• Polygraph Examiner Insurance Questionnaire

  • Applicant is:
  • Do you currently carry liability insurance?

  • GENERAL INFORMATION
    (Private Investigator, Private Detective, Process Server, Insurance Claims Adjuster, Skip Tracing, Polygraph Testing, Undercover Surveillance, Detective/Security Instruction, Forensic, “Expert Witness” Testimony, Security Consulting, Firearms Training)

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  • 3. Do you use Drones or Unmanned Aircraft?
  • 5. Limits of Liability desired:
  • 6. Is your agency licensed?
  • 7. Do you belong to any associations?
  • 8. Have you or any employee ever had a license revoked, suspended, or non-renewed? (except MO)
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  • Note: “Employees” include: Sole proprietors, Partners, Executive Officers, Seasonal employees, Part-time employees, Full-time employees.

  • 10. Do you or any of your full or part-time employees carry firearms?
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  • 11. Do you ever hire sub-contractors/independent contractors that carry their own insurance?
  • 11b. If yes, are certificates of insurance provided?
  • 11c. Do you require contractors to name you as additional insured on their policy?

  • FIREARMS INSTRUCTION

  • Do you offer Firearms Instruction?
  • 3. Do you provide live fire instruction at a gun range?
  • 3a. If yes, do you own or rent the gun range?
  • 4. Do you offer any tactical, military, law enforcement, survivalist, or SWAT/Crisis Team training?
  • 5. Are participants required to sign any waiver/release form? (If yes, please attach a copy of waiver.)
  • 6. Are eye and ear protection required?
  • 7. If students provide their own weapons, does the instructor check each weapon before firing?

  • 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?
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  • 3. Do any of the employees, owners or officers drive personally owned automobiles/other vehicles in the course of their work?
  • 3b. Do you verify they have liability coverage?

  • PROPERTY INSURANCE

  • 1. Do you need Building and/or Content Coverage?
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  • 2. Do you need Equipment Coverage?
  • 2a. If yes, total value to insure for?
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  • 3. Do you need Computer Coverage?
  • 4. Do you need Earthquake Coverage?

  • COMMERCIAL CRIME

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

  • UMBRELLA & WORKERS' COMPENSATION INSURANCE

  • 1. Do you need a Commercial Umbrella?
  • 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.

  • 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://polygraphexaminerinsurance.com/

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