Personal Trainer Insurance Questionnaire

PROPERTY INSURANCE

1. Do you need Building and/or Content Coverage?

1a. If yes, please complete chart below or provide a separate property schedule with the following information:

Rows	Building Age	Building Construction	Building Limit ($)	Content Limit ($)
Building 1
Building 2

2. Do you need Equipment Coverage?

2a. If yes, total value to insure for?

Total Value ($)

2b. If yes, please complete equipment schedule below or provide a separate equipment schedule with the following information:

Rows	Year	Make	Model	Value to Insure For ($)
Item 1
Item 2
Item 3

COMMERCIAL AUTOMOBILE INSURANCE

1. Does the business title any automobiles or other operating vehicles in the business name?

2. Is insurance coverage needed for owned automobiles?

2a. (If yes, complete chart below or provide a separate vehicle/fleet schedule with following info.)

Rows	Vehicle Make	Vehicle Model	Cost New ($)	Year
Vehicle 1
Vehicle 2
Vehicle 3

2b. If yes, limits desired:

Rows	Amount ($)
Limit of Liability
Comprehensive Deductible
Collision Deductible

3. Do any of the employees, owners or officers drive personally owned automobiles/other vehicles in the course of their work?

3a. If yes, how many?

3b. Do you verify they have liability coverage?

3c. Limits? ($)

COMMERCIAL CRIME

1. Do you desire coverage for Crime (Employee Dishonesty, Money, Forgery)?

1a. If yes, requested amount?

COMMERCIAL UMBRELLA & WORKERS COMPENSATION

1. Do you need a Commercial Umbrella?

1a. If yes, limit of liability needed? ($)

2. Do you need Workers Compensation? (If yes, please contact Kevin Morency.)

SIGNATURE

The information I have provided is true and accurate to the best of my knowledge. I have not willfully concealed or misrepresented any material fact(s) or information. I understand completion of this questionnaire does not compel the company to provide coverage.

Signature

Or Enter Full Name as Signature:

Date:

Questions? 877-244-9090
Kevin Morency | kmorency@morencyinsurance.com

Morency & Associates Inc.
141 New Shackle Island Rd, Hendersonville, TN 37075
Fax: 615-452-6580

https://insurancefitnesscenter.com/