Business Insurance Review: What's Changing Review | Forms

Contact & General Information

Business Name

Contact Name

Position Title

Business Address

Address Line 1

Address Line 2

City

State

Zip Code

Business Phone

Mobile Phone

Email

# of full-time employees

# of part-time employees

# of independent contract employees

Changes at your business that we may not know about

GENERAL ISSUES (Check all that apply)

Change in scope of business activities or services?
Conduct business in another state?
Change in business legal structure i.e. partnership, corporation, etc.?
Expand your workforce?
Use subcontractors as part of you business operation?
Planning changes to employee benefits offering?

PROPERTY & EQUIPMENT ISSUES (Check all that apply)

COMMERCIAL AUTO ISSUES (Check all that apply)

Have not completed an annual screening of driving records of employees who drive company vehicles?
Business provides company cars for some employees?
Employees may at times use their own personal vehicles for company business or errands?
Business equipment/tools transported between locations?

LIABILITY ISSUES (Check all that apply)

Business may assume liability as part of a contract? or services?
Store credit card, banking or other personal information of customers or employees?
Conduct business over the internet, i.e. sales, contracts, service delivery, billing, etc.?

WORKERS' COMPENSATION ISSUES (Check all that apply)

If you elected not to cover business owners and partners, would you like to revisit this decision?
Do you or employees perform work and/or live in another state?
Any temporary or leased employees?
Any jobs that are on or near water?

BOND ISSUES (Check all that apply)

Upcoming jobs that require bid bonds?
Require a fidelity/surety bond for employees who manage funds or cash?

EMPLOYEE BENEFITS ISSUES (Check all that apply)

If you don’t obtain your employee benefits through Murphy Insurance Agency, would you like to have our Employee Benefits Team provide you with a review and comparative quote for any of the above?

CONTINGENCY & FUTURE PLANNING ISSUES (Check all that apply)

Do you need to create a business continuation plan if something happens to an owner, i.e. How would your family manage without your income? How would business partners compensate your heirs?
Do you need to create a plan in case a key employee were to die or become disabled?

OTHER ISSUES: Are there any other issues on your mind that you’d like to discuss with us? Describe.

Thank you for taking a few moments to review this checklist.

If you checked any issues above, simply submit the form, and your Account Manager will reach out to discuss further with you. If everything seems up to date, and you didn't check off any issues that's good news. Please keep these questions in mind and reach to us as soon as possible if anything new occurs in the future.

Business Insurance Review: What’s Changing Review

Complete this checklist to help keep us informed about changes at your business that may impact your insurance needs.

What’s Changing Checklist

Contact & General Information

Changes at your business that we may not know about

Thank you for taking a few moments to review this checklist.

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