Owen Moore Agency, Inc.
March 10, 2010

 

Contact Us

Linwood Location:
69 South Huron Road
P.O. Box 99
Linwood, MI 48634 Map
(989) 697-4422
(888) 595-6936
(989) 697-4424 (fax)
info@owenmoore.com

Standish Location:
110 N James St
P.O. Box 746
Standish, MI 48658 Map
(989) 846-9971
(989) 846-9981 (fax)

Family Risk Questionnaire

To make sure you're adequately protected, we recommend a yearly review of all of your insurance policies. This questionnaire helps make that review quick and efficient. Please take a moment to answer the questions and click on "Submit".

Name
Street Address
City
State, Zip
Home Phone
Business Phone
Fax
E-mail

Automobile/Vehicle

 Yes    No   Would you consider increasing your deductibles to lower your premium?
 Yes    No   Do we currently insure all of the vehicles in your household? If not, how many do you insure elsewhere?
 Yes    No   Are all of the licensed drivers in your household listed on your auto policy?
 Yes    No   Would you like to include your car stereo (if mounted under the dash), tapes, CDs, CB or two-way radio on your auto policy for an additional premium?
 Yes    No   If you own a pickup or a van, does it contain any customized equipment?
 Yes    No   Do you own a pickup camper or a camper shell?
 Yes    No   Do you own minibikes, mopeds, or motorcycles? If so, how many?
 Yes    No   Do you have vehicles furnished for regular use that you do not own, such as a company car? If so, how many?
 Yes    No   Do you want rental reimbursement or towing and labor coverage in the event that your car is damaged in in accident?
 Yes    No   Do you own any boats, motorbikes, motor homes or other recreational vehicles such as snowmobiles or golf carts?
 Yes    No   Would you like a quote for higher limits of liability insurance or personal injury protection?
 Yes    No   Do you have other electronic devices you wish to cover (e.g. cell phone)?

Homeowner/Renter/Condos

Coverage for questions 1 to 5 may be limited or excluded under your policy.

 Yes    No   Do you own any antiques, fine arts or collections, such as unique dishes and figurines?
 Yes    No   Do you own any jewelry or furs? If so, what is the total appraised value of such items?
 Yes    No   Do you own valuable camera equipment, silverware, or guns?
 Yes    No   Do you frequently carry or keep in your home more than $200 in cash?
 Yes    No   Do you have a coin or stamp collection?
 Yes    No   Would you prefer to cover your personal belongings for their full replacement value (i.e. no deduction for depreciation)?
 Yes    No   Would you be interested in adding earthquake insurance to your homeowners protection?
 Yes    No   Would you be interested in adding flood insurance to your homeowners protection?
 Yes    No   Do you currently have a burglar, fire, or smoke alarm, fire extinguishers or dead bolts on all doors in your home?
 Yes    No   Would you like an estimate of your home's replacement cost at today's prices?
 Yes    No   Would you like home replacement guarantee protection?
 Yes    No   Do you own a second home or any other real property such as a cabin, farm property, or any income producing property?
 Yes    No   Are you engaged in any form of farming or ranching?
 Yes    No   Do you conduct any business (including child care) or give private lessons in your home?
 Yes    No   Would you be interested in an umbrella or excess liability policy that extends your auto and homeowners liability coverage to $1 million or more?
 Yes    No   Do you own a computer for business?
 Yes    No   Do you own a computer for pleasure?
 Yes    No   Do you have water backup of sewers/drains coverage?
 Yes    No   Would you like identity theft coverage?

Other Personal Insurance

 Yes    No   Do you have disability income insurance in case you become sick or disabled?
 Yes    No   Are you concerned about estate taxes?
 Yes    No   Do you have a mortgage redemption insurance policy (which pays off your house in the event of your death)?
 Yes    No   Are all members of your family protected by life insurance?
 Yes    No   Would you like a review of the beneficiaries, ownership, and cash values (if any) of your life insurance policies?
 Yes    No   Are you interested in discussing life insurance within the next year?
 Yes    No   Do you have a retirement or pension plan?
 Yes    No   Are you self-employed?
 Yes    No   If so, have you heard about SEP or Keogh retirement plans? 
 Yes    No   Would you like to know more?
 Yes    No   Is your health insurance up to date? (consider recent increases in hospital rates)
 Yes    No   If you are a self-employed professional, would you like a quote for business property, professional liability, or malpractice insurance?
 Yes    No   Have you been contributing to an IRA (standard or Roth)?
 Yes    No   Are you interested in other financial services?

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