PL Questionnaire - Plastridge Insurance

Insured’s Name*

Select Your Account Manager*

Email*

Phone Number*

Property Address - responses below will apply only to this address*

Street Address City State ZIP Code

Please provide an answer to ALL questions

Have you reviewed the coverage limits on your current policy and feel that they are still adequate?*

Yes
No

Have you recently completed, or are planning any additions or renovations to your property?*

Yes
No

Have you recently updated your roof, or installed hurricane shutters or impact glass?*

Yes
No

Is any part of your home ever rented to others?*

Yes
No

Is any type of business conducted on the premises?*

Yes
No

Is any business property regularly kept on the premises?*

Yes
No

Is any childcare conducted at your home?*

Yes
No

Do you have any domestic employees?*

Yes
No

Do you own a golf cart?*

Yes
No

Has there been a change in ownership (such as a trust) or have you changed mortgage companies or paid off your loan?*

Yes
No

Does your home have any protective devices such as a monitored burglar/fire alarm or auto-shutoff water leak detection?*

Yes
No

Would you consider increasing your deductible in order to reduce the premium?*

Yes
No

Your policy limits or excludes certain categories of personal property, such as: Jewelry/Watches, Musical Instruments, Silverware, Antiques, Fine Arts or Collectibles, Personal Computers, Sports Memorabilia, Stamps, Coins, Furs, Firearms, Cameras, and more. Do you own items in any of these categories, and would like us to quote coverage? If so, we may need full descriptions, values, or appraisals/receipts.*

Yes
No

Your policy contains limitations and exclusions for watercraft. Do you own any watercraft (such as powered or non-powered boats or jet skis), and would like us to quote coverage?*

Yes
No

Homeowner’s insurance typically excludes coverage for flooding. Would you like a quote for flood coverage?*

Yes
No

We can provide coverage for personal autos, business autos, and antique/collectible vehicles. Would you like a quote for automobile insurance?*

Yes
No

Umbrella (Excess Liability) coverage provides liability of $1 million or more, and is available at a reasonable premium. If your primary residence is in Florida would you like an Umbrella quote?*

Yes
No

Please share any other important information that might be relevant to your insurance situation (change in your lifestyle, your primary residence status, your household, etc.)

Personal Residential Property Questionnaire

Personal Residential Property Questionnaire

Please complete our Personal Residential Property Questionnaire.

Please provide an answer to ALL questions

*Disclaimer: Coverage cannot be bound or changed based on submission of this questionnaire.

Thank you for your submission.

Your account manager will contact you soon.

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STUART OFFICE

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