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