Name: Modern Insurance Group
Price range: $

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Legal Business Name

Your Name

First Last

Email

Phone

Business Review Sections

A business risk evaluation involves completing the sections of this form that are applicable to your business. You can deselect the options below that do not apply to your business.

General Operations

Real Property

Commercial Vehicle(s)

Business Staffing

Coverage Assessment

Real Property Review

Let's begin reviewing your real property such as assets, buildings, equipment, machinery, etc.

Do you have a recent property appraisal showing replacement cost of any building the business owns or is responsible for?

Yes

No

What is the replacement cost?

Upload copy of appraisal

Drop files here or

Max. file size: 2 MB, Max. files: 1.

More than one location?

Yes

No

Additional Location(s)

Location Address	Value of Business Personal Property	Actions

There are no Locations.

Have you added or removed any security alarms, bars, or other protective devices?

Yes

No

Please briefly explain details about security added or removed.

Has the occupancy status of any building changed?

Examples: rented, vacant, under renovations, etc

Yes

No

Not sure

Please explain any occupancy status change for any location(Required)

Do you use a property management company?

Yes

No

Does the business have any properties that we do not currently insure?

Yes

No

Did the business earn rental income last year?

Yes

No

What will the annual rental income be this year?(Required)

What is the estimated annual rental income next year?(Required)

Does the business own any outdoor property?

Check all that apply

Sign(s)

Lighting

Generator

Fencing

Other

Explain other outdoor property

Commercial Auto Review

This area will help identify some common changes and updates to commercial auto exposures.

Has the business purchased or leased any new vehicles

Yes

No

New Vehicle List

VIN	Year	Make	Model	Actions

There are no Vehicles.

Any new drivers to be added?

Yes

No

New Drivers List

Driver Name	Drivers License Number	Drivers License State	Actions

There are no Drivers.

Do you allow employees to use your personal vehicle for business use?

Yes

No

Wrapping Up

Additional Comments

Documents

Upload any relevant documents for review. Examples: Property appraisals, certificate requests, etc.

Drop files here or

Max. file size: 20 MB.

Your Agent

DISCLAIMER: This online questionnaire is a tool used to gather information. It is not an application for insurance. No insurance coverage will be bound or put into effect by submitting this form.

Business Account Review