Auto Insurance Checklist

To assist us conducting an Annual Insurance Review, we have prepared the following form. Please complete, it should take about 15 minutes to complete. Once we have reviewed the form, we will get back to you with any coverage recommendations or available discounts.

Acknowledgement of Insurance Review

Please select from below: *

I decline a review at this time

I have completed the renewal checklist

Insured Name & Date: *

Insured Name & Date:

Policy Questions

1. Has your marital status changed?

Yes

No

2. Have you purchased, sold, or leased any vehicles?

Yes

No

If so, did you inform Fish-Johnson Insurance?

3. Does anyone on your policy use their vehicles for business?

Yes

No

If yes, are they insured with a business/commercial policy with Fish-Johnson?

Yes

No

4. Any vehicles used to deliver goods (mail, pizza, newspapers)?

Yes

No

5. Any vehicles used to transport people for a fee (Uber, Lyft, etc.)?

Yes

No

If yes, who and with vehicle?

6. Do any vehicles have custom equipment?

Yes

No

If yes, which vehicle(s) and when?

7. Have any car loans or leases been paid off during the current policy term?

Yes

No

If yes, who and which vehicle?

8. Have the miles driven to work changed for any driver?

Yes

No

if yes, who and what vehicle(s)?

9. Are any licensed drivers residing in your home that are not listed on the policy?

Yes

No

If yes, who and do they have their own insurance?

10. Do all drivers live at the insured address?

Yes

No

If no, who and why?

11. Are there any full-time students that achieve a 3.0 GPA?

Yes

No

If yes, who?

12. Are there any drivers away at college without a car?

Yes

No

If yes, who?

13. Do any drivers have access to non-owned vehicles?

Yes

No

If yes, who?

14. Do we insure all autos in the household?

Yes

No

15. Are any vehicles titled in someone else's name?

Yes

No

If yes, which vehicle and what is the individual's name?

16. Are any vehicles driven under 7,000 miles a year?

Yes

No

If yes, which vehicle(s)?

17. Do you own any Classic or Antique cars?

Yes

No

If yes, are they insured with Fish-Johnson Insurance?

18. Are any vehicles used in racing?

Yes

No

If yes, which vehicle(s)?

19. Do any vehicles have a salvage title?

Yes

No

If yes, which vehicle(s)?

20. Do you own any utility or camping trailer?

Yes

No

If yes, is it insured by Fish-Johnson Insurance?

21. Are any vehicles or trailers not kept at home?

Yes

No

If yes, where are they and are they insured by Fish-Johnson Insurance?

22. Do any vehicles have safety features, such as adaptive headlights, anti-lock brakes, autonomous operation mode, back-up warning, driver fatigue sensing, forward-crash avoidance with or without auto brake, lane departure with or without blind-spot monitoring?

Yes

No

If yes, which features and on what vehicle(s)?

23. Do any drivers not have a valid drivers' license?

Yes

No

If no, who and why?

24. Do you have an Umbrella Liability Policy?

Yes

No

25. How would you like us to communicate any recommendations or discounts available to you regarding this review?

Email

Phone

Appointment

26. Could Fish-Johnson Insurance offer you a quote on any of the policies below?

27. Do you have any additional questions or comments? Yes/No

28. Are you aware that when you refer someone to Fish-Johnson Insurance to quote their insurance, we send you $10? It is our Referral Program, so be sure to have them give us your name when they call for a quote. It's our way of thanking you for referring us to your friends, relatives, and neighbors.

Yes

No

Yes, please contact these people: