Renewal Checklist Insured Name (required) Name of person filling out this form (if different from Insured Name) Insured Email (required) Insured Primary Phone Number Preferred method of contact EmailPhoneTextWhat type of insurance do you have with us? Check all that apply. (required) HomeownersAutoHomeowners InsuranceHave you completed any improvements to your home (e.g. new roof, an addition, a four-season room)? YesNo Please Describe What year was your roof last replaced? Roof type (Asphalt, Shingle, Metal, etc)? Do you operate a business out of your home? YesNo Please Describe: Do you own tools, equipment, or instruments used in your trade or profession? YesNo Please Describe: Have you added a permanent swimming pool? YesNoAre you interested in earthquake coverage? YesNo Additional Comments: Every policy has sub-limits. Do you have any of the following and need a quote to schedule these items to your policy: JewelryAntiquesFine ArtsGunsMore Than $1,000 Cash or SecuritiesOther Valuables Jewelry $: Antiques $: Art $: Guns $: Other $: Do you want a quote to add OR increase your current limit of Backup of Sewer and Drains? YesNo Additional Comments: Flood is excluded from your homeowners policy. Would you like more information on how to purchase Flood Insurance? YesNo Additional Comments: Do you own a vacation home that needs insurance? YesNo Please Describe: Coverage for liability from a Trampoline may be excluded. Do you own a Trampoline and need to discuss this? YesNoIs your home titled in a Trust? (this is NOT the same as a mortgagee). YesNo What is the name of the trust? Do you want a quote to increase your Umbrella Liability Policy OR do you want a quote for an Umbrella Liability Policy? YesNo Additional Comments: Do you own a dog? YesNo What breed? Do you have a wood burning stove? YesNo Please Describe: Automobile InsuranceWould you like to review your current liability limits and options to increase them? YesNo Additional Comments: Does your auto policy specify by name all of the drivers in your household? YesNo Name of additional drivers: Do you have a teen in your household that will obtain a drivers license or school permit this year? YesNo Additional Comments: Do you have a company car furnished for your regular use? YesNo Please Describe: Does our agency insure all of the vehicles you own? YesNo Please Describe: Do you want to discuss additional coverage(s) available, such as Lease Gap, Towing, or Rental? YesNo Additional Comments: Would you like us to send you an Insurance ID Card for each of your vehicles? YesNoDo you or anyone in your family use your vehicle for Uber, Lyft, or other delivery service (food, newspapers, pizza, etc)? YesNo Please Describe: Is anyone, other than you or your spouse, a titled owner of a vehicle listed on your policy? YesNo Please Describe: Do you have any children listed on your auto policy who no longer live at home and are not in college? YesNo Please Describe: Do you own any of the following that are NOT insured? (Check all that apply): CamperMopedGolf CartMotorcycleMotorhomeATV/UTVBoatJet SkiE-Bike Please Describe: Would you like your agent to contact you regarding any questions/concerns regarding any of your insurance policies? YesNo Additional Questions, Comments, or Concerns.