Commercial Lines Renewal Form

Select Producer*

Business Legal Name (and DBA, if applicable):

Phone Number:*

Email Address:*

Are there any significant changes in your business operation since we last spoke? (Merger/Acquisition, New lines of business, new categories of operation, etc.)

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

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

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

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

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

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

Do we need to add any additional insured's to your policy? (Bank, landlord, new contracts, etc)

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

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

You may upload up to 3 files to us, if necessary.

Drop files here or

Max. file size: 300 MB, Max. files: 3.

This field is for validation purposes and should be left unchanged.

Commercial Lines Renewal Form

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