Client Renewal Form

Existing Specialty Food & Beverage Insurance clients can renew their insurance by filling out the client renewal form below.

Looking for insurance? Read more about food insurance or beverage insurance provided by Specialty Food & Beverage.

    Company Name (Required)

    Contact Changes

    Has your company name changed?
    NoYes

    What is your new company name?

    Has your location changed?
    NoYes

    What is your new location?

    Has your mailing address changed?
    NoYes

    What is your new mailing address?

    Has your phone number changed?
    NoYes

    What is your new phone number?

    Has your email address changed?
    NoYes

    What is your new email address?

    Has your fax number changed?
    NoYes

    What is your new fax number?

    Has your primary insurance contact changed?
    NoYes

    What is your new primary insurance contact?

    Liability

    Ending Sales (Policy Term)

    Projected Sales (Policy Term)

    Product Deletions

    Product Additions

    Importation of Product
    NoYes

    Please describe setup

    Export of Product
    NoYes

    Please describe setup

    Property

    Building Improvement Amount

    Average Inventory Values (Policy Period)

    Equipment Value

    Location(s) of Owned Inventory

    Copacker Coverage Provided?
    NoYesUnsure

    Copacker Coverage Amount

    Copacker Limit of Insurance

    Copacker Loss Valuation

    Transit Coverage Provided?
    NoYesUnsure

    Transit Coverage Amount

    Transit Limit of Insurance

    Transit Loss Valuation

    Employee/1099 Services

    Do you have employees now?
    NoYes

    Did you hire new employees?
    NoYes

    Where do employees live?

    How many employees?

    Total Payroll (Policy Term)

    Do you issue 1099's?
    NoYes

    Amount Issued (Policy Term)

    Do 1099 independent contractors only work for you?
    NoYes

    Are independent contractors employed by another company?
    NoYes

    What other company(s) employs your independent contractors?

    Do independent contractors carry General Liability insurance?
    NoYes

    Do independent contractors carry Workers Compensation?
    NoYes

    Have you reviewed your states Workers Compensation requirements regarding the use of independent contractors?
    NoYes

    Questions, comments, or anything else that doesn't fit? Please let us know here!

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