PL Renewal Questionnaire Name(Required) First Last Email(Required) Enter Email Confirm Email What are you renewing? (Select all that apply) Home Auto Umbrella Rental Property Material Assets HomeHave you purchased any additional properties in the last year? Yes No If yes, please explain.Have you Remodeled your home, added an addition built any detached structures/pools/ garages, or finished you basement? Yes No If yes, please explain.Do you feel it would cost more to rebuild your home than the amount it is insured for (Dwelling Cov. A)? Yes No Do you own any watercraft, jet skis, recreational vehicles, ATVs etc.? Yes No If yes, please list. Add RemoveHave you added an alarm system or any other security system? Yes No Fire? Yes No Burglar? Yes No Fire and Burglar? Yes No Do you have a home based business? Yes No If yes, please explain.Have you purchased any fine jewelry, art or collectibles that would like to be scheduled onto your Home Policy? Yes No If yes, please list. Add RemoveAutoHave you acquired any new vehicles not listed on your policy? Yes No If yes, please explain.Do you have a company car? Yes No If yes, please explain.Do you drive any of your vehicles 8,000 miles/year or less? Yes No Do you use any vehicles on your policy for snow removal, Uber, or delivery? Yes No If yes, please explain.Are all drivers in the household listed on your policy? Yes No If no, list additional drivers and relationship to youFull NameRelationship Add RemoveAre any of your vehicles customized? Yes No If yes, list vehicles and customizationsVehicleCustomization Add RemoveOther CoveragesDo you have an umbrella liability insurance policy with adequate limits? Yes No If no, would you like a personal liability umbrella quote? Yes No Have you acquired or have any rental properties that we do not insure? Yes No Date of PurchaseMonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Address of Rental Property Street Address Address Line 2 City State Select StateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Are there any other material changes or new assets you have acquired? Yes No If yes, please explain.
