Insurance Service Center DePere - Home Insurance Checklist

Before you begin this paperwork, please review this list of items that may be unacceptable to some insurance companies. If any of these items pertain to you, please be sure to point it to your agent before completing this paperwork.

Fuses (Instead of Circuit Breakers or 60 amp service of any kind)
Certain Breeds of Dogs (Doberman, Rottweiler, Pit Bull, Akita, Alaskan Malamute, Chow, German Shepard, Husky, wolf hybrids or any dog that may be deemed “vicious.”)
Any prior animal claims (dog bites, animal causing damage)
Exotic animals
Home claims in the past 5 years
Swimming pool with slide or diving board, and/or an unfenced yard
Woodburners/wood stove/pellet stoves in sheds or garages
Woodburners/wood stove/pellet stoves not professionally installed
Fireplace Inserts
No prior homeowners insurance
Bankruptcy in past 5 years
Stairs/decks missing handrails (if more than 2 steps up)
Damage to foundation (cracked, crumbling)
Outbuilding(s) in poor condition
Damage to siding or missing siding
Business on premises
Trampoline
Outdoor hot tub without a locking cover and/or in an unfenced yard
Vacant home or not owner occupied
Home for sale
Debris or abandoned vehicles around home
Moss/algae growth on home or roof
Home owned by an LLC or Corporation (not in a personal name…trusts are ok, but be sure to point this out to your agent)
Roof showing signs of wear (curling or lifting of shingles, missing shingles, etc.)

PLEASE NOTE: These issues may be unacceptable to some companies, but ok for others. It is important to address these issues up front so we can get pre-approval or place you with another company if necessary. We strongly recommend that you do not cancel your current homeowner’s insurance policy until these issues have been addressed and approved by the new company.

Client Name*

First NameLast Name

Email Address

Optional Coverages

Are you interested in...*

	Yes	No	Call Me
Sewer/Sump Pump Backup Coverage - Provides coverage for the backup of a sewer drain or sump pump. This is NOT flood insurance.* (Approximately $40 per year for $5000. If interested in higher limits, check the “Call Me” box.)
Scheduled jewelry, guns, other valuables - Provides “all risk” coverage for specifically listed valuables. (Examples: A diamond falling out of an engagement ring. A hearing aid is lost).* Please note: There will be no coverage until the insurance company receives an appraisal for each item you want covered. (Additional charge varies by item. If interested in prices, check the “Call Me” box.)
Identity Theft Coverage - coverage varies by company.* Price varies by company.
Recreational Vehicle Coverage - provides liability and/or physical damage coverage for boats, ATVs, snowmobiles, motorcycles, etc.* (These items are not automatically covered, even if stored in your garage.)
Personal Injury Liability -coverage for libel, slander, defamation of character, (ie.Facebook), wrongful eviction, etc.*
Ordinance or Law Coverage - provides additional coverage if an ordinance or law requires modifications to your home in the event of a claim.* (Client should check with local building inspector if uncertain of local ordinances.)
Business/Farm Endorsement - Examples: day care, lessons (piano, sports...), selling crops, renting land to others, product consultant (purses, jewlery, candles...), auto repair.*
Are you interested in Flood or Earthquake Insurance?
Floods and earthquakes are not covered under your homeowners policy.

Questions*

	Yes	No	Call Me
Do you want to increase the amount of coverage on your home? Please note - the coverage amount used is an estimate only. You are responsible to determine adequate coverage amount.
Do you want coverage to pay off your mortgage in the case of a premature death or disability?*
Would you like to increase your liability limits?

	Yes	No	Call Me
Do you have any animals?

If yes, please decribe:

	Yes	No	Call Me
Are you planning any MAJOR repairs or remodeling

If yes, please decribe:

	Yes	No	Call Me
Do you own any other land, property or buildings? (Farm land, rental properties, barns, hunting land, etc.)

If yes, please decribe:

	Yes	No	Call Me
Do you have any children away at college? (If renting an apartment, they may need renter’s insurance.)
I understand there is no coverage on my policy for a roommate's personal property or liability. (Coverage may be available. If interested, please check "call me".)
I understand unmatched siding/roofing is not covered (may be available for purchase with some companies ), I also understand that cosmetic damage to metal siding or roofs is typically not covered (* AAA, AOI, ASI, MVM)*

*Coverage subject to policy limitations and payable in the event of qualified claims. Subject to underwriting approval.

Comments

I have personally reviewed the answers above. I understand that this checklist is not meant to imply, in any manner, that these are the ONLY items that may be of concern to me. I understand it is my responsibility to advise Insurance Service Center of any special circumstances or insurance needs I may have, or as my situation changes.

Client Signature*

Date*

MonthDayYear

Enter the message as it's shown*

Send to*