• EXPOSURE PROFILE

Thank you for taking the time to update your Exposure Profile. This profile will allow us to get an idea of the exposures you have even if we do not currently service all your insurance needs. Your candid responses will better enable us to help you make educated decisions in regards to your insurance. Please answer all questions that pertain to you.

Contact Information

  • Yes No

  • Please list the primary contact's relation to the insured.
    Please list cell phone number for primary contact
    Please list email addresses for primary contact.
    Please list work number for primary contact.
    • Do you have a preference in how we contact you for non emergency items?
    • Mail
    • Phone
    • Email
    • No Preference

Homeowners, Condominium, and Renters

  • Any updates to your home/condo/apartment that are greater than $5,000 or 5% of your insured value?
    Yes No

  • do you have a security system in your home/condo/apartment?
    Yes No
    Is it monitored by a central station
    Yes No
    How long have you had your alarm
  • Do you have an inventory of house items in the event of a significant claim?
    Yes No
    Would you like more information on how to create a household inventory?
    Yes No
  • Do you currently have a disaster kit prepared in your home?
    Yes No
    Would you like to have more information on preparing a disaster kit for our home?
    Yes No
  • Would you be interested in an updated estimate for the replacement value of your home?
    Yes No
  • There can be limitations of coverage for jewelry, furs, camera equipment, antiques and other collectibles. If you have these items would you like us to contact you regarding these limitations and how to best handle them?
    Yes No

  • Flood is not covered under your Home/Condo/Renters policy. Would you like us to contact you regarding this coverage?
    Yes No
  • Have you acquired real property of any type since your last renewal?
    Yes No

  • Is your home now or will it soon be put into a trust?
    Yes No

  • Do you rent any portion of your home on a regular basis?
    Yes No

  • Do you run a business your own from your home?
    Yes No
    Do you own the buisness?
    Yes No
    Is the buisness operated from a structure on your property other than your home?
    Yes No

    Exclusions for buisness activities exist in your Home/Condo/Renters policy, would you like more information?
    Yes No
    We offer options for health insurance for sole proprietors and employee groups of 2 or more, would you like more information?
    Yes No
  • Do you have structures on your premises that you rent to others?
    Yes No

  • Do you live in a Condominium or Homeowners Association?
    Yes No
    If yes, please forward any insurance requirements included in your bylaws?

Automobile

  • Has any driver listed on your policy recently completed an approved Accident Prevention course?
    Yes No

  • Were you aware the Accident Prevention course can be taken online?
    Yes No
    would you like information?
    Yes No
  • Does a resident of your household have a company car?
    Yes No
  • Does a resident of your household have a vehicle furnished and available for their regular use that is not insured on your current policy?
    Yes No

  • Do you rent vehicles for more than 30 days?
    Yes No
    do you buy the rental car companies collision damage waiver?
    Yes No
  • Have you added customized items to your vehicle?
    Yes No


    What is the value of your customizations?
    $
  • Do you own a vehicle with another party that is not a resident of your household?
    Yes No
    If the vehicle is listed on your policy which vehicle is jointly owned?
    If the not on your policy where is it insured?
    Please supply the following information on the co-owner of the vehicle:
    Name:
    Relationship:
    Phone:
    Address:
  • Do you currently own a collector vehicle?
    Yes No
    Do we insure your vehicle
    Yes No
    Would you like us to contact you for a second opinion
    Yes No

Rental Property

  • Do you own rental property?
    Yes No
    • Do we insure your rental property
      Yes No
      Would you like us to contact for a second opinion?
      Yes No
      Have you made any improvements to the:
       
      None
      partial update
      complete update
      when completed
      Roof
      Wiring
      Plumbing
      Heating/AC
    • Have you made other improvements that would impact the replacement value of your property
      Yes No


    • Approximate annual rents your receive from your property:
      $
    • Are tenants required to carry renters insurance
      Yes No
      how often do you monitor
      never annually Other:

Life, Disabilty, and Long Term Care

  • Check all that apply
  • Do you own?
    Life Insurance
    Disability
    Long Term Care
  • If no would you like information on which policy or policies?
    Life Insurance
    Disability
    Long Term Care
  • If your policy was purchased from another agent would you be interested in a second opinion?
     
     
    Yes No
    which policy or polices would you like reviewed?
    Life Insurance
    Disability
    Long Term Care
  • If your policy is placed through our agency would you like any of the following?
    • My situation has changed and I would like to review my limits of coverage
    • I would like to amend my beneficiary designation
    • I would like to talk about replacing my policy with something else
    • My term policy is almost up and I would like to review my options

Watercraft and Recreational Vehicles

  • WaterCraft
    Close
    • I own (check all that apply)
       
      Length
      Horsepower
      Outboard motor boat
      ft.
      hp.
      Inboard/Outboard motorboat
      ft.
      hp.
      Sailboat
      ft.
      N/A
      Canoe/Kayak
      Yes
      No
    • Do we currently insure a boat for you?
      Yes No
      Would you be interested in a second opinion?
      Yes No
    • Have you taken a boater safety course in the last three years
      Yes No


    • Is you boat used in any racing activities?
      Yes No


    • Do you rent your boat on a regular basis
      Yes No

    • Is your boat titled to you personally or owned by a corporation
      personal corporate
    • Where is your boat principally docked?
    • Where do you use your boat?
    • There can be limitations for certain types of equipment aboard your boat do you have valuable equipment on board your boat?
      Yes No


    • If you were to buy a new boat today that is similar to the boat you have now approximately how much would the new boat cost?
      $
    • If you were to sell your boat today approximately how much could you sell it for?
      $

  • Recreational Vehicles
    Close
    • Do you own an ATV?
      Yes No
      Do we insure it?
      Yes No


      Would you like another opinion on your insurance
      Yes No
    • Do you own a Snowmobile?
      Yes No
      Do we insure it?
      Yes No


      Would you like another opinion on your insurance
      Yes No

Survey Questions

  • Yes No
  • Mail Email
    • Review policies
    • Make payments
    • Claim reporting
    • Do not use
    • Did not know I could

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