Skylands Insurance | Business Insurance Annual Questionnaire

Named Insured Business:

Thank you for placing your business insurance with Skylands Insurance Group. It is important to periodically review your current insurance policies to confirm that your coverage and limits meet your business needs. To assist us with this review, please take a few minutes to complete and return this questionnaire.

Has your company engaged in any new products or services in the past two years?

Have you had a change in business operations such as expansion to another state?

Have you discontinued any operations?

Have you changed the nature or scope of your business?

Have you purchased, leased or acquired any new locations or property (including vacant land)?

Have you vacated any previously occupied locations?

Does the business own a drone? For what use?

Have you made any major capital expenditures?

Does your building and property limits on your policy accurately reflect the cost to replace the specified property at today’s costs?

Have you entered into any leases or mortgages on your business property?

Have you added any fire or security protection or permanently installed generators?

Have you paid off or disposed of any major capital assets?

Have you entered into any new mergers, joint ventures, new corporations/partnerships in the past year?

Has the company ownership changed in the past 2 years?

Have you changed your vehicle schedule?

Any changes in your list of drivers?

Have you modified your vehicles?

Do you want to increase or change any coverage?

Do you feel that your liability limits are adequate?

Your policy may be audited. Have your payroll or sales changed?

Do you carry any business insurance policies other than the ones written through Skylands Insurance Group?

Do you have any employees that are not covered by workman’s compensation?

Your workman’s compensation will be audited, have your payrolls changed significantly?

Do you have employees that work in another state?

Do employees work from home?

Skylands Insurance Group offers enhanced insurance products and coverages that may not be included in your current insurance portfolio. These coverages will minimize potential insurance gaps. Please indicate below if you are interested in discussing any of the following:

Other Coverages/Specify:

Any other changes we should know about?

Your Signature

Clear Signature

Date

Please provide the following information and indicate your preferred method of contact.

Print Name *

Business Phone

Business Name *

Mobile Phone

Email *

We appreciate you taking the time to complete this questionnaire. If you are not submitted using the electronic form, please remember to sign and return this document to us by mail, fax at 973-347-2597, email info@skylandsgroup.net, or our website www.skylandsgroup.net.

Upon receipt, we will review your questionnaire, update our records and contact you if necessary. If we do not receive a completed questionnaire from you, the insurance carrier will renew your policies based on existing information on file and we will assume there are no changes to be made.

Thank you for continued business and support.

Sincerely,

Rhonda Linnett Graber, CIC, CPRM

President

Skylands Insurance Group

354 Route 206 South Flanders, NJ 07836

Skylands Insurance Group

1405 3rd Ave Spring Lake, NJ 07762