Personal Insurance Checkup

Are your current insurance plans overlapping? Are they sufficient to meet the needs of you and your family? Use this to do a checkup on your personal home – auto – umbrella – RV.

Click here to view and fill out our insurance checkup form. After printing it, please fax to (760) 741-9308, email, or bring it by our office. We’ll do an in depth checkup and let you know our suggestions for your coverage. Alternately you can print the text below .

It’s time for an insurance check-up. To better serve you and to help eliminate gaps in your insurance coverage, we developed this questionnaire. Please answer the following questions and return the form to us in the enclosed postpaid envelope. We will use it to evaluate the adequacy of your present coverage and will advise you of any changes that may be in order. This information, like all of your personal business, will naturally be kept in the strictest confidence.

Name ________________________________________________________________________________________________________
Mailing Address _____________________________________________________________________________________________
Street Address (if different) _________________________________________________________________________________
City ___________________________________________________________________________________________________________
State __________________________________________________________________________________________________________
Zip ____________________________________________________________________________________________________________
Day phone ___________________________________________________________________________________________________
Evening phone _______________________________________________________________________________________________
Email address ________________________________________________________________________________________________

Circle Yes or No. If Yes, please provide a brief description or explanation.

Are there any corrections or changes to the address or location of your home as shown above?
Yes / No
Does anyone, except a mortgagee listed on your policy, have a financial interest in your home?
Yes / No
Do you have any outbuildings or separate garages?
Yes / No
Do you own or rent any other real estate, by yourself or with others?
Yes / No
Do you serve on any charitable, social, or governmental boards?
Yes / No
Have you done any remodeling or made other improvements to your home?
Yes / No
Is the amount of insurance on your home less than it would take to rebuild it?
Yes / No
Are your personal belongings covered for less than it would cost to replace them in a total loss?
Yes / No
Do you have collectibles such as antiques, fine art, stamps, or coins?
Yes / No
Do you own tools, equipment, or other property used in your trade, business, or profession?
Yes / No
Do you do any work at home?
Yes / No
Do you own expensive jewelry, furs, or silverware?
Yes / No
Do you own costly sporting equipment, guns, hobby equipment, or musical instruments?
Yes / No
Do you own a boat, jetski, or waverunner? Ever rent them?
Yes / No
Do you ever keep or carry cash over $200?
Yes / No
Are you interested in doing a video inventory of your home?
Yes / No
Do you own a golf cart, go-cart, dirt bike, ATV, snowmobile, dune buggy, hovercraft, or any other self-propelled vehicle including riding lawn mowers, garden tractors, or scooters?
Yes / No
Do you need coverage for flood or earthquake?
Yes / No
Do you have any employees?
Yes / No
Do you own any cars, trucks, motorcycles, motorhomes, campers, or trailers not shown on a policy with us?
Yes / No
Do you often drive vehicles owned by others, including an employer’s vehicle?
Yes / No
Are there any non-family members living with you?
Yes / No
Do you ever use your vehicles for business reasons?
Yes / No
Do you ever rent cars?
Yes / No
Do any of your vehicles have custom equipment?
Yes / No
Do you own any other personal property valued over $1000 per item not mentioned above?
Yes / No
Are you interested in increasing your liability coverage?
Yes / No
Do you need to review your life insurance coverage?
Yes / No
Would you like information on disability coverage?
Yes / No
Would you like information on medical insurance?
Yes / No
Do you have any questions about your insurance coverage?
Yes / No

Signed_________________________________________________________________________________________________

Date____________________________________________________________________________________________________