General Liability Questionnaire
Business name:
Is your business address different than your residential address?	-- No Yes
Business physical address:
Business physical city, st, zip:
Do you lease or own your business location?	-- Lease Own
Type of business:
Brief Description Of Operations:
How is the business structured:	-- Individual/Sole Proprietor Partnership Corporation S Corporations Limited Liability Company (LLC)
Years of industry experiences:
What year did the business begin?
Business website:
Number of full time employees:
Number of part time employees:
Do you use sub-contractors?	-- Yes No
Annual sales:
Annual payroll (not including sub-contractors, clerical, or owner):
Annual clerical payroll:
What percent of annual sales is paid to sub-contractors:
Building construction type:	-- Framed Joisted Masonry Masonry Non-Combustible Non-Combustible Fire Resistive
Total square footage of building:
Total square footage occupied:
Year built:
Number of stories:
Roof replaced:
100% sprinklered:	-- No Yes
How much business property coverage do you need?
How much tool coverage do you need?
How much equipment coverage do you need?
Do you do anything with new construction or track homes?	-- No Yes
How much liability coverage do you need?	-- 500,000 1 Million 2 Million 5 Million 10 Million
Current General Liability Carrier:
Number of claims in the last 5 years:
Do you need a workers compensation policy?	-- No Yes
Current Workers Comp Carrier: