Annual Insurance Checklist First Name*Last Name*Phone*Email* Which type of insurance do you have with us? Select all that apply.* Personal Insurance Business Insurance Personal InsuranceHome Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Have you renovated, remodeled, added on to, or otherwise updated your home(s)?YesNoHave you started a business based out of your home?YesNoDo you protect your home with a professional security system?YesNoHave you added a permanent swimming pool?YesNoDo you or any family members perform babysitting services in your home?YesNoDo you employ any part-time or full-time domestic help, including nannies, housekeepers, or landscapers?YesNoHave you purchased any additional residences such as condos, timeshares, or second houses?YesNoDo you rent out your home as part of the home-sharing economy?YesNoIf you’ve started renting out your home or any other property, do you have renters insurance?YesNoAre all of your vehicles, including recreational vehicles and watercraft, insured with this agency?YesNoHave you recently purchased any additional automobiles, recreational vehicles, or watercraft?YesNoHave you upgraded any of your vehicles with new equipment?YesNoDo you need to add any new drivers to your policy?YesNoDo you drive any employer-sponsored vehicles?YesNoDo you own any older vehicles that may be classic or collector cars?YesNoDo you provide ride services as part of the ridesharing economy?YesNoDo you have any children who no longer live at home and can no longer be considered dependents?YesNoHave you purchased any jewelry, electronics, or other valuables that you would like to add to your policy?YesNoAre there any such items that you would like to change or remove from your policy?YesNoDo you insure your personal possessions for their full replacement value?YesNoHave you recently added or otherwise changed ownership of assets such as trusts, titles, or LLCs?YesNoAre there any other insurance coverage issues you would like to discuss?YesNoBusiness InsuranceCompany NameCompany Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Total Number of EmployeesAre there any business properties or pieces of equipment that you have recently acquired, leased, or sold?YesNoHave you closed or opened any business locations?YesNoHas your company building undergone any renovations, additions, or other significant changes?YesNoHave you added, changed, or removed any company products?YesNoHas your inventory level experienced any significant shifts or fluctuations?YesNoDo you either purchase supplies from or sell your products to foreign countries?YesNoHas the ownership structure of your business changed?YesNoHas there been a 10% or greater change in your business's revenue in the last year?YesNoDo 50% or more of your materials come from a single supplier?YesNoDo 50% or more of your sales come from a single buyer?YesNoDo any of your employees regularly work from home or from another state?YesNoDo any of your employees regularly travel to other states or countries for business?YesNoDo any of your employees travel for business in their personal vehicles?YesNoHas your company leased, purchased, or sold any automobiles or other vehicles?YesNoDo you require all vendors, subcontractors, and 1099 workers to provide certificates of insurance?YesNoAre there any other insurance coverage issues you would like to discuss today?YesNo
