Personal Policy Review

Agency*
- Glass Insurance
- Schenning Insurance
Name*
First Last
Address
Street Address Address Line 2 City State ZIP Code
Email
Phone*
Is any property in the name of any other name than what is listed on the policy? (Example: Trust)
Name in which property is held in
Insured #1 Education
Insured #2 Education
Insured #1 Occupation/Miles one way
Insured #2 Occupation/Miles one way
Personal Auto
Do you own any vehicles that we do not insure?
- Yes
- No
If you answered "Yes," please note that you will possibly reduce your premium by having ALL of your vehicles insured in the same place. That would also reduce the possibility of GAPS in your coverage. It would be in your best interest to have a discussion with your agent concerning this.
Are there any new drivers in your household?
- Yes
- No
In order to avoid problems at the time of an accident, it is vitally important that ALL DRIVERS residing in your household are accounted for on your policy. It would be in your best interest to have a discussion with your agent concerning this.
Do any of your vehicles include "after-market" accessories or customization that increases the value of the vehicle?
- Yes
- No
In order to avoid problems at the time of an accident, and to make sure the value of your vehicle is fully protected, it is important that you document and insure any and all accessories and/or customization for your vehicle.
Are you interested in learning more about, or adding to your policy any of the following coverages?
- Roadside Assistance/Emergency Service/Towing
- Rental Reimbursement
- Loan/Lease GAP coverage
- New Vehicle Replacement Cost
Roadside Assist: Whether you locked yourself out of your vehicle, have a flat tire, or are broke down on the side of the road, this coverage will pay when you call for help.
Rental Reimbursement: When your vehicle is in the shop for a covered repair, having this coverage will pay some or all of the cost of renting a replacement vehicle.
Loan/Lease GAP Coverage: Protects you when your vehicle is totaled by paying the difference between the value of the vehicle and the balance still owed on the loan.
New Vehicle Replacement: Coverage for Damage to Your Auto, is changed from Actual Cash Value to Replacement Cost for losses caused by other than fire, theft, vandalism, or larceny.
Do you participate in any Transportation Networks with your vehicle, such as UBER/LYFT?
- Yes
- No
UBER/LYFT: The insurance landscape is continuously evolving to meet the safety needs of drivers and passengers. Be sure to consult with your agent to further discuss your coverage options and to make sure you're adequately protected.
Do you use your vehicle for ANY business purpose, including delivery services such as GrubHub?
- Yes
- No
Business Use: Personal auto insurance doesn't provide adequate coverage for any accidents that occur while you are driving for business purposes. Be sure to consult with your agent to further discuss your coverage options and to make sure you're adequately protected.
Has the loan status on any of your vehicles changed in the past year?
- Yes
- No
If you have paid a vehicle off, be sure to let us know so we can remove the lienholder from your policy.
Notes:
Homeowners/Renters
Who is your current mortgage holder?
What year was your roof last replaced?
Do you own any additional of the following items of Personal Property that we do not already insure?
- Antiques, fine arts, silverware, or collections
- Jewelry
- Furs
- Value Camera Equipment or Musical Instruments
- Large amounts of Cash in your home
- Coin or Stamp Collection
- Guns
- None of the above
Your policy contains Sub-Limits for the Theft of these items. Please be sure to consult with your agent to further discuss your coverage options and to make sure you're adequately protected.
Have you made any major improvements, home additions, or added outbuildings in the past year?
- Yes
- No
If you answered "Yes," please be sure to consult with your agent to further discuss your coverage options and to make sure you're adequately protected.
Do you own any of the following?
- Second/Seasonal Home
- Rental Property
- Vacant Land
- Farm Property
- None of the above
If you selected any of the above property types, please be sure to consult with your agent to further discuss your coverage options and to make sure you're adequately protected.
List the Address and Mortgage Holder of Additional Properties
Do you participate in any House Sharing such as AirBNB?
- Yes
- No
Airbnb does offer its hosts two forms of protection through its host guarantee program and host protection insurance. While hosts may be inclined to rely exclusively on these programs to manage their risks, there are significant gaps related to these offerings. Be sure to consider ALL of the risks. Please be sure to consult with your agent to further discuss your coverage options and to make sure you're adequately protected.
Do you have an above ground or in ground pool?
- Yes
- No
Do you have a trampoline?
- Yes
- No
Do you conduct any business or give private lessons in your home?
- Yes
- No
If you answered "Yes," Please be sure to consult with your agent to further discuss your coverage options and to make sure you're adequately protected.
Do you own any additional items listed that we do not currently list on your policy?
- Boat/JetSki/Wave Runner
- Motorbikes
- ATV
- Golf Cart
- Snowmobile
- Quad/Side-by-Side/Gator
- Drone
Operating a recreational-type vehicle or device is fun and exciting, but accidents happen. While you may not be concerned about the value of your boat or ATV or DRONE, you need to be concerned about the liability that comes with simply operating such items. Please consult with your agent to further discuss your coverage options and make sure you're adequately protected.
Are you interested in learning more about, or adding any of the following optional coverages, which are not included in the standard policy?
These coverages ARE NOT included in your standard homeowner's Policy. Please be sure to consult with your agent to further discuss your coverage options and to make sure you're adequately protected.
- Water Sewer Backup
- Service Line Coverage
- Equipment Breakdown
- Flood
- Earthquake
Would you be interested in an Umbrella policy that extends your Auto & Homeowners Liability coverage an additional $1M or more?
- Yes
- No
If you answered "Yes," a personal umbrella policy provides an extra layer of insurance coverage over your standard liability policies. It protects your personal assets by kicking in when your standard liability coverage is exhausted. Please consult with your agent to further discuss your coverage options and make sure you're adequately protected.
Life
Are all members of you family protected by Life Insurance?
- Yes
- No
Would you like an agent to call you to discuss life insurance options?
- Yes
- No
Closing
Thank you for taking the time to complete this review. An agent will be in touch to follow up on any items that may have triggered a need for adjustments to your policies.
If you have any additional questions or items you would like to discuss, please let us know in the Notes field below.
Thank you once again,
Glass & Schenning Insurance
Notes
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