Menu Bar
Back to Top
Home Section
Personal
liability Coverage
Auto Coverage
Umbrella Coverage
Other Risks
Financial Planning
General Information
Emergency Contact
Exit Form
   
Personal Insurance Risk Management Check List
 
 
Note: Hello Mr./Mrs. my name is from Pappalardo Agency Inc. Your Homeowners coverage is coming up for renewal on and we have a renewal review that should only take a couple of minutes. Is Now a good Time?
 
Home, Condo, Rental, Vacation Homes
 
Questions Yes No
 
1. Your home is insured for are you sure that is enough should you have a fire, tornado, etc?
2. Does your home have an alarm for fire and or burglary notifying policy or fire Dept?
3. Have you made any remodeling changes to your home over $5000 that we are not aware of?
4. Do you desire flood insurance for your home and personal property?

If Insured Wants a Flood Quote Click Here
Flood Quote
   
Property Address
City
Zipcode
   
Building Occupancy
Total Building Coverage
Total Contents Coverage
Building type
Construction Date

5. Do you keep over $200 in cash in your home, if yes do you want that insured?
6. Do you have children away at College?

If Insured has a Child Away at School Click Here
Child Away at School
 
Questions Yes No
Living in a Dorm?
Off Campus?
Do they have a vehicle with them?
Attending Full Time?
 

7. Do you rent any part of your home or other buildings on your property to anyone?
8. Do you use any part of your home or other buildings for business Purposes?
9. Is your home titled in a Trust or to someone other than you or your spouse?
  << Back Next >>
 
Personal Property
 
Questions Yes No
 
1. Do you have any collectibles such as antiques, Fine Arts, Stamps, Coins or baseball cards?
2. Do you own valuable jewelry or furs that you want protected from loss?
3. Do you own valuable sporting equipment and/or guns?
4. Do you have silverware that you need protected?
5. Do you have valuable camera or photo equipment?
I.) Do you use them for money?
6. Do you own a personal computer used to store financial or business data?
I.) Is the data backed up?
7. Do you have any Business Personal Property kept in your home or other structure?
8. Do you own any Equipment, Instruments or tools used in your occupation or trade?

If If Insured Has Collectibles Click Here?
Collectibles
 
Collectible
Collectible
Collectible
Collectible
 

  << Back Next >>
 
Liability Coverage
 
Questions Yes No
 
1. Do you operate a studio or office in your home or have a home-based business?
2. Do you have a hobby that brings in any money?
3. Do you have any clients who come into your home to purchase products or services?
4. Do your children have private jobs like babysitting, mowing grass, or developing websites?
5. Do you own any property other than your home, not insured by us: this could be rental property, office property? Free Quote?
6. Do you own any vacation property not insured by us, cabin, trailer, land share, condo, etc?
7. Do you have anyone employed, for example a nanny or housecleaner that may need Workers Compensation coverage?

Click here if any notes
Notes
 
 

  << Back Next >>
 
Automobile Coverage
 
Questions Yes No
 
1. Do we insure all the vehicles you own? Can we provide a free quote?

For Auto Quote Click Here
Auto Quote
 
Who does?
When does it renew?
Auto Premium
 
Vehicles
 
Questions Vehicle #1 Vehicle #2 Vehicle #3 Vehicle #4
         
Year
Model
Make
Serial#
Usage
         
Questions Driver#1 Driver#2 Driver#3 Driver#4
 
Driver
         
Name
DOB
Sex
Tickets
Lic. Number
Social Security
Vehicle
 
Coverage
 
Questions Vehicle#1 Vehicle#2 Vehicle#3 Vehicle#4
         
BI
PD
MP
UM
UMPD
Collision
Comp
Towing
Trans.
 
Notes
 
   
 

2. Do you have any drivers in your home other than you & your spouse?
3. Do you have any students away at college over 100 miles from home?
I.) With a Vehicle?
II.) Are they attending full time?
4. Do you have a company vehicle or a vehicle given to you for regular daily use that you do not own?
5. Do you have CDs, tapes, phones, stereos, or other NON-manufactured installed items in your vehicle?
6. If your vehicle were involved in an accident, would you like us to provide the money to get a rental car?
7. How about towing, car breakdowns. Would you like us to pay for that?
I.) Do you have AAA?
8. Do you own any motorcycles, mopeds, ATVs, Golf Carts, Antique Autos, Motor Homes, or Trailers?
9. Do you own a new vehicle or currently have loan/lease gap coverage on a vehicle?
10. Do you have a customized vehicle or truck cap?

Click here if any notes
Notes
 
 

  << Back Next >>
 
Umbrella Liability Policy
 
Questions Yes No
 
1. Imagine a bad auto accident, the other party sues for $769,000, do you want us to pay for all of that?
2. Do you own any animal that could bite someone or cause a lawsuit?
3. Do you own a trampoline or swimming pool?
4. If your net worth is more than your auto or home insurance limits, would you pay $2-$3 a week to have it protected?

Click here if any notes
Notes
 
 

  << Back Next >>
 
Other Insurance Risk
 
Questions Yes No
 
1. Do you own any of these items Not insured by us? Boat, Motor home, Camper, Motorcycle, Golf Cart, Jet Ski, 4 wheeler, Other recreational item or aircraft?
2. Do you own a business not insured by us?

I.) When does that renew?

II.) Can we contact you then?

Click here if any notes
Notes
 
 

  << Back Next >>
 
Financial Planning
 
1. If you get sick or injured and can't work for 7-13 weeks, would you like us to make your car payments and/or house payments?
2. Would you please tell me the names and ages of your family members!
Name Age Male Female
Name Age Male Female
Name Age Male Female
Name Age Male Female
Name Age Male Female

Click here if any notes
Notes
 
 

  << Back Next >>
 
General Information
 
1. What is your e-mail Address?
  << Back Next >>
 
Emergency Contact Program
 

Imagine This, Disaster Strikes- and we don't know where to find you. For these situations, we have created Pappalardo Agency Emergency Contact Program. Here are a couple of examples of how the program works.

We recently had a situation where an insured of our had his house burglarized, luckily he was not home at the time. We were able to start the claim but had no way of contacting the insured or his family. You see the police were calling us trying to find the insured. We ask that you give us every way to contact you in the event of an emergency. In addition could you set up a special contact for us in the event something happens and you are unreachable, this person could be family, friends, and neighbors, anyone who you would want to handle immediate issues in case you were out of town for instance. We promise NEVER to call these individuals, unless you have a claim and we can't reach you.

* An individuals home was badly damaged by fire while they were on vacation. The Emergency Contact contacted the agency and got the claim going immediately. The agency contacted a contractor and had the home secured that day.
** A business owner's business was broken into one Friday evening. His business-neighbor, an Emergency Contact saw the damage to the front door and called. The business owner was contacted and had the claim going before he arrived.

 

By providing the names of three EMERGENCY CONTACTS we may be able to prevent a situation from getting worse.

Name: Phone: Address:
Name: Phone: Address:
Name: Phone: Address:

Notes
Thank you again for being such a great client, we greatly appreciate you and please do tell your friends and neighbors about us when talking about insurance!