Renewal Review Form CL 1Step 1/32Step 2/33Step 3/3 Business Name(s):* If the business listed above is not the legal owner or lessee of all property, autos and equipment listed on the policy please explain:Mailing Address:* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Primary Contact Name:* First Last Phone:*Email:* Preferred Method of Contact:* Website Address: Entity Type:* Sole Proprietor Partnership Corporation LLC FEIN:* The offer of insurance being made by Kinney Pike is based upon the exposures to loss that were made known to the agency. All changes in exposures need to be reported to Kinney Pike in order that proper coverage may be affected. A Kinney Pike Account Manager will contact you if any answers below indicate that additional discussion about your coverage is needed.It is your responsibility to determine appropriate property values. Have there been, or are you contemplating, any changes to your Property Exposures? Changes that could affect your policy include (but are not limited to) changes in business locations, new property purchases or leases, renovations, tenants’ betterments and improvements to leased or rented space and increases or decreases in tools, equipment, business personal property or stock values. Yes No No Change Have there been any changes in your business operations or gross annual sales? Yes No No Change Liability can take many forms. General Liability is the most common coverage, providing coverage for general bodily injury and property damage. Additional, more specific liability forms include (but are not limited to) Professional Liability, Liquor Liability, Errors & Omissions, Employment Practices Liability, Employee Benefits Liability and Directors & Officers Liability. Have there been or are you contemplating any changes that might affect your liability coverages? Yes No No Change Do you have employees? Yes No No Change If you have employees, have there been any changes to their job responsibilities or annual payroll figures? Changes in employee classifications and payroll can result in large additional premium audits. Yes No No Change Please answer one of the following regarding Workers’ Compensation coverage: • If your business operates as a Sole Proprietorship or Partnership: Sole Proprietors and Partners are automatically EXCLUDED from Workers Compensation coverage. Do you wish to include yourself and/or any partners in you Workers Compensation coverage? Yes No No Change • If your business operates as an LLC or Corporation: Members of an LLC and Officers of a Corporation are automatically INCLUDED in Workers Compensation coverage. Do you wish to exclude any members or officers from your Workers Compensation coverage?• If your business operates as an LLC or Corporation: Members of an LLC and Officers of a Corporation are automatically INCLUDED in Workers Compensation coverage. Do you wish to exclude any members or officers from your Workers Compensation coverage? Yes No No Change Have you added any employee benefit plans? Examples of employee benefits plans include (but are not limited to) Retirement Plans or Health, Life or Disability Insurance. Yes No No Change Have you made any changes to vehicles or drivers that we have not been made aware of? Yes No No Change Are any of your business vehicles equipped with plows, sanders, or any other specialized equipment that we have not been made aware of? Yes No No Change Do you lease or rent vehicles in the business name on a short-term basis? Yes No No Change Do any employees use their personal vehicles for company business? Yes No No Change In the past 12 months have you paid off any property or vehicle loans that we have not been made aware of? Yes No No Change Would you like to explore any additional lines of coverage? Personal Auto Homeowners Personal Umbrella Life Disability Health Group Benefits Other The offer of insurance being made by Kinney Pike is based upon the exposures to loss that were made known to the agency. All changes in exposures need to be reported to Kinney Pike in order that proper coverage may be affected. Any business with a connection to the internet is at risk of a Cyber Attack. Even the smallest business can experience a data breech that can lead to an interruption in your operations and high expenses including investigative services, cost of data recovery, legal fees and settlement costs. Cyber Liability coverage can provide protection for your business against this growing threat. Please contact us if you would like more information. Due to COVID-19 many companies have added Communicable Disease exclusions to General Liability and Umbrella policies. Please contact us with any questions after careful review of your policy for these exclusions.Umbrella or Excess Liability coverage may be available to extend additional limits of liability over your existing policies. Please contact us if you would like a quote.Subcontractors can be a crucial part of your business however some policies exclude coverage for work performed by subcontractors you hire. Hiring uninsured subcontractors can also increase your premiums. It is important to verify that any subcontractors you hire have their own General Liability and Workers Compensation policies in force. Always request a current Certificate of Insurance to confirm insurance coverage before a subcontractor begins work.Ordinance or Law coverage can provide you with coverage for three types of common building ordinance or law requirements that may apply after you have suffered a physical loss such as a fire. These ordinance or law damages are normally excluded in standard property coverage forms. The coverages available include the cost to demolish the undamaged portion of the building, the cost to replace with superior construction as required by law, and the cost to clear the land of debris after demolition.Flood and Earthquake coverages are excluded from most standard insurance policies. Quotes for these coverages are available upon request.Coverage for Fungi, Wet Rot, Dry Rot and Bacteria is typically excluded from liability policies and is limited on property policies. Additional limits may be available.How would you rate the service our agency provides? Excellent Very Good Satisfactory Needs Improvement Unacceptable What can we do to make your experience with us even better?Please provide any additional questions, comments, or concerns:The offer of insurance being made by Kinney Pike is based upon the exposures to loss that were made known to the agency. All changes in exposures need to be reported to Kinney Pike in order that proper coverage may be affected.