Insurance Log

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From: - Heidi Walker - Vice President - CBIZ Insurance Services, Inc

Cbiz Insurance - Application Form.pdf

Aaron, per our conversation, following is a list of various insurance lines of coverage to consider and what would be needed in order to offer terms:

Property – covers physical loss due to covered perils for buildings, contents and equipment (fire, lightning, theft etc) Location address

Construction of structure – wood frame, concrete, brick etc

Age of structure – if over 30 years old, we will need year of updates on roof, wiring, plumbing, heating/AC

Number of stories of structure

Square footage of structure – area

Are there any other occupants or are you the sole occupant?

Desired limit for structure - $

Desired limit for contents & equipment - $

Commercial General Liability – covers settlement and defense cost arising out of third party liability law suits

Annual sales- operating budget

Annual payroll

Detailed description of operation

Workers Compensation – covers work related injuries to employees including medical bills, lost wages and any settlement related to same

FEIN – 45-4997514

List of officers including name, date of birth, office held and job duties

Annual payroll per employee (excluding officers) with a description of each employees job duties

Executive Protection – Directors & Officers, Employment Practices etc – covers lawsuits brought against directors & officers due to operational and management decisions made on behalf of the organization

Attached completed application including all additional documentation/information listed on the application

I know this is a lot to digest and believe it or not, I could more than double what I have supplied you with. The above will get us started. After reviewing the above and obtaining the necessary information, please contact me and we will plan our next step.