Policy Review – Home & Auto Policy Review - Personal Auto & Home/Renters Accepting Coverages*Yes, I have.Not Interested.Your input is essential to eliminate gaps in your insurance coverage. Please accept that you have reviewed your policy, you accept your coverages and you have addressed any questions you have had with our team and/or insurance carrier. This checklist is used prior to the renewal of your insurance policy(ies) for the purpose of verifying your coverage is up to date to protect against losses. This checklist does not cover every situation, but it is a good starting point to prompt you to consider major items or questions. Date MM slash DD slash YYYY Client Name* First Last Mailing Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone - Best#*Text Messages*Yes - ApprovedNo - Do Not TextPlease let us know if you approve contact via text message.Email Preferred Method of Contact*Phone CallEmailTextHousehold Drivers*Have there been any change in your household drivers? Ex. Drivers regularly using your vehicle, drivers that have moved out. Household Vehicles*Have there been any changes in the vehicles listed on your policy? Ex Vehicles sold, purchased, in storage, loaned out, customized or altered, refinanced or a loan paid offCustom Equipment*Do any of your vehicles have custom equipment? Ex. stereo systems, after market parts or grill guards, etc. Other Vehicles & Business Use*Do you often drive vehicles owned by others, including your employer's vehicle? Or use your vehicle(s) for business reasons? Do you use your vehicles for ride-share Lyft, Uber, Turo or other? Annual Miles - Low Mile Discounts*Please list the estimated annual miles of your vehicle(s). AAA Roadside Discounts*Are you a member of AAA Roadside? Purchased Property*Have you bought or sold a house, vacation property, farm, vacant land? Mortgage Company*Have there been any recent changes in your mortgage company information? Does anyone, except a mortgagee, have financial interest in your home?Home Business*Do you have any hobbies or conduct any business from your home that grosses more than $2000 per year? *There are limitations and exclusions for businesses at home, in your garage or renting out space to others for business purposes.Home Updates*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?Home - Outbuildings*Is there enough "Other Structures (Coverage B)" to cover all outbuildings, shops, sheds, detached garages, carports, fences, awnings, etc? Valuables*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. Safety/Smart Features Burglar Alarm Centrally-Monitored Alarm System Fire Alarm Fire Extinguisher Smart Water Smart Thermostat Have you added any of the following to your home? Check all that apply. Specialty Features*Does your home have any specialty features? Ex wine vault, home theater, Jacuzzi, skylights, pool, etcHome Sharing*Do you rent your home as part of a home-sharing/renting program like AirBnb, VRBO or other? Are you interested in: "It COULD happen to me coverage"?*The purpose of an Umbrella Policy is increasing your limits of liability AND potentially filling gaps that your home or auto insurance won't cover. If you don't have an umbrella policy, we'll give you 4 reasons we strongly encourage it - potential coverage for fun gone wrong: 1. Hosting social gatherings where alcohol is involved. 2. Traveling out of the country. 3. Renting/Borrowing toys (ATVs, JetSkis, Boats). 4. The cost is generally less than paying for one hour of an attorney's time to defend you. Other Insurance* Umbrella or Excess Liability Insurance Auto Homeowners or Renters Water or Sewer Pipe Coverage Flood Boat or Personal Watercraft Motorcycle or ATV Farm or Agriculture Business/Commercial Life or Health Insurance: We do not write but can offer a referral Are there any other coverages we can answer questions about or quote for you? Community PartnershipsDid you know that for all referrals we receive, we donate to a local nonprofit? Is there an organization that is close to your heart that you want to share with us? Feedback*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?