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It includes a NOTICE OF INFORMATION PRACTICES (PRIVACY) explaining how personal and credit-related data may be collected, used for eligibility and premium determination, and shared with third parties. 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Such information as well as other personal and privileged information collected by us or our agents may in certain circumstances be disclosed to third parties without your authorization. Credit scoring information may be used to help determine either your eligibility for insurance or the premium you will be charged. We may use a third party in connection with the development of your score. You may have the right to review your personal information in our files and request correction of any inaccuracies . You may also have the right to request in writing that we consider extraordinary life circumstances in connection with the development of your credit score. These rights may be limited in some states. Please contact your agent or broker to learn how these rights may apply in your state or for instructions on how to submit a request to use for a more detailed description of your rights and our practices regarding personal information.  \nV111024  \nWelcome!  \nThe purpose of this questionnaire is to gather necessary information to generate quotes for your business. For best results, download and save a copy of this fillable form prior to completing it. The last page of the questionnaire has a NOTES section. Use this space to enter information that will not fit in the spaces provided, ask questions, or provide additional details that will assist us with your quotes. Please send the questionnaire back by replying to our original email. For the fastest response be sure to select “Reply to All”.  \nOur current turnaround time for quotes is approximately 3 weeks depending on the back and forth required by underwriting, in California it is 4 weeks. If your effective date, renewal date or quotes needed date is sooner than that, please list RUSH in the subject line of your email.  \nIf you are currently insured, please contact your agent, broker or insurance carrier and request your last three years of currently valued loss runs. Currently valued means the loss runs need to be dated within the last 30 days. Loss runs allow us to negotiate the best possible pricing on your behalf and are required by insurance carriers prior to binding your policies.  \nRenewal or Effective Date of Policies:   Date Quotes Needed:   \nCurrent Insurance Providers:  \n\n|  | Insurance Company | Policy Number | Expiration\u003Cbr>Date | Annual\u003Cbr>Premium | Coverage\u003Cbr>Limits |\n| --- | --- | --- | --- | --- | --- |\n| Commercial Auto |  |  |  |  |  |\n| General Liability |  |  |  |  |  |\n| Workers Compensation |  |  |  |  |  |\n| Commercial Umbrella |  |  |  |  |  |\n| Personal Auto Insurance * |  |  |  |  |  |\n\n* A commercial auto discount is available based on the coverage limits of your current commercial or personal auto policy – if you don’t know your limits, please send us a copy of your current auto policy declarations with the completed questionnaire. An accurate discount cannot be applied to your quote if this information is missing. Proof of prior insurance will be required by the carrier when the policy is bound to maintain the discount.  \nSelect type of quote needed: Commercial Auto General Liability Workers Compensation Umbrella  \nBusiness Basics:  \nEntity Name:   DBA:   Legal Entity Structure: LLC S-Corp C-Corp Other:    \nFEIN / Federal Tax ID Number:   Date Business Established:   Business Address:   Office Phone Number:   Mailing Address:   Email Address:    \nBusiness Profile:  \nPrior Year Gross Sales","cbCaimvILlpSiV1G","https://ap.wps.com/l/cbCaimvILlpSiV1G","pdf",530500,6,"English","# Notice of Information Practices (Privacy)\n# Questionnaire Instructions and Turnaround Time\n## Quote Submission and Rush Requests\n## Loss Runs Requirement\n# Renewal or Effective Date and Quote Needed Dates\n# Current Insurance Providers and Coverage Limits\n# Select Type of Quote Needed\n## Business Basics\n## Business Profile\n# Business Owner Profile\n## Driver Details, Ownership, and Personal Information\n# Commercial Auto Information","[{\"question\":\"What information is this questionnaire used to collect?\",\"answer\":\"It gathers business and owner details needed to generate insurance quotes and provide underwriting information.\"},{\"question\":\"How are credit scoring and personal information used?\",\"answer\":\"Personal information may be collected from other sources, credit scoring may be used to determine eligibility and premium, and some information may be disclosed to third parties in certain circumstances.\"},{\"question\":\"What insurance documents are required if the business is already insured?\",\"answer\":\"The form asks for the last three years of currently valued loss runs, with dates within the last 30 days, and proof of prior insurance to maintain applicable discounts.\"}]","Junk Removal and Dumpster Rental Business Insurance Questionnaire - v01.21.2025 | PDF",1790131974]