Insurance Service Center DePere - Commercial Insurance Checklist

Client Name*

First NameLast Name

Phone Number*

Area CodePhone Number

Email Address

Please 'SELECT' Yes, No, or Call Me:*

	Yes	No	Call Me
Do you own or lease any other land/locations pertaining to your business?
Do you rent or lease equipment to or from others?
Do you take your trailer, tools, or equipment (including a laptop computer) off of your premises?
Do you understand it is your responsibilty to get a certificate of insurance from each of your subcontractors each year? (Note: the subcontractor must have liability limits at least as high as your limits. If not, you could be responsible to pay additional liability and workers compensation premiums for the subcontractor)
Do you have a workers compensation policy?
If yes, do you understand that your policy will be audited and understand what this means?
If no, do you understand it is your responsibility to check with your health insurance carrier to determine whether you are covered on the job.
Do you understand your general liability policy will not cover any individual that is "helping you," whether paid or volunteer?
Do you have a personal automobile or a trailer (not titled to the business) that you use for business purposes?
Do you use your commercial vehicle or trailer (titled to the business) for personal purposes?
Do you want a commercial umbrella policy or higher limits of liability insurance?
Do you ever do any work outside of Wisconsin?
Do you understand that if you purchase additional tools or equipment, it is your responsibility to call and have them added on to your policy?
I have a laptop computer.

Client Signature*

Date*

MonthDayYear

Optional Commercial Coverages

Please 'SELECT' Yes, No, or Call Me:*

	Yes	No	Call Me
Hired and non-owned auto. This coverage should be included if your company ever rents a car for business purposes or if employees use their personal vehicles to run company errands or visit clients.
Drive other car coverage. Coverage for a person who is supplied a company vehicle, but who does not own a personal vehicle, thereby not having personal automobile coverage and the added benefits provided on a personal auto policy. An endorsement may be added to the commercial automobile policy giving protection to the individual (or a member of his family) while they are driving a car borrowed from a third party or renting a car for personal use.
Liquor liability. Provides coverage and legal defense to an owner of a business which serves or allows the consumption of alcoholic beverages where the alcohol was a substantial factor in causing injury may be responsible for damages to a third party.
Life Insurance for Buy/Sell Agreement. Life insurance that is designed to pay off your partners spouse/family in the event of their death.
Disability Insurance. A form of disability insurance designed to pay for your on going business expenses in the event of your disability.
Group or Individual Health Insurance. Health Insurance for your employees or for you personally.
Flood Insurance. Coverage against damage done by the rising or overflowing of bodies of water.
Peak Season Coverage. An endorsement which provides increased amounts of coverage on inventories during peak seasons.
Employment Practices Liability. Protection for the company including but not limited to; wrongful terminations, harrassment, discrimination, defamation and unfair hiring/firing practices; it also may provide defense costs associated with responding to employment related lawsuits.
Employee Benefits Liability. Responds to claims in the "management" of employee benefits. For example, a clerical error that resulted in the failure to add an employee to the company health insurance program that resulted in an unpaid claim.
Directors and Officers Liability Policy. Provides liability coverage for wrongful acts of a board of directors (or similar group) of a corporation or even a not-for-profit organization.
Transit Insurance. Covers your business personal property and/or inventory while being transported to and from various locations. For example, coverage would apply to your property that is stolen or lost while being shipped via common carrier.
Exhibition Floater. Covers your business personal property used at a trade show or convention while it is away from your premises. For example, coverage would apply to a stolen or missing laptop computer that is part of your trade show booth.
Ordinance and Law coverage. Generally provides coverage for any buildings that must be torn down as required by law after a fire or other physical damage or loss. It would also cover changes that need to be made to a building, after a covered claim, due to changes in ordinances or laws. (Example: ADA requires wider doors and ramps to allow wheel chair access). Very important for buildings built prior to 1993.
Employee dishonesty coverage. Commonly protects you against dishonest or criminal acts performed by your employees while at your premises. For example, embezzlement, theft of money, securities, computer equipment or some other high valued property.
Equipment Breakdown Coverage. Covers the heart of your business, your equipment, machinery, and systems that operate your buildings. Equipment Breakdown Coverage generally pays for damage caused by electrical arcing, mechanical breakdown, power surges, centrifugal force, etc. It DOES NOT cover wear and tear.
Crime Coverage. Protects against loss of money, securities and property by such causes of loss as forgery, theft, burglary, robbery, kidnap, extortion and fraud.
Sign Coverage. Provides additional coverage for your business signs.
Professional liability. Helps protect from lawsuits brought against the insured because a client claims the product/service provided failed to perform or malfunctioned and the client suffered a financial loss as a result.
Sewer and sump-pump coverage. Covers property damaged by water or sewer back up from a sewer or sump pump.
Glass or window coverage. Covers plate glass, lettering, frames and ornamentation. Also used for tenant to provide glass coverage when required by lease agreement.
Business income and extra expense coverage (and/or Loss of Rents). Provides coverage for the actual loss of business income (net income plus continuing operating expenses such as payroll) and extra expenses (add'l cost to rent a new building) during a period of restoration after a covered loss.
EDP Equipment and media software coverage. Generally covers electrical damage, power surge, brown-out, short circuit and magnetic damage or erasure of EDP data and/or software, mechanical breakdown, change in temperature or humidity, computer virus and earthquake and flood. For example, coverage would apply if a software virus infected your information systems and destroyed all the data saved on the hard drives.
Accounts receivable. Protects businesses against their inability to collect their accounts receivable because records have been destroyed by a covered loss.
Valuable papers coverage. Covers the cost of research to reconstruct damaged records including books, maps, films, drawings, abstracts, deeds, mortgages, and manuscripts.
Care, Custody, and Control Coverage. Coverage for damage to property in the insured's care, custody or control.

Client Signature*

Date*

MonthDayYear

I (we) further agree and understand that higher limits of liability are available and can be requested in lieu of the limits we currently have for insurance. I (we) understand and have been advised by Insurance Service Center that in the event of an applicable claim, the limits I have may be inadequate. In such event, I (we) shall hold harmless Insurance Service Center, LLC any employee or agent of Insurance Service Center, LLC for any additional liability exposure, claim, or uncovered expense, I (we) may be subject to or liable for.

Client Signature*

Date*

MonthDayYear

Enter the message as it's shown*

Send to*