Your input is ESSENTIAL in our attempt to eliminate gaps in your insurance coverage. Please accept that you have reviewed your current and existing insurance policy(ies) and accept the coverages you currently have. This checklist is used prior to the renewal of your insurance policy(ies) for the purpose of verifying your coverage is up to date. This checklist does not cover every situation, but is a starting point to prompt you to consider major items and questions.

I hereby certify that all statements included in the checklist are true and correct to the best of my knowledge. I understand that any false statements may lead to claims being denied, premiums to be adjusted, and/or policies ultimately canceled.

Please Enter the name listed first on your insurance policies

Please let us know if you approve contact via text message

Please Provide Us With Your Best and Preferred Email Address

Please List All Household Members Over The Age of 15 and provide Date of Birth. We will cross reference this list with the list we have on file to ensure accuracy.

For the purpose of this review, we would like to know about your private passenger automobiles.

Please Provide the Details of All Other Vehicles Not Previously Listed

Do any of your vehicles have custom equipment? Ex. stereo systems, after market parts or grill guards, custom rims, performance accessories, etc.

Please specify that equipment, it's value, and which vehicle it has been added to.

Do you or any drivers listed on the policy use any vehicles listed on the policy for delivery for hire, such as Doordash, Uber Eats, Shipt, etc...

Are any vehicles on the policy used for transportation for hire, such as Uber or Lyft?

Have you bought or sold a house, vacation property, farm, vacant land since your last insurance review?

Have there been any recent changes in your mortgage company information? Does anyone, except a mortgagee, have financial interest in your home? Do you have a second mortgage or home equity line of credit?

Is the "Other Structures (Coverage B)" adequate to cover all outbuildings, shops, sheds, detached garages, carports, fences, awnings, etc?

Have there been any additions or updates to your home? Ex remodeling, improvements, updates to the water, heating, plumbing, electrical or roof? *Is the amount of insurance on your home less than it would take to rebuild it?

Do you rent your home as part of a home-sharing/renting program like AirBnb, VRBO or other?

Do you have any hobbies or conduct any business from you home that grosses more than $2,000 per year? *There are limitations and exclusions for businesses at home, in your garage or renting out space to others for business purposes.

Do you have any antiques, fines arts, silverware, collectibles, valuable jewelry or furs? Or sporting equipment, guns, musical instruments? *Many policies have limitations to the coverages available for these items, unless they are scheduled.

We realize that people add pets to their household families and these can have implications with regards to your insurance.

For us to do a complete job in making sure you are protected, we need to be aware of any additional policies or assets you may have purchased to ensure there are no gaps in coverage.

Do you have any feedback for us? Is there an area we can improve your experience? Is there a team member you'd like to give kudos to for their effort?