehouses; Airports; Other

Number of armed guards

How many of your guards are armed?

Control: countslider
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: None

Number of unarmed guards

How many of your guards are unarmed?

Control: countslider
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: None

State licensed / certified

Is the business licensed and/or certified as required by your state to provide security services? (Yes/No)

Most states require security-guard companies to be licensed; carriers verify this before quoting.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Armed personnel firearms-certified

If you provide armed guards, are all armed personnel state-certified in the use of firearms? (Yes / No / N/A - no armed guards)

Armed guards are a materially different exposure and carriers require state firearms certification for every armed officer.

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No; N/A - no armed guards

Weapons / defensive tools carried

Which of the following are guards authorized and trained to carry? (Select all that apply.) Mace; Pepper spray; Night sticks or batons; Stun guns or tasers; Handcuffs or other restraints.

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Mace; Pepper spray; Night sticks or batons; Stun guns or tasers; Handcuffs or other restraints; None of these

Guard dogs / K-9 used

Do you use dogs (K-9) as part of your operation? (If yes, describe how and where the dogs are used.)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Pre-employment screening

Do you run background checks and pre-employment screening on all guards before hire? (If yes, briefly describe the process.)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Subcontracted guard work

Do you subcontract any guard work to other companies? (If yes, what type of work?)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Payroll breakdown by operation

Give us a rough yearly payroll breakdown by the kind of account or job your guards work (for example bars and nightclubs, construction sites, apartments, retail, hospitals). Add a row for each type of operation, pick the category, and enter the armed and/or unarmed payroll for it, matching the armed and unarmed split you gave above. If a category is not listed, add a row and type your own.

Carriers rate a guard company off payroll, and armed work at a nightclub is priced very differently from an unarmed patrol of an office park. Splitting your payroll by operation and by armed versus unarmed is what lets us get you the right price instead of a worst-case one.

Control: rows
Response needed when shown: Optional
Shown when: When this step is shown in the live form.

Use-of-force policy

Do you have a written use-of-force policy that all guards are trained on? (If yes, briefly summarize it.)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Formal training required

What training do you require of your guards? Select all that apply: State guard card or license; Firearms certification; De-escalation or conflict training; First aid or CPR; Written post orders; On-the-job training only; No formal requirement.

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: State guard card or license; Firearms certification; De-escalation or conflict training; First aid or CPR; Written post orders; On-the-job training only; No formal requirement

Off-duty police officers

Do you employ any off-duty police officers? (If yes, how many?)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Affiliated with another business

Is the business owned by, associated with, or otherwise involved with any other enterprise? (If yes, provide details.)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Subcontractor certificates required

If you subcontract guard work, do you require certificates of insurance with equal limits from every subcontractor before work begins? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Subcontractors name you as AI

If you subcontract guard work, are all subcontractors required to name your business as an additional insured? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Security consulting work

Do you perform any security consulting work? (If yes, briefly describe it.)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Temporary Staffing Agency Specific Questions: Temporary Staffing Agency Specific Questions (23 questions)

Staffing services provided

Which staffing services do you provide? (Select all that apply.)

Carriers rate and classify a temporary staffing agency, a PEO, a payrolling/EOR firm, and a direct-hire recruiter differently, so the application needs to state exactly which services you offer.

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Temporary staffing; PEO (professional employer organization); Direct hire / placement; ASO (administrative services only); EOR / payrolling; VMS / MSP

Types of workers placed

What types of workers do you place with clients? (Select all that apply.)

The kinds of positions you staff are the single biggest driver of workers compensation class and general liability rating, so this shapes which carriers and prices apply.

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Administrative / clerical; Architects / engineers; Attorneys; Drivers / transportation; Financial / accounting; Light industrial / warehouse / factory; Heavy industrial; Construction / skilled labor; Hospitality; Teachers / teacher aides; Healthcare (excluding doctors and dentists); Computer / IT; Security services (unarmed); Daycare / nanny

In-house (corporate) payroll

What is your estimated annual payroll for your own in-house corporate/office staff (recruiters, administrators, not the workers you place)?

Your internal staff payroll is rated separately from the payroll of the workers you place, so carriers ask for the two figures apart.

Control: money
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Placed / temporary employee payroll

What is your estimated annual payroll for the temporary, contract, or leased employees you place at clients?

The payroll of the workers you place is the main exposure basis for a staffing agency's workers comp and liability, so an accurate estimate matters most here.

Control: money
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Years in business and staffing experience

If the business is already operating: how many years has the business operated, and how many years of staffing or industry experience do you have?

Carriers rate staffing agencies partly on how long the business and its principals have operated in this field.

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Higher-hazard placements

Do you place workers in any of these higher-hazard roles? (Select all that apply.)

Placing workers to operate cranes, drive trucks, work on scaffolding, handle hazardous materials, or work on aircraft or watercraft changes the risk sharply, and some carriers exclude these, so we flag them up front.

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Crane or bulldozer operation; Truck driving; Long-haul trucking; Hazardous materials handling; Scaffolding erection or assembly; Aircraft or watercraft; None of these apply

Transporting placed employees

Do you transport your placed employees to job sites? (Yes/No; if yes, is it in vehicles the business owns?)

Transporting workers, especially in company-owned vehicles, creates an auto exposure the underwriter needs to account for.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Driver screening for placed drivers

If you place workers who drive, which of these do you do? (Select all that apply.)

For any placement that drives, carriers look for motor vehicle record checks at hire, annual re-checks, and driver training before they will quote the auto exposure.

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Motor vehicle records (MVRs) at hire; Annual MVR re-checks; Driver training or evaluation; Not applicable - we do not place drivers

Employment practices in place

Which of these employment practices does the business have in place? (Select all that apply.)

Employment practices liability underwriters look for a standard application, a handbook, at-will language, and written anti-harassment and anti-discrimination policies. Answering honestly, including what is not in place yet, helps set expectations with the carrier.

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Standard employment application; Employee handbook; Documented handbook receipt; At-will provision; Written anti-harassment policy; Written anti-discrimination policy; Collect or store biometric data; None of these yet

Criminal background checks

Do you run criminal background checks on workers before placing them? (Select all that apply.)

Background screening is a core underwriting control for a staffing agency and affects several coverages, so carriers ask which level of check you perform.

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: National criminal check; State criminal check; Local criminal check; None yet

Client service agreement terms

Does your written client service agreement include all of the following? (Select all that apply.)

The Berkley/employee-leasing market requires the client contract to confirm workers comp, employers liability, a mutual hold-harmless, and client supervision before it will offer terms, so this asks which are already in your agreement.

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Employees covered by workers compensation; Employers liability required; Mutual hold-harmless; Client provides supervision and carries workers comp; None of these

Business other than staffing

Is the business involved in, or does it own an interest in, any business other than staffing? (Yes/No)

Any non-staffing operation or affiliated entity can bring its own exposures onto the policy, so underwriters ask about it directly.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Employees holding professional licenses

Do any of the workers you place hold professional licenses or certifications? (Yes/No; if yes, describe)

Placing licensed professionals (nurses, engineers, accountants, and similar) adds a professional-liability exposure the underwriter needs to size.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Prior-employment verification

Do you verify prior employment on all new hires before placing them? (Yes/No)

Verifying work history is a basic screening control underwriters expect from a staffing agency.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Human resources department

Does the business have a human resources department or function? (Yes/No)

An in-house HR function is a favorable employment-practices control, so carriers ask whether one is in place.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Franchise operations

Is the business part of, or does it operate, any franchise? (Yes/No)

Franchise arrangements change how the risk is structured, so underwriters flag them.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Taking over a client's workforce

Do you, or will you, take over a client's department or another staffing firm's employees and move them onto your payroll? (Yes/No)

Absorbing an existing workforce brings unknown prior exposures onto your policy, so carriers underwrite it separately.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Clinical trial placements

Do you specialize in clinical trial placements, such as recruiting participants or setting up trials? (Yes/No)

Clinical trial work carries a distinct liability profile that several carriers exclude, so it is a knockout question up front.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Video game developer clients

Do you place, or will you place, workers with video game developer clients? (Yes/No)

This is a specific carrier screening question because of the intellectual-property and professional exposures involved.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Healthcare placements in corrections or mental health

Do you make healthcare placements in correctional facilities or mental health institutions? (Yes/No)

These settings carry a higher abuse and liability exposure, so carriers underwrite them separately.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Cannabis industry placements

Do you provide services or place workers in the cannabis industry? (Yes/No)

Cannabis exposure is excluded or specially underwritten by many carriers, so it is a required screening question.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Coverage and claims history

In the last 5 years, has any insurer declined, cancelled, or non-renewed coverage for the business, or are you aware of any claim, incident, or circumstance that could lead to a claim? (Yes/No; if yes, explain)

Carriers always ask about adverse insurance history and known circumstances. It does not disqualify you, but disclosing it up front lets us place you with the market that treats your history best.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Sensitive personal information handled

Which kinds of sensitive personal information does the business collect or store for candidates, clients, or third parties (not counting your own employees)? (Select all that apply.)

Staffing agencies hold large volumes of personal data, so this drives the optional cyber and privacy portion of the application.

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Social Security, bank, or driver's license numbers; Medical or health information (PHI); Credit or debit card information

Quick Eligibility Check: Quick Eligibility Check (1 questions)

Excluded products and operations

Do any of these apply to your food business: a restaurant, cafe, bakery, or storefront customers walk into (owned or leased); serving or selling alcohol; CBD or hemp products; supplements, energy drinks, kombucha, or weight-loss products; baby food; or importing seafood, meat, or poultry?

The quick online policy is built for mobile and home-based food businesses. If any of these apply, Lee can quote the business through a different market instead, which avoids a policy that would not pay a claim.

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Restaurant / cafe / storefront customers walk into; Serving or selling alcohol; CBD or hemp products; Supplements, energy drinks, kombucha, or weight-loss products; Baby food; Importing seafood, meat, or poultry; None of these

Medical Spa Specific Questions: Medical Spa Specific Questions (24 questions)

Procedures offered

Which of these procedure categories do you offer? (Select all that apply.) Injectables (Botox, dermal fillers); Laser and IPL treatments; IV therapy or vitamin infusions; Weight management or GLP-1 injections; Body contouring (CoolSculpting, RF, HIFEM); Microneedling, PRP, or PRF; Chemical peels and medical facials; Permanent makeup or microblading; Laser or waxing hair removal; Threads or minor in-office surgical procedures.

Your procedure mix is the single biggest driver of which carriers will write a medspa and at what price. Injectables, lasers, and any in-office surgical work raise the hazard, so flagging them up front lets us go straight to the right market.

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Injectables (Botox, dermal fillers); Laser and IPL treatments; IV therapy or vitamin infusions; Weight management or GLP-1 injections; Body contouring (CoolSculpting, RF, HIFEM); Microneedling, PRP, or PRF; Chemical peels and medical facials; Permanent makeup or microblading; Laser or waxing hair removal; Threads or minor in-office surgical procedures; None of these

Medical director / supervising physician

Who is your medical director or supervising physician? Please give their name and medical license number.

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Medical supervision & protocols

How are treatments medically supervised? Is a physician, NP, or PA on site or on call, and who writes the standing orders and treatment protocols your staff follow?

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Staff licensing

What licenses do your treating staff hold (MD/DO, NP, PA, RN, licensed esthetician, laser technician), and roughly how many of each?

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Good-faith exam before treatment

Is a physical exam and/or bloodwork required before prescribing medication or performing a treatment? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Informed consent

Are signed consent forms obtained for every procedure, including parental consent for minors? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Tier 1 services

Which of these services do you offer? (Select all that apply.)

The carrier's application lists services in three groups and asks which ones you offer. Your service mix generally affects which carriers can consider the business and how it is priced.

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Membership or loyalty programs; Sound and vibration relaxation therapy; Custom facials; Microblading, micro-shading, powder brows; Waxing, sugaring, and threading; Vitamin infusion facials; Gua Sha and contour massage facials; HydraFacial, Préime DermaFacial, OxyGeneo; Personalized skincare planning; Aromatherapy and oxygen bars; Scalp micropigmentation and areola restoration; Brow lamination and shaping; Laser hair removal; Pigment-control protocols (tranexamic acid, mesotherapy); Oxygen or enzyme facials; Dermaplaning; AI-based skin analysis; Paraffin hand and foot therapy; Lip blushing and permanent eyeliner; Lash lifts, tints, extensions; Complexion and pigment correction; LED light therapies (red, blue, NIR, amber); LED-assisted or lymphatic drainage facials; Microdermabrasion; None of these

Tier 2 services

Which of these services do you offer? (Select all that apply.)

The carrier's application lists services in three groups and asks which ones you offer. Your service mix generally affects which carriers can consider the business and how it is priced.

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Chemical peels (TCA, glycolic, salicylic); Weight management (GLP-1s, lipotropics); Tattoo removal (Q-switch/picosecond laser); Laser acne therapy (1450 nm, 1726 nm, 1064 nm); HIFEM / EMS muscle-building devices; IPL and BBL photorejuvenation; RF microneedling (face, neck, body); Non-surgical labial rejuvenation; Exosome facials and injections; Kybella / deoxycholic acid (submental or body areas); Skin boosters and bio-remodelers (Profhilo, Rejuran, NCTF); Microneedling and nano-needling; Hormone replacement or testosterone optimization; Photodynamic therapy (ALA + light); Lymphatic drainage / compression therapy; Laser or RF lipolysis (non-invasive); HIFU technologies (Ultherapy, Sofwave); Picosecond and non-ablative resurfacing; Microneedling with biologics (PRP, PRF, exosomes); PRP, PRF, PRFM injections and facials; Treatments for facial lines, masseter slimming, platysmal bands, lip flip, hyperhidrosis; Hyper-dilute CaHA / PLLA for skin tightening; Cryotherapy / infrared sauna / red-light therapy; Glutathione and B12 injections; LED acne treatments (blue/red light); Acoustic wave and RF cellulite reduction; Cryolipolysis (CoolSculpting or equivalents); Monopolar or multipolar RF tightening; CO₂ or Er:YAG laser resurfacing; Stem-cell-derived growth factor treatments; Sclerotherapy (reticular and spider veins); Botulinum toxin injections; CaHA, PLLA, and PMMA fillers; Hyaluronic acid fillers; None of these

Tier 3 services

Which of these services do you offer? (Select all that apply.)

The carrier's application lists services in three groups and asks which ones you offer. Your service mix generally affects which carriers can consider the business and how it is priced.

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Micro-lipo / mini-lipo (small-volume); Chin or jawline implant adjustments (office-based); Scar revision, cyst, or benign lesion excision; Collagen-stimulating butt lift (injectable or energy-assisted); Lower blepharoplasty (in-office); Transfer (micro / nano-fat grafting); PDO, PLLA, or PLA thread lifts (face, neck, brow, body); Lip lift (performed under local anesthesia); None of these

Number of locations

How many locations does the business operate?

Control: countslider
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: None

Cost of goods sold

What is your annual cost of goods sold (products and consumables)?

Express pricing on this program requires annual revenue minus cost of goods sold to be $1,000,000 or less, so the carrier needs both numbers.

Control: money
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Number of practitioners

How many total practitioners perform treatments at the business?

Control: countslider
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: None

Annual patient visits

Roughly how many patient visits do you handle per year?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Device maintenance

Are all devices maintained and serviced regularly per the manufacturer's recommendations? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Practitioners licensed & trained

Are all practitioners properly licensed and trained for the services they perform? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Prescriptions by licensed professional

Are all prescriptions written by a licensed medical professional, where applicable? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Adverse-event process

Do you have a standard written process for handling adverse events and patient complaints? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Health & safety compliance

Do all locations comply with state and local health and safety regulations? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Property / equipment coverage

Do you want property or equipment coverage quoted? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Business income limit

If you want business income coverage, what limit would you like?

Control: money
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Employment practices liability

Would you like employment practices liability coverage quoted? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Sexual abuse & misconduct coverage

Would you like sexual abuse and misconduct liability coverage quoted? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Industry association member

Are you a member of any industry association? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Association names

If yes, which association(s)?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Life Sciences Specific Questions: Life Sciences Specific Questions (73 questions)

Products & Services Mix

What do you make, sell, or distribute, and roughly what percentage of your revenue comes from each? Categories: pharmaceuticals, generic drugs, biopharmaceuticals, biosimilars, medical devices, contract manufacturing/services, distribution, research, dietary supplements/nutraceuticals, equipment rental, repair/service, other.

This is the single most important answer for a life-sciences risk. Carriers price products liability by exactly what you make and in what proportion.

Control: percentage mix
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Pharmaceuticals (NDA); Generic pharmaceuticals (ANDA); Biopharmaceuticals (NDA); Biosimilars; Medical devices; Contract services; Distribution; Research; Dietary supplements / nutritional; Equipment rentals / leasing; Repair / installation / service; Other

Business Model

How do you bring products to market? (Select all that apply.) Under your own name / label; Contract manufacturing or services for others; Distribute or resell others' products; Repackage.

Whether you make your own label, produce for others, or only distribute changes who is liable and how the risk is rated.

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Under your own name / label; Contract manufacturing or services for others; Distribute or resell others' products; Repackage

Ingredient & Component Sourcing

Where do you source your ingredients, components, or finished products, and do you import any? If you import, list the countries of origin.

Imported ingredients (especially APIs and botanicals) carry supply-chain and adulteration exposure carriers weigh heavily.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

FDA / FTC Compliance

To the best of your knowledge, are you in compliance with FDA (and FTC where applicable, or the foreign-agency equivalent) regulations? Have you received any FDA warning letters or 483 observations, or have any open product recalls? (Yes/No; if any issues, explain.)

Regulatory standing is the first thing a life-sciences underwriter checks.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Product Recalls

How many product recalls have you had in the past 3 years, and please describe any Class I recall.

Recall history is a primary rating and eligibility factor for products liability.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Human Clinical Trials

Do you conduct or sponsor any human clinical trials? (Yes/No)

Human clinical trials are a distinct, higher-hazard exposure that needs its own coverage part (HCT).

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Batch Testing & Traceability

Do you batch-test your products and keep records tracing when, where, and by whom each batch was manufactured, and to whom it was sold?

Batch records let a recall be contained to affected lots instead of your entire catalog, which materially lowers the risk.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Label & Claims Review

Are your product labels, claims, and advertising reviewed for regulatory compliance before use? (Yes/No; note who reviews them.)

Non-compliant labels and unsubstantiated health claims are the leading cause of nutraceutical and supplement claims.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Previous Names

List any previous names under which you have operated.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Subsidiaries / Acquisitions

List any acquired companies or subsidiaries.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Trade Organization

Are you a member of any trade organization? If yes, which ones?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Domestic Revenue

Projected current-year domestic revenue.

Control: money
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Foreign Revenue

Projected current-year foreign (non-US) revenue.

Control: money
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Units Sold

Projected current-year units sold (drugs / devices).

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Customers

What types of business entities do you sell to (e.g. retailers, distributors, hospitals, direct-to-consumer)?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Insurance Declined

In the past 5 years, has any insurance been declined, cancelled, or nonrenewed? If yes, explain.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Customer Complaints

Number and details of any customer complaints about your products or services in the past 5 years.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Product-Safety Violations

Have you been in violation of any consumer product safety act or other federal or local legislation? If yes, provide details.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Pharmaceutical Types

If you make pharmaceuticals: describe the types (e.g. active ingredients, injectable, oral, topical, over-the-counter, vaccines, hormones/steroids, blood products) and approximate mix.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Products Without FDA Approval

Any past, present, or planned products without formal FDA marketing approval (e.g. DESI, OTC monograph, drug review)? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Device FDA Registration

If you make medical devices: FDA registration number (if applicable).

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Medical Device Detail

If you make medical devices: FDA class (I / II / III), device types, and projected sales/units.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Contract Services

If you provide contract or outsourced services: describe each type and its projected annual revenue (e.g. manufacturing for others, sterilization, clinical trials, lab, consulting).

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Contracts In Force

How many service or manufacturing contracts are currently in force?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Top Clients

Top clients: contract size, length, and product/service provided.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Discontinued Services

Have you discontinued any services in the past 5 years? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Failure Impact

What is the largest financial and business impact on your customers from a failure of any of your products or services?

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Others' Property Value

Projected total value of others' personal property at your facility.

Control: money
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Used Equipment

Do you purchase, sell, or lease used equipment? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Recondition Used Equipment

If you sell used equipment, do you recondition or repair it before resale? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Repair / Install

Do you repair or install any products? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Healthcare At Site

Are any healthcare services performed at your site? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Return Policy

Describe your customer return policy.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Vendor Certificates

Do you obtain certificates of product-liability insurance from your manufacturers and suppliers? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Non-Supplement Products

Name and describe any product you sell that is NOT a dietary supplement as defined by the Dietary Supplement Health and Education Act of 1994 or by the FDA.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

High-Hazard Supplement Mix

Approximate percentage of supplement revenue from weight-loss, body-building/sports-nutrition, and sexual-enhancement/erectile-dysfunction products.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Flagged Ingredients

Do any products contain creatine, kava, magnolia, or yohimbe? List product, dosage, and estimated sales.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

New Dietary Ingredient

Has any product ever fit the definition of a new dietary ingredient? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Drug-Defined Ingredient

Has any product ever had an active ingredient that would be defined as a drug by a regulatory agency? If yes, which product and ingredient?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Multi-Level Marketing

Do you sell any of your products through a multi-level marketing system? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Health / Structure Claims

Do any of your products make health or structure/function assertions? If yes, describe and explain how they are substantiated.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Trial Summary

For each trial: product(s), protocol/phase, number of subjects enrolled, and status (planned / ongoing / completed).

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Trial Previously Excluded

Has any human clinical trial been excluded, uninsured, or self-insured from any previous coverage? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Trial Subjects Under 18

Do any clinical trials involve persons under 18? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Pregnant Trial Subjects

Do any clinical trials involve pregnant women? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Serious Adverse Events

Have there been any serious adverse events reported (SAER) in connection with your trials? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Trial Deaths

Have any trials resulted in death? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Trial Halted For Safety

Have any trials involving your product been discontinued or placed on hold for safety reasons? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

In-Patient Facility

Do you operate an in-patient facility? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Direct Patient Care

Do any of your employees provide direct patient care? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Black-Box Warning

Do any of your products require a black-box warning? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Controlled Substances

Are you involved in the sale of any controlled substances, or any other products requiring DEA registration? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Off-Label Use

Do you promote, or are you aware of, any off-label use of your products? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Approved For Minors

Are any products approved for persons under the age of 18? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Products Discontinued For Safety

Have any products been discontinued for safety reasons? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Banned Products

Do you have any association with banned products? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Last FDA Inspection

When was your last FDA inspection?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

FDA 483

Were you issued an FDA 483 form? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

FDA Warning Letter

Have you received any warning letters from the FDA? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

REMS

Identify any product requiring a Risk Evaluation & Mitigation Strategy (REMS).

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Staff In Procedures

Are any of your employees or contractors present during patient procedures, surgeries, or examinations? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

GxP Citation

In the past 5 years, have you been cited for non-compliance with any GCP, GLP, GMP, QS, or advertising/promotion guidelines? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Risk Manager

Do you have a risk manager on site? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Quality-Control Program

Do you have a formal written quality-control program? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Recall Plan

Do you have a formal product-recall plan? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Material Control

Describe how you control your materials to assure product purity and safety.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Hazardous Substances

Do you keep hazardous substances on site? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Hazardous Quantity

If yes, approximately how many gallons are kept on site?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Biohazard Rating

Highest biohazard lab rating (e.g. BSL-1 to BSL-4), if any?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Animal Facility

Do you have an animal facility or house animals? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Information-Security Policy

Do you have a formalized information-security policy governing access to critical data and systems? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Privacy Policy

Do you have a formalized privacy policy in place? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Crisis-Management Team

Do you have a crisis-management team in place? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Products & Product Liability: Products & Product Liability (31 questions)

Business role

Which best describes the business: Retailer, reselling products made by others; Manufacturer; Distributor or wholesaler; Direct importer; Broker, arranging sales without handling the product; or A mix or other?

Your role in making, importing, or reselling products helps describe the business to the carrier.

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Retailer, reselling products made by others; Manufacturer; Distributor or wholesaler; Direct importer; Broker, I arrange sales but never handle the product; A mix or other

Products & end users

What products do you make or sell, and who typically uses them? Please describe your main product lines and whether they are aimed at consumers, businesses, or both.

The product itself sets the hazard class. A clear picture of what it is and who uses it lets us describe the risk accurately and avoid coverage disputes later.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Foreign sales

Are any of your products sold outside the United States? If yes, in which countries?

Foreign sales change the legal landscape a claim can arrive from, so carriers ask for the split and the countries involved.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Prior-year sales

For each of the past 4 years, roughly what were your gross sales? Please split U.S. and foreign sales if any products were sold abroad.

Product liability is rated on sales, and the multi-year picture shows the underwriter how the exposure has grown.

Control: rows
Response needed when shown: Optional
Shown when: When this step is shown in the live form.

Products made by others

Do you sell products made by another business, including products you buy from U.S. wholesalers? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Contract manufacturing

Does another business make products to your designs or for your own brand? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Install / service / repair

Do you install, service, repair, or maintain your products after the sale? If yes, roughly what percent of sales does that work represent?

Completed-operations claims from installation or service work are rated separately from the products themselves.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Quality control program

Do you have a formal written process for checking product quality and testing products you make or sell? (Yes/No)

Carriers may consider a written quality-control and testing process when evaluating the application.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Recall procedure

Do you have a formal written product recall procedure? (Yes/No)

A recall plan shows the carrier you can limit how far a defective batch spreads, which matters as much as preventing the defect.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Recalls

Have you ever recalled a product, or are you considering recalling one now? If yes, please describe.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Products made outside the U.S.

About what share of the products you sell are made outside the U.S.? Your best estimate is fine. If you buy from U.S. wholesalers and do not know, choose Not sure.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Original packaging and labels

Do you sell products in the manufacturer's original packaging with the manufacturer's labels and instructions, without relabeling or repackaging? If no, describe what you change.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Direct imports

If you sell products made by someone else: do you directly import any of them? If yes, what are the products and their countries of origin?

A direct importer is treated by U.S. courts much like the manufacturer, so carriers underwrite imported lines closely.

Control: yesno
Response needed when shown: Yes when shown
Shown when: Products made by others starts with Yes
Options: Yes; No

Supplier certificates of insurance

Do you obtain certificates of product liability insurance from your manufacturers and suppliers? If yes, what minimum limits do you require?

A supplier's own product liability coverage is the first line of defense when their product fails; carriers reward distributors who collect certificates.

Control: yesno
Response needed when shown: Yes when shown
Shown when: Direct imports starts with Yes
Options: Yes; No

Named as additional insured by suppliers

Do all suppliers whose products you sell carry product liability insurance that names your business as an additional insured vendor?

Any vendor additional-insured coverage depends on the supplier's policy wording and insurer approval.

Control: yesno
Response needed when shown: Yes when shown
Shown when: Products made by others starts with Yes
Options: Yes; No

Written sub-manufacturer agreement

If someone else manufactures products for you: do you have a formal written agreement with them? (Yes/No)

A written agreement that addresses product liability is how the carrier knows who stands behind a defect.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Records retention

How long do you keep your quality control, testing, and product records?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Product identification

Could you identify your own product versus a competitor's, for example by serial numbers, branding, labeling, or batch codes? (Yes/No)

If you can prove a failed product isn't yours, you can walk away from a claim entirely; carriers rate on that traceability.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Records you keep

Which of these records do you keep? (Select all that apply.) When and where each product was made; Who bought each product and when it was sold; Which suppliers provided parts or materials; Design changes over time; Advertising and labeling changes over time.

Each record type is its own underwriting question. The more of the product's paper trail you keep, the easier a claim is to defend, and the better your application looks.

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: When and where each product was made; Who bought each product and when it was sold; Which suppliers provided parts or materials; Design changes over time; Advertising and labeling changes over time; None of these

Who designs the products

Who designs the products you make or sell, for example your staff, an outside design firm, or the manufacturer? If you buy ready-made products and do not know, choose Not sure.

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Outside design review

Are your product designs reviewed or tested by anyone outside the design team? If yes, by whom, and what are their credentials?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Labels reviewed by counsel

Has an attorney reviewed the warning labels and instructions for products you make or sell? (Yes/No)

Carriers may ask whether an attorney has reviewed product warnings and instructions.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Government or industry standards

Do any government rules or industry standards apply to products you make or sell, such as UL, ASTM, FDA, or CPSC rules? If yes, name them and tell us whether you fully comply. If you buy from U.S. wholesalers and do not know, choose Not sure.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

ISO / QS certification

Is the business certified under ISO 9002, QS 9000, or a similar quality standard? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Customer training offered

Do you offer training to customers on the use of your products? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Trainees certified

If you offer training: do you certify the people you train? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Nanotechnology

Do any of your products employ nanotechnology, that is, engineered particles at the nanometer scale? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Nanoparticles embedded

If nanotechnology is used: are the nanoparticles embedded or fixed so they will not be released from the product? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Businesses or product lines acquired

Have you purchased any businesses or product lines in the last 5 years? If yes, please describe what was acquired and when.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Discontinued products

Have you discontinued any products? If yes, describe each discontinued product and its rough historical sales.

Discontinued products can still produce claims years later, so the carrier prices the tail exposure from past sales.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Regulator complaints or notices

In the last 3 years, have you had any complaint or notice filed with, or received from, a government agency such as the Consumer Product Safety Commission (CPSC) about any of your products? If yes, please describe.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Distributor / Wholesaler Specific Questions: Distributor / Wholesaler Specific Questions (26 questions)

Goods distributed

What goods do you distribute or wholesale? Please describe your main product lines, and note whether the goods are new, used, or both.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Operations

Do any of these apply to your operations? (Select all that apply.)

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: More than 25% of sales from used goods; Consignment sales; Equipment rental (including golf carts); Rental or sales of diving equipment; Rental or sales of firearms, weapons, or ammunition; Setup or installation of fitness or exercise equipment; Sales, rental, or repair of paintball guns or supplies; Paintball gaming operations; None of the above

What you do to the products

Which of the following do you do to the products you sell? (Select all that apply.)

Re-labeling, repackaging, assembling, designing, or manufacturing a product moves you up the product-liability chain, so carriers rate those operations differently than pure pass-through distribution.

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Re-label; Repackage; Design (or have designed on my behalf); Assemble; Manufacture (or have manufactured on my behalf); None of the above

Direct imports

Do you directly import any of the goods you sell? If yes, please describe the goods and roughly what percent of your total sales come from imported products.

When a distributor imports directly, product-liability claims that would normally fall on a U.S. manufacturer can land on you, so carriers ask about it closely.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Dietary supplements

Do you sell or distribute any dietary supplements? If yes, roughly what percent of total sales do they represent?

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Common ownership: the other businesses

If you hold 50% or more of another business: please list those businesses and note whether their operations are included in this quote or insured elsewhere.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Known losses or incidents

Are you aware of any accidents, incidents, losses, or claims that have happened, or that could lead to a claim under the policy? If yes, please describe.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Assembly: percent of sales

If you assemble products: roughly what percent of sales comes from goods you assemble?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Assembly process

Describe your assembly process, including the tools and equipment used.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Design: percent of sales

If you design (or have designed on your behalf) products: roughly what percent of sales comes from those goods?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Products designed

Describe the products you design or have designed on your behalf.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Repackaging: percent of sales

If you repackage products: roughly what percent of sales comes from repackaged goods?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Changes to instructions

When you repackage, do you change any instructions or manuals? If yes, describe the changes.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Re-labeling: percent of sales

If you re-label products: roughly what percent of sales comes from re-labeled goods?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Manufacturing: percent of sales

If you manufacture (or have manufactured on your behalf) products: roughly what percent of sales comes from those goods?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Distributor products made outside the U.S.

About what share of the products you sell are made outside the U.S.? Your best estimate is fine. If you buy from U.S. wholesalers and do not know, choose Not sure.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Distributor original packaging and labels

Do you sell products in the manufacturer's original packaging with the manufacturer's labels and instructions, without relabeling or repackaging? If no, describe what you change.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Distributor U.S. suppliers' vendor endorsement

Do your U.S. suppliers carry product liability insurance that names your business as an additional insured vendor?

Control: yesno
Response needed when shown: Yes when shown
Shown when: Direct imports is No
Options: Yes; No

Multiple imported product lines

Do you import multiple products or product lines? If yes, roughly what percent of sales come from them?

Control: yesno
Response needed when shown: Yes when shown
Shown when: Direct imports starts with Yes
Options: Yes; No

Country of origin

What are the countries of origin for the goods you import? (Select all that apply.)

Control: multichips
Response needed when shown: Yes when shown
Shown when: Direct imports starts with Yes
Options: EU member state; Canada; Japan; Australia; New Zealand; South Korea; Israel; China; Mexico; Other

Imported goods: percent of total sales

What percent of your total sales come from imported goods?

Control: line
Response needed when shown: Yes when shown
Shown when: Direct imports starts with Yes

Imported goods: total annual sales

What are your total annual sales from imported products?

Control: money
Response needed when shown: Yes when shown
Shown when: Direct imports starts with Yes

Product testing to U.S. standards

Are imported products tested to confirm they meet U.S. standards? If yes, who conducts the testing (your own employee, a U.S.-based contractor, a foreign contractor, the manufacturer, or someone else)?

Control: yesno
Response needed when shown: Yes when shown
Shown when: Direct imports starts with Yes
Options: Yes; No

Warnings and instructions provided

Are warnings, labels, and assembly or operating instructions provided with the imported products? If no, explain why not.

Control: yesno
Response needed when shown: Yes when shown
Shown when: Direct imports starts with Yes
Options: Yes; No

Foreign manufacturer standing

Which protections do the foreign manufacturers provide for goods you import directly? Select all that you know apply, or choose Not sure.

Any vendor coverage or supplier agreement depends on its written terms and applicable policy wording.

Control: multichips
Response needed when shown: Yes when shown
Shown when: Direct imports starts with Yes
Options: Provides U.S. vendors coverage to wholesalers for all products distributed; Carries domestic U.S. vendors coverage; Has a U.S.-domiciled operation or assets in the U.S.; Has a written contract to add me as additional insured and hold me harmless; Has a written contract to cover product recall expenses and reimburse me for product-related losses; Purchase order or verbal agreements only; None of the above

Wind / hail losses

How many wind or hail losses have you had in the last 3 completed policy years plus the current year to date?

Control: line
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Smoke Shop Specific Questions: Smoke Shop Specific Questions (21 questions)

Products and operations

Do you do any of these? Select all that apply: ammunition sales or reloading; fireworks sales; pre-owned cribs, children's furniture, or used children's clothing; mad honey; kratom or products containing kratom; gun sales or repair; tire dealer. Choose 'None of these' if none apply.

These operations fall outside most smoke-shop carriers' appetite. Flagging any up front lets Lee approach a market that can cover them, rather than a policy that would not respond.

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Ammunition sales or reloading; Fireworks sales; Pre-owned cribs, children's furniture, or used children's clothing; Mad honey; Kratom or products containing kratom; Gun sales or repair; Tire dealer; None of these

Cannabis / THC products

Do you sell cannabis, or any product containing THC or synthetic THC, including hemp-derived Delta-8? (Yes/No)

THC and synthetic-THC products are underwritten very differently from ordinary tobacco and vape, and many carriers exclude them, so this is one of the most important answers for placing a smoke shop.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Age verification

Do you check and validate the age of every customer? (Yes/No)

Age verification is a core control for tobacco, vape, and related products, and carriers weigh it heavily.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Onsite consumption

Does any onsite consumption take place on the premises, such as a hookah or smoking lounge? (Yes/No)

On-site smoking or a lounge adds fire and liability exposure that a retail-only shop does not have.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Late hours

Are you open past 12:00 AM? (Yes/No)

Late-night hours raise the risk of theft and after-hours incidents, so carriers factor them into pricing.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Lottery sales

Do you sell lottery tickets? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Weapon on premises

Do you keep a weapon on the premises? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Direct imports

Do you directly import any of the products you sell? (Yes/No)

Importing directly can shift product-liability claims that would normally fall on a U.S. manufacturer onto you, so carriers ask about it closely.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Sells imported products

Do you sell any imported products, whether or not you import them yourself? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Blending / mixing / repackaging

Do you do any blending, mixing, or re-packaging of products, for example mixing your own e-liquid? (Yes/No)

Physically altering a product moves you up the product-liability chain, so carriers rate it differently than reselling sealed goods.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Own-label products

Do you sell any products under your own label, or relabel or repackage products as your own brand? (Yes/No)

Selling under your own brand can make you the product's manufacturer in the eyes of the law, which changes your product-liability exposure.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Storefront

Is this location a storefront that customers walk into? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Warehouse on site

Do you have a warehouse at this location? (Yes/No)

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Detached parking lot

Do you have a parking lot that is not attached to the building? (Yes/No)

A detached lot you are responsible for adds slip, trip, and fall exposure separate from the store itself.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Habitational exposure

Does this location have any habitational exposure, such as apartments, dorms, sober living or a halfway house, a nursing home or assisted living, dwellings, a mixed-use building with apartments or condos overhead, a hotel or motel, a shelter, or a short-term rental like Airbnb? (Yes/No)

Overnight-occupancy exposure at or above your shop changes which carriers can write the risk and how the building is rated.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Planned major renovation

Are you planning a major renovation during the policy term, meaning structural work or a project that exceeds 20% of the building's value? (Yes/No)

A major renovation changes the building's risk during construction and may need a mid-term update or a separate builder's-risk policy.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Business income limit

What limit would you like for Business Income with Extra Expense coverage? This replaces lost income and covers extra costs if you have to close temporarily after a covered loss. Enter a limit, or None if you are not sure.

Business Income with Extra Expense keeps paying your rent, payroll, and lost profit while you recover from a covered shutdown, so the limit should reflect the income you would need to stay afloat.

Control: money
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Smoke shop products made outside the U.S.

About what share of the products you sell are made outside the U.S.? Your best estimate is fine. If you buy from U.S. wholesalers and do not know, choose Not sure.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Smoke shop original packaging and labels

Do you sell products in the manufacturer's original packaging with the manufacturer's labels and instructions, without relabeling or repackaging? If no, describe what you change.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Smoke shop U.S. suppliers' vendor endorsement

Do your U.S. suppliers carry product liability insurance that names your business as an additional insured vendor?

Control: yesno
Response needed when shown: Yes when shown
Shown when: Direct imports is No
Options: Yes; No

Continuous prior coverage

Have you had continuous general liability and property coverage in place since the business was established, with no gaps? (Yes/No)

A gap in past coverage is something carriers ask about. Disclosing it up front lets Lee approach the markets that treat it best.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Salon / Shop Specific Questions: Salon / Shop Specific Questions (8 questions)

Stylists / barbers

How many stylists or barbers work at the shop now, or do you expect to over the next 6 to 12 months?

Headcount is a rating basis on salon policies, and forward-looking numbers matter because the audit is taken on what the year actually looked like.

Control: countslider
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: None

W-2 employees

Of those, how many are W-2 employees on your payroll?

W-2 staff and booth renters are rated differently. Renters generally need their own policy, and an uninsured one can be charged back to yours at audit.

Control: countslider
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: None

Booth / chair renters

How many are booth or chair renters who run their own books? To be treated as renters rather than your employees, they will generally need to carry their own insurance.

If a booth or chair renter doesn't carry their own liability coverage, carriers usually treat them as your employee at audit, which adds their pay to your payroll basis and raises your premium. Asking each renter for proof of their own policy keeps them off your policy and counted as a true renter.

Control: countslider
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: None

Licensing

Are all stylists and barbers licensed as required by state law? (Yes/No)

Carriers generally condition salon coverage on properly licensed operators, so an unlicensed stylist can put a claim in dispute.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Stations / chairs

How many stations or chairs does the shop have?

Station count is the standard size measure for a salon and drives both the liability and the contents figures.

Control: countslider
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: None

Primary services

Which of these are among your primary services? Select all that apply: whole body treatments; facials; massage (beyond hand, neck, or foot during a nail service); waxing (beyond the face); aromatherapy; steam room or sauna; none of these.

The service mix decides the market. Cutting and color sit inside most salon programs, while injectables, laser and body treatments generally move the account to a medical or spa market.

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Whole body treatments; Facials; Massage (beyond nail service); Waxing (beyond the face); Aromatherapy; Steam room or sauna; None of these

Specialized services

Do you offer any of these services? Select all that apply: cosmetic manufacturing; cryotherapy; hydrotherapy; colon cleanse procedures; tattooing or tattoo removal; skin injections; laser treatments (hair removal, skin, or fat reduction); intense pulsed light (IPL) therapy; overnight or lodging accommodations; an exercise center with fitness equipment; none of these.

These higher-hazard services change which carriers will offer coverage, so it helps to flag them up front.

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Cosmetic manufacturing; Cryotherapy; Hydrotherapy; Colon cleanse procedures; Tattooing or tattoo removal; Skin injections; Laser treatments (hair/skin/fat); Intense pulsed light (IPL); Overnight / lodging; Exercise / fitness center; None of these

Own-label products

Do you sell any products that you re-label, repackage, or manufacture yourself, rather than reselling them as-is? (Yes/No) If yes, which products (hair care, cosmetics, styling tools, skin care, or other) and please describe.

Re-labelling or making your own products makes you the manufacturer in the eyes of a products-liability claim, which is a different exposure from reselling a brand as-is.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Quick Eligibility Check: Quick Eligibility Check (1 questions)

Excluded services

Do any of your services involve: microblading or permanent makeup; piercings, needles, or anything that punctures the skin; laser or IPL treatments; electrolysis; tanning beds; or any procedure that requires a medical license?

These services sit outside the quick online beauty and bodywork policy. A few, like acupuncture and cupping, can be added back as an endorsement, so mention those in the comments if they apply and Lee can point you the right way.

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Microblading or permanent makeup; Piercings, needles, or skin-puncturing services; Laser or IPL treatments; Electrolysis; Tanning beds; Procedures requiring a medical license; None of these

Quick Eligibility Check: Quick Eligibility Check (1 questions)

Excluded ingredients and products

Do any of your products contain or involve: talc; CBD or other ingestible hemp; formaldehyde (including some nail polishes); prescription ingredients; plug-in or electrical devices; vitamins or supplements; or permanent or invasive cosmetics?

Product liability for a beauty line is priced on the ingredient list. Any of these puts the line outside the quick online product, and Lee can quote a specialty market instead.

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Talc; CBD or ingestible hemp; Formaldehyde (incl. some nail polishes); Prescription ingredients; Plug-in or electrical devices; Vitamins or supplements; Permanent or invasive cosmetics; None of these

Quick Eligibility Check: Quick Eligibility Check (2 questions)

Excluded work types

Does your work include any of these: drone or aerial filming you want covered; adult-content work (now or in the past); or paparazzi-style work?

Drone liability is not included in the online photo and video policy, and the carrier declines adult or paparazzi work outright. Lee can quote drone coverage separately if you need it.

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Drone / aerial filming to be covered; Adult-content work (now or past); Paparazzi-style work; None of these

Claims, cancellations, and privacy complaints

In the past 5 years, have you had a liability claim over $5,000, a policy cancelled or non-renewed, or any complaint involving privacy, identity theft, or libel?

The online application asks this word for word, so knowing it up front saves you from starting an application the carrier would decline.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Quick Eligibility Check: Quick Eligibility Check (2 questions)

Excluded pet operations

Do any of these describe your pet business: training guard, protection, or police dogs; breeding; kennel or long-term boarding; caring for more than 10 pets at a time or more than 5 overnight; transporting more than 5 animals at once; or working with exotic or non-domestic animals?

The quick online pet-care policy covers everyday sitting, walking, grooming, and training. Higher-volume or specialized operations are rated differently, so Lee can quote those through other markets.

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Guard, protection, or police dog training; Breeding; Kennel or long-term boarding; More than 10 pets at a time, or more than 5 overnight; Transporting more than 5 animals at once; Exotic or non-domestic animals; None of these

Annual revenue check

Is your annual pet-care revenue more than $100,000?

The online pet-care program caps eligible accounts at $100,000 in annual sales. Bigger operations get a standard market quote instead, which is often still very competitive.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Quick Eligibility Check: Quick Eligibility Check (1 questions)

Excluded training activities

Does your training involve any of these: pole, aerial, or exotic-style fitness; aqua therapy; selling or recommending vitamins or supplements; cryotherapy or medical-type devices; or dietary work for hospitals, schools, or professional sports teams?

The online fitness policy covers mainstream personal training, yoga, and group fitness. These specific activities are excluded, so they need a different market.

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Pole, aerial, or exotic-style fitness; Aqua therapy; Selling or recommending vitamins/supplements; Cryotherapy or medical-type devices; Dietary work for hospitals, schools, or pro teams; None of these

Quick Eligibility Check: Quick Eligibility Check (1 questions)

Excluded gig types

Do your gigs involve any of these: shows that run past 2:00 am; raves, trance shows, or adult venues; fireworks or pyrotechnics; organizing or promoting the events yourself; or touring acts and production companies?

The DJ policy covers weddings, parties, and normal venue gigs. Late-night, rave, and pyrotechnic shows are excluded, and event organizers need event coverage instead. Note the DJ policy also does not include liquor liability.

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Shows past 2:00 am; Raves, trance shows, or adult venues; Fireworks or pyrotechnics; We organize/promote the events ourselves; Touring acts or production companies; None of these

Quick Eligibility Check: Quick Eligibility Check (1 questions)

Other professional services

Beyond certified auditing (EMS, food safety, water quality, ISMS, QMS, laboratory, or aerospace), do you also do any of these: accounting or CPA work; engineering, architecture, or surveying; legal, insurance, or real estate services; healthcare services; product-safety design appraisals; or other work besides certified auditing?

The auditor policy only covers certified auditing work. Any other professional service line needs its own errors and omissions policy, which Lee can quote alongside.

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Accounting or CPA work; Engineering, architecture, or surveying; Legal, insurance, or real estate services; Healthcare services; Product-safety design appraisals; Other work besides certified auditing; None of these

Quick Eligibility Check: Quick Eligibility Check (1 questions)

Excluded coaching services

Does your coaching involve any of these: therapy, counseling, or mental health treatment; medical or clinical advice; financial or investment advice; or in-person fitness training?

Coaching and education are covered; regulated advice (mental health, medical, financial) and fitness instruction each need their own policy, so they are screened out here.

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Therapy, counseling, or mental health treatment; Medical or clinical advice; Financial or investment advice; In-person fitness training; None of these

Quick Eligibility Check: Quick Eligibility Check (1 questions)

Excluded cleaning operations

Does your cleaning work include any of these: exterior work above 3 stories or on scaffolding; post-construction cleanup or water, fire, or mold remediation; hospitals, medical, or dental offices; industrial plants or hazardous materials; hotels, schools, retail stores, or other facilities open 24 hours; floor waxing as more than 30 percent of the work; property management services; or handyman and repair services on the side?

The online janitorial policy is built for routine office and residential cleaning. These operations carry different hazards and are excluded, so Lee can quote them through standard markets instead.

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Exterior work above 3 stories or on scaffolding; Post-construction or disaster remediation; Hospitals, medical, or dental offices; Industrial plants or hazardous materials; Hotels, schools, retail stores, or 24-hour facilities; Floor waxing over 30% of the work; Property management services; Handyman or repair services on the side; None of these

Quick Eligibility Check: Quick Eligibility Check (2 questions)

Excluded lawn and landscape work

Does your work include any of these: tree removal or stump grinding; tree trimming you cannot reach from the ground; landscape design, grading, or hardscaping such as retaining walls or water features; installing new irrigation or sprinklers; snow and ice removal; restricted-use (non-consumer) pesticides or herbicides; or any work above 2 stories?

Maintenance work qualifies for the quick online policy; construction-type landscape work and tree work are rated as contracting and need a different policy. Arborist work has its own market Lee already uses.

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Tree removal or stump grinding; Tree trimming not reachable from the ground; Landscape design, grading, or hardscaping; New irrigation/sprinkler installation; Snow and ice removal; Restricted-use pesticides or herbicides; Work above 2 stories; None of these

Claims and cancellations

In the past 3 years, has the business had a liability claim over $5,000 or a policy cancelled or non-renewed?

The online application asks this word for word, so knowing it up front saves you from starting an application the carrier would decline.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Quick Eligibility Check: Quick Eligibility Check (1 questions)

Excluded instruction types

Does your teaching involve any of these: operating a school (charter, private, or vocational); driving instruction; cooking classes; fitness instruction; trade skills such as welding, carpentry, or power tools; childcare or daycare; medical, counseling, or therapy services; or weapons or gun-safety courses?

The tutor policy covers academic tutoring and test prep. It also does not include abuse and molestation coverage; if a school or district contract requires that, say so in the comments and Lee can quote a market that includes it.

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Operating a school (charter, private, vocational); Driving instruction; Cooking classes; Fitness instruction; Trade skills (welding, carpentry, power tools); Childcare or daycare; Medical, counseling, or therapy services; Weapons or gun-safety courses; None of these

Quick Eligibility Check: Quick Eligibility Check (2 questions)

Excluded product types

Do you make or sell any of these: food or drink products; candles with liquid fuel gel; cosmetics, lotions, or soaps; toys, furniture, or any products made for children or infants; vitamins or supplements; or weapons or knives?

The artists and crafters policy covers most handmade goods but hard-excludes these categories. Some (like cosmetics or food) have their own quick online policy instead, so this answer routes you to the right one.

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Food or drink products; Candles with liquid fuel gel; Cosmetics, lotions, or soaps; Toys, furniture, or products for children/infants; Vitamins or supplements; Weapons or knives; None of these

Excluded operations

Does your work include any of these: commercial painting, murals, or construction trades; a retail storefront; portrait photography or videography services for a fee; salon or spa services; tattoo work; or organizing and promoting fairs or festivals?

Selling your craft is covered; running a storefront, trade services, or the event itself needs a different policy, so it is important to flag up front.

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Commercial painting, murals, or construction trades; Retail storefront; Portrait photography / videography for a fee; Salon or spa services; Tattoo work; Organizing or promoting fairs/festivals; None of these

Quick Eligibility Check: Quick Eligibility Check (1 questions)

Excluded show types

Do your performances involve any of these: shows that run past 2:00 am; adult venues or adult performers; live animals; fire, pyrotechnics, or weapons; aerial, acrobatic, or stunt work; touring, or groups larger than 10; or organizing and promoting the events yourself?

The entertainer policy is built for solo and small-group performers at normal venues. Any of these needs a specialty entertainment market, which Lee can quote for you.

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Shows past 2:00 am; Adult venues or adult performers; Live animals; Fire, pyrotechnics, or weapons; Aerial, acrobatic, or stunt work; Touring, or groups larger than 10; We organize/promote the events ourselves; None of these

Quick Eligibility Check: Quick Eligibility Check (2 questions)

Employees or staff

Do you have any W-2 employees, or do you expect to hire staff or 1099 providers who work like staff, in the next 12 months? (Yes / No)

CM&F's quick online policy is built for an individual provider with no staff. If you have or plan to add employees, that's completely fine. Lee can quote you as a group/practice instead so your staff can be covered too. Just answer honestly and the form takes you down the right path.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Add your business as an Additional Insured

Do you operate through an LLC or other business entity you'd like added to this policy as an Additional Insured, at no additional cost? If yes, what is its exact legal name? (Yes / No)

CM&F lets an individual add their own business entity as an Additional Insured for free. Landlords and facilities often require it, and there's no downside to including it.

Control: yesno
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes; No

Business vehicles: Auto Insurance (16 questions)

Business use of any vehicle

Will you or anyone else use any vehicle for business purposes, even occasionally? Include owners, LLC members, partners, employees, volunteers, and contractors. Examples include visiting clients or job sites, running errands, picking up supplies, carrying tools or products, making deliveries, transporting people, or renting or borrowing a vehicle. Do not count only an ordinary personal commute to one fixed workplace. For a home-based business, include trips from home to clients, job sites, appointments, or other business locations. If you do not have a vehicle yet but plan to buy one (or several) for the business, choose the planning option. (Yes, a vehicle will be used / No vehicle will be used for business / Not yet, but we plan to buy one or more vehicles / Not sure)

Using any vehicle for business can create an auto exposure, even if the vehicle is personally owned or used only occasionally. Personal auto policies may limit or exclude some business uses. Depending on who owns the vehicle and how it is used, coverage may need to be addressed through a personal auto policy endorsement, commercial auto insurance, and/or hired and non-owned auto liability coverage. Coverage terms and availability vary by insurer. Completing this form does not add or bind auto coverage.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Vehicles you plan to buy

About how many vehicles do you expect to add for the business in the next 12 months? (1 / 2 / 3 / 4 / 5 or more / Not sure)

A rough count tells us whether you're heading toward a single-vehicle policy or a small fleet, which affects how the coverage is structured and rated. Nothing is bound until a vehicle is actually purchased.

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: 1; 2; 3; 4; 5 or more; Not sure

When you expect to buy

Roughly when do you expect to have the first vehicle on the road for the business? (Within 3 months / 3 to 12 months / More than a year out / Not sure)

Commercial auto coverage generally needs to be in force before a business vehicle is driven, so knowing your timing lets us line up a quote to bind at purchase rather than after.

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Within 3 months; 3 to 12 months; More than a year out; Not sure

How the vehicles will be titled

When you buy, will the vehicles be titled to the business or to an owner personally? (Titled to the business / Titled to an owner personally / A mix of both / Not sure)

Who holds title affects whether the exposure is addressed through commercial auto, a personal auto policy, and/or hired and non-owned auto liability coverage. This only helps us plan ahead; it changes nothing about your current policies.

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Titled to the business; Titled to an owner personally; A mix of both; Not sure

Whose vehicle may be used

Whose vehicle may be used for the business? Select all that apply. (A vehicle owned, titled, or leased by the business / A personal vehicle owned or leased by an owner, member, or partner / A personal vehicle owned or leased by an employee, volunteer, or contractor / A rented, borrowed, or short-term leased vehicle / Not sure)

Owners, partners, LLC members, employees, volunteers, and contractors can all create an auto exposure when they drive for the business. Who owns the vehicle affects whether the exposure may need to be addressed through a personal auto policy endorsement, commercial auto insurance, and/or hired and non-owned auto liability coverage.

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: A vehicle owned, titled, or leased by the business; A personal vehicle owned or leased by an owner, member, or partner; A personal vehicle owned or leased by an employee, volunteer, or contractor; A rented, borrowed, or short-term leased vehicle; Not sure

How vehicles will be used

How will vehicles be used for the business? Select all that apply. (Visiting clients, appointments, or job sites / Running errands or picking up supplies / Carrying tools, equipment, materials, or products / Delivering food, products, materials, or other property / Transporting clients, patients, passengers, or members of the public / Towing a trailer / Rideshare or app-based delivery / Other / Not sure)

How a vehicle is used decides the class code and the rate. Errands and job-site visits price very differently from delivery or carrying passengers.

Control: multichips
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Visiting clients, appointments, or job sites; Running errands or picking up supplies; Carrying tools, equipment, materials, or products; Delivering food, products, materials, or other property; Transporting clients, patients, passengers, or members of the public; Towing a trailer; Rideshare or app-based delivery; Other; Not sure

Other vehicle use

If you chose Other above, please describe how vehicles will be used for the business.

A use that does not fit the list usually means a different class code, and describing it is what keeps the vehicle from being rated as something it is not.

Control: textarea
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

How often vehicles will be used

How often will vehicles be used for business? (Less than once per month / A few times per month / Weekly / Most days / Not sure)

Frequency separates an occasional-use vehicle from a daily one, and some carriers price a low-mileage business auto quite differently.

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Less than once per month; A few times per month; Weekly; Most days; Not sure

Personal auto insurer notified of business use

If a personally owned vehicle may be used: has the personal auto insurer or agent been told exactly how the vehicle will be used for the business? (Yes, and the insurer confirmed the use in writing / Yes, but I do not have written confirmation / No / Not sure)

Personal auto policy treatment of business use depends on the insurer, the policy, any endorsement, who owns the vehicle, and the nature of the use. Please describe the planned use to the insurer or agent responsible for the personal auto policy and request confirmation or an appropriate endorsement. Commercial auto or hired and non-owned auto coverage may separately be appropriate and available; Lee can go over those options with you.

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes, and the insurer confirmed the use in writing; Yes, but I do not have written confirmation; No; Not sure

Vehicle details

List each vehicle that will be used for the business, including its VIN, year, make, and model. Its approximate value is optional, and if you give it, use the value of the vehicle only (not any permanently attached equipment). Pick the closest annual mileage band. Tell us whether the vehicle has any permanently attached equipment and, if so, its value. For each vehicle, choose who holds title: the business, an owner, or another individual. If it is titled to a person, give that person's name. Tell us whether the vehicle is leased or financed and, if so, the lender or lessor name exactly as it should appear as the loss payee.

The approximate value sets the physical-damage (comprehensive and collision) coverage on each vehicle, so it's worth getting close. Annual mileage is a commercial auto rating factor, so a rough band per vehicle is fine. Permanently attached equipment is anything bolted, welded, or built onto the vehicle so it stays with it: a utility or service bed, tool boxes, a crane or boom, a liftgate, a snow plow, a refrigeration unit, a fuel or water tank, or a camper shell (not loose tools you load in and out). We list its value separately so your physical-damage coverage repairs or replaces the equipment, not just the truck, after a covered loss. The title holder and any lender or lessor are application facts for that specific vehicle. Whether an endorsement applies, and whether one is available, depends on the carrier and is subject to the policy wording.

Control: vehicle_rows
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Driver information

List each driver, including their full name, date of birth, driver's license number, and the state that issued it.

Carriers order motor vehicle records on every listed driver, and an unlisted driver is the most common reason a commercial auto claim gets questioned.

Control: driver_rows
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Travel radius

What is the farthest one-way distance you will travel to see a client 90% of the time?

Travel radius is a commercial auto rating factor. More road time means more exposure.

Control: number
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Trailers

If you'll use any trailers, list each one separately with its year, make, model, serial or VIN, and approximate value.

Trailers are scheduled and rated separately from the power unit, and one left off the schedule is generally not covered for physical damage.

Control: rows
Response needed when shown: Optional
Shown when: When this step is shown in the live form.

Personal auto history

Have you carried your personal auto insurance for more than one year?

We ask about your personal auto coverage because several commercial carriers offer a discount based on your personal insurance history and limits.

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: Yes, more than a year; No; Not sure

Personal auto renewal

When does your current personal auto insurance renew?

Knowing when the personal policy renews lets the timing line up, so you are not paying twice or leaving a gap between the two.

Control: date
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.

Personal auto limits

What liability limits do you currently carry on your personal auto insurance? ($25k/$50k is the Arizona state minimum; you may carry higher.)

Some commercial carriers offer a discount based on the limits you carry personally, and higher personal limits can qualify you for better commercial rates. If you carry more than the options shown, choose Other and tell us the amount.

Control: pillset
Response needed when shown: Yes when shown
Shown when: When this step is shown in the live form.
Options: $25k / $50k (AZ state minimum); $50k / $100k; $100k / $300k; $250k / $500k; Other; Not sure

Renters Insurance: Renters Insurance (0 questions)

Follow the carrier handoff shown in the live form.

Life Insurance: Life Insurance (0 questions)

Follow the carrier handoff shown in the live form.