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Homeowners, Condo & Renters Checklist
To assist us in conducting an Annual Review, we have prepared the following form. It should take about 15 minutes to complete. Once we have reviewed, 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 and Date:
*
Insured Name and Date:
1. Has any of your contact information recently changed (phone number, email)?
Yes
No
Please provide your information:
2. Are you aware that you are not covered for Flood & Earthquake?
Yes
No
3. Is your home currently vacant or for sale?
Yes
No
If yes, please elaborate:
4. Is any of your property owned by a Trust or LLC?
Yes
No
5. Has your marital status changed?
Yes
No
6. Do you own any rented or vacant property, second home, or farmland that is not insured by Fish-Johnson?
Yes
No
7. Have you aded, paid off, or refinanced any mortgage?
Yes
No
If yes, have you informed Fish-Johnson?
8. Have you recently added any detached structures (garage, gazebo, shed)?
Yes
No
If yes, what has been added?
9. Do you rent out any part of your home or garage space?
Yes
No
If yes, please elaborate?
10. Do you ever rent out your home?
Yes
No
If yes, please elaborate?
11. Have you made any recent improvements to your home (kitchen, bath, deck)?
Yes
No
If yes, please elaborate?
12. Have you updated your roof, electrical, furnace, or AC in the last 5 years?
Yes
No
If yes, please elaborate?
13. Does your home have any Smart technology (Home Monitoring/Security System, Water Detection)?
Yes
No
If yes, please indicate.
14. Does your home have any smoke, water, or burglar alarms?
Yes
No
If yes, please indicate.
15. Is there any business in your home (office, daycare, lessons)?
Yes
No
If yes, please indicate.
16. Do you employ any nanny, home cleaners, or dog walkers?
Yes
No
17. Have you made an inventory of your possessions (photo or video)?
Yes
No
18. Do you own expensive items or collectibles (jewelry, fine arts, antiques, firearms, sporting equipment)?
Yes
No
If you own any of these items, please review your coverage limits for adequacy.
19. Do you own any musical equipment for personal or business use?
Yes
No
If yes, please indicate personal or business and elaborate on equipment.
20. Do you own tools and equipment used for your work?
Yes
No
If yes, please elaborate:
21. Do you participate in any sporting tournaments?
Yes
No
If yes, please elaborate:
22.. Do you operate any model aircraft or drones?
Yes
No
23. Do you own any Utility or Camping trailers not insured by Fish-Johnson?
Yes
No
If yes, please indicate:
24. Do you own any boats, snowmobiles, ATV's, or motorcycles?
Yes
No
25. Do you own an outboard motor over 35HP?
Yes
No
26. How would you like for us to communicate any recommendations or discounts available to you regarding this review?
Email
Phone
Appointment
27. Does anyone in the household wear hearing aids?
Yes
No
28. Were 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 is our way of thanking you for referring us to your friends, relatives, and neighbors?
*
Yes
No
Request For Additional Products
29. Could Fish-Johnson Insurance offer you a quote on any of the following policies?
Yes, Auto
Yes, Business
Yes, Motorcycle
Yes, ATV
Yes, Life Insurance
Yes, Health Insurance
Yes, Medicare Supplement
30. Do you have any additional questions or comments?