Insurance Service Center DePere - Dwelling 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.)

Client Name*

First NameLast Name

Email Address

I want coverage for my personal property (i.e. stove, refrigerator, washer, lawn mower) that is kept at the location?*

YesNoCall Me

If yes, how much do you want to insure it for?

I want my personal property at this rental covered if it is stolen?*

YesNoCall Me

I have detached structures (garages, outbuildings) at this location?*

YesNoCall Me

If yes, please describe the structure and how much you want to insure it for.

I have a woodstove in ANY building? *

YesNoCall Me

I want coverage for rental income I will lose due to a covered claim?*

YesNoCall Me

If yes, how much $ per month?

How many months do you want coverage for?

I own additional rental properties not insured with ISC. *

YesNoCall Me

I would like coverage for sewer/sump pump back up?*

YesNoCall Me

This property is being substantially renovated or remodeled?*

YesNoCall Me

If yes, please describe.

I would like insurance to pay off my mortgage in the case of a premature death? *

YesNoCall Me

I understand that the amount of insurance coverage on this property is only an estimate of what it might cost to replace it. To get an accurate value I could get an estimate from a contractor or real-estate agent. *

YesNoCall Me

I am interested in higher liability coverages and/or an umbrella liability policy. *

YesNoCall Me

Comments

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

Client Signature*

Date*

MonthDayYear

Enter the message as it's shown*

Send to*