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Home > Request-A-Quote >

GENERAL CLIENT INFORMATION

DWELLING – COVERAGE A

Construction Type:
Type of Heating:

Year of last update:

Is there a Fireplace?:
Central Burglar Alarm?:
Fire Alarm?:
Inside sprinkler system?:
Have there been any water-related losses (including backup of sewers of drains)?:

Others in Household:

ADDITIONAL STRUCTURES – COVERAGE B

Describe all Structures at the same address that are not attached to the residence

Does the insured employ domestic help?

List the name of each individual, their duties, if he or she live on premises and number of hours he or she works per week.

Live on Premises
Jewelry in Excess of $1,500?:
Unusual Items that should be scheduled?:
Does the insured own other dwellings?

PERSONAL LIABILITY

List all animals kept at the primary residence.

Are there any outdoor:

Trampolines:
Swimming Pools:

Drivers on Policy:

What are the occupations of all insured individuals?

Does the insured own vacant land?

If yes, List the location of the vacant land and the acreage.

PERSONAL UMBRELLA

PERSONAL AUTO

Are any of the vehicles considered antique or classic cars?

RECREATIONAL VEHICLES

List all owned or leased recreational vehicles – licensed and unlicensed. This includes but is not limited to trailers, campers, motorcycles, all-terrain vehicles, dune buggies, race cars and similar motorized vehicles.

WATERCRAFT

List all owned watercraft.

Where does the watercraft operate
Is the watercraft taken outside United States territorial waters?

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P: 614-899-3161 | F: 234-678-4816
 
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