Fort Lauderdale Policy Review

Fort Lauderdale Policy Review

Client Information

Your Name
Your Name
First
Last
What insurance do you currently have with us?
Home Address
Home Address
City
State/Province
Zip/Postal
Country
Company Address
Company Address
City
State/Province
Zip/Postal
Country

Your Home(s)

Have you remodeled or made any major updates to an existing home(s)?
(New roof, furnace, or electrical system)
Have you added a home security system?
Have you started a home-based business?
Have you purchased a secondary residence, including a condo or timeshare?
Have you started participating as a service provider in the home sharing economy?
(Airbnb, VRBO)

Your Automobiles and other “Vehicles”

Please think back over the last year when answering these questions.
Have you added an automobile, watercraft, or recreational vehicle?
Have you added any new drivers?
Have you added a vehicle provided by an employer?
Have you had a child leave home to attend school or no longer considered a dependent?
Have you started participating as a service provider in the ridesharing economy?
(Uber, Lyft, Sidecar)

Your Other Life Events

Please think back over the last year when answering these questions.
Have you added or changed ownership of any assets including titles, trusts or LLCs?
Have you hired domestic help, nanny or housekeeper, either full or part-time?
Have you purchased jewelry, art or other valuables that need to be added? Are there items that need to be changed or deleted?
Have you had a significant change in net worth?
Have you accepted a position on a board(s) of a profit or nonprofit organization(s)?

Your Business Structure

Have you changed the ownership structure of your business?
Have you added new or changed your existing operations and/or products?
Have you begun to buy supplies or sell your products overseas?
Are you operating out of any new locations or have you closed locations?

Additional Protection

We're a full service agency providing solutions for personal, business, employee benefits and specialty Insurance needs for our clients.
Would you like to discuss any additional insurance protection with our firm?
Coverage will not be bound or changed until confirmed by a licensed agent.

Your Personal Liability

Please think back over the last year when answering these questions.
Have you acquired, leased or sold a building, business property and/or equipment?
Checkboxes
Have there been any improvements and/or significant alterations to your building?
Has your Inventory level changed significantly?
Have you purchased, leased or sold any Vehicles?

Your Income Protection

Please think back over the last year when answering these questions.
Have your Businesses revenues changed by more than 10% since last year?
Do you rely on a single supplier for more than 50% of your materials?
Do you rely on a single buyer for more than 50% of your sales?

Your Employees & Professional Liability Exposure

Please think back over the last year when answering these questions.
Do you have employees that regularly travel out of state or overseas for business?
Checkboxes
Do any employees use their own personal cars for business purposes?
Do any Employees work outside your home state or work from their home regularly?
Do you obtain Certificate of Insurance from all subcontractors, vendors and 1099 workers?
Are any of the owners a member of any board of directors whether for profit or not?