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Insurance Protection Review Survey


from Bailey Place Insurance

Umbrella Insurance Policy Review

Please complete the form below to help us understand your evolving insurance needs.

Contact Information
Are you the policy holder? ✶
Additional Vehicles
Besides your auto, do you or a resident family member own any other motorized vehicles? ✶
(motorcycle, moped, mini-bike, snowmobile, ATV, go-kart, dune buggy, motorboat, yacht, sailboat, jet-ski, golf cart)
Farming Business
Are you in the farming business? ✶
(incidental farming, custom farming, or livestock, etc.)
Domestic Employees
Do you have any employees or domestic help at your residence? ✶
(nanny, care giver, cleaning person, etc.)
Non-Owned Property Care
Are you caring for any property that is not your own and it exceeds $1,000? ✶
Business Actitivies
Are there any business activities conducted at your home, or in or on any property that you own? ✶
(daycare (adults or children), home based business, lawn mower repair, etc.)
Rental Property
Is any portion of your premises rented to anyone? ✶
Other Real Estate
Do you own or have any interest in any other real estate? ✶
(timeshare, vacation property, vacant land, camp, farm land, etc.)
Younger Drivers
Are there any drivers in your household under the age of 25? ✶
Pilot License
Do you own, lease, or charter an aircraft, or have a pilot license? ✶
Business Use
Do you use your property, vehicles, watercraft, or aircraft for business purposes? ✶
Uninsured Vehicles
Do you have any vehicles, watercraft, aircraft, or property that are owned, hired, leased, rented, or used on a regular basis that are not covered by insurance? ✶
Swimming Pool
Is there a swimming pool on your property? ✶
Type
Pool features
Attractive Nuisances
Are there any other “attractive nuisances”? ✶
(trampoline, pond, unregistered vehicles, etc.)
Animals & Exotic Pets
Do you, any household resident, or any tenant have any animals or exotic pets? ✶
(dogs, cats, reptiles, birds, farm animals, etc.)
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