1. Are you responsible for the Building you are in?
Own the Building
Rent the Building
___ Condo ownership
___ Office in residence
2. Are you responsible for the Permanent Attachments to the building, Fixtures, and
Equipment for servicing the premises:
Not responsible rent
___ Responsible for common areas and rent
___ Responsible for improvements in condo ownership or renter
I am responsible for all property
3. Business Personal Property and Property of Others:
The owner of the equipment in my office
Care, custody, control of the property of others ie do you lease equipment like a copier?
___ Have mobile equipment provided to employees such as computers and cell phones
4. Income Protection if there was a disaster:
Lose money if I could not operate my practice.
Would not be able to pay my employees If could not operate
Could not pay my expenses if I could not operate
Would have extra cost to continue my business after a disaster at this location or
at another location
___ Do you have another space to relocate to if need be for a period of time
5. Practice has employees or contract employees?
___ Workers Compensation Insurance
___ Employment Practices Liability Coverage
6. Have Trust/IOTA Accounts
___ Crime Insurance
___ Clients required to be names on crime coverage
Money and Securities
7. Have Data Breach/Cyber Liability Exposures, store sensitive information about clients on computers, servers or paper files
___ Data Breach/Cyber Insurance
___ Clients that require Data Breach/Cyber Insurance
8. Does firm use autos for business?
___ Employees Occasionally use Personal autos
___ Employees Frequently use Personal autos
___ Firm Leases autos for employees
___ Firm owns autos used by employees
9. Other Insurance needs?
___ Directors & Officers/Management Liability Insurance
___ ERISA Bonds
___ Employee Benefits Errors & Omissions coverage
___ Excess Insurance – Professional Liability Insurance
___ Earthquake Coverage
___ Surety Bonds
___ Umbrella Insurance
10. Do you need coverage for any of the following: Check all that apply
_ Valuable Papers & Records
___ Law Library
___ Art Work
Newly Acquired or Constructed Property
Exterior Signs, Lights and Clocks
Fire Department Service Charge
Fire Extinguisher Recharge
Electronic Data Processing Equipment Coverage-Property
Other, Describe unusual property you my own:
11. Specific Insurance Coverage questions:
___ Number of years Owned Business( ____)
___ Have current insurance coverage
___ If no have had coverage in past let lapse
___ Will provide copy of expiring coverage(s)
__ The legal status of entity is:
___ LLC/PA/PLLC etc
___ More than one location
___ Had nonprofessional liability insurance claims?
The above information is not an insurance policy. It is only intended to provide a general
guide to possible exposures for Small Firm/In-Home Firm. Actual insurance policies contain specific details of the coverages, conditions and exclusions.