Insurance Service Center DePere - Renters Insurance Checklist

Client Name*

First NameLast Name

Email Address

Optional Coverage*

	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, hearing aids, 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.*
Business/Farm Endorsement
Examples: day care, lessons (piano, sports...), selling crops, renting land to others, product consultant (purses, jewlery, candles...), auto repair.*
Leasehold Improvements - Provides coverage for structural changes or improvements you make to a leased space.*
Are you interested in Flood or Earthquake Insurance? Floods and earthquakes are not covered by your homeowners policy.

Questions*

	Yes	No	Call Me
Do you want to increase the amount of coverage on your personal property? Please note - the coverage amount used is an estimate only. You are responsible to determine adequate coverage amount.
Do you want coverage for life insurance or disability?*
Are you interested in higher liability limits and/or an umbrella liability policy?*
Do you have any children away at college? (If renting an apartment, they may need renter's insurance.)

Do you have any animals? *

YesNoCall Me

If yes, please describe:

Do you own any other land, property or buildings? (Farm land, rental properties, barns, hunting land, etc.)*

YesNoCall Me

If yes, please describe:

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".)*

YesCall Me

*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*

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