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Annual Insurance Review

Annual Insurance Review

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First Name*

Last Name*

Phone*

Email*

Which type of insurance do you have with us? Select all that apply.*

Personal Insurance

Business Insurance

Personal Insurance

Home Address

Street Address Address Line 2 City State ZIP Code

Have you renovated, remodeled, added on to, or otherwise updated your home(s)?

Yes

No

Have you started a business based out of your home?

Yes

No

Do you protect your home with a professional security system?

Yes

No

Have you added a permanent swimming pool?

Yes

No

Do you or any family members perform babysitting services in your home?

Yes

No

Do you employ any part-time or full-time domestic help, including nannies, housekeepers, or landscapers?

Yes

No

Have you purchased any additional residences such as condos, timeshares, or second houses?

Yes

No

Do you rent out your home as part of the home-sharing economy?

Yes

No

If you’ve started renting out your home or any other property, do you have renters insurance?

Yes

No

Are all of your vehicles, including recreational vehicles and watercraft, insured with this agency?

Yes

No

Have you recently purchased any additional automobiles, recreational vehicles, or watercraft?

Yes

No

Have you upgraded any of your vehicles with new equipment?

Yes

No

Do you need to add any new drivers to your policy?

Yes

No

Do you drive any employer-sponsored vehicles?

Yes

No

Do you own any older vehicles that may be classic or collector cars?

Yes

No

Do you provide ride services as part of the ridesharing economy?

Yes

No

Do you have any children who no longer live at home and can no longer be considered dependents?

Yes

No

Have you purchased any jewelry, electronics, or other valuables that you would like to add to your policy?

Yes

No

Are there any such items that you would like to change or remove from your policy?

Yes

No

Do you insure your personal possessions for their full replacement value?

Yes

No

Have you recently added or otherwise changed ownership of assets such as trusts, titles, or LLCs?

Yes

No

Are there any other insurance coverage issues you would like to discuss?

Yes

No

Business Insurance

Company Name

Company Address

Street Address Address Line 2 City State ZIP Code

Total Number of Employees

Are there any business properties or pieces of equipment that you have recently acquired, leased, or sold?

Yes

No

Have you closed or opened any business locations?

Yes

No

Has your company building undergone any renovations, additions, or other significant changes?

Yes

No

Have you added, changed, or removed any company products?

Yes

No

Has your inventory level experienced any significant shifts or fluctuations?

Yes

No

Do you either purchase supplies from or sell your products to foreign countries?

Yes

No

Has the ownership structure of your business changed?

Yes

No

Has there been a 10% or greater change in your business's revenue in the last year?

Yes

No

Do 50% or more of your materials come from a single supplier?

Yes

No

Do 50% or more of your sales come from a single buyer?

Yes

No

Do any of your employees regularly work from home or from another state?

Yes

No

Do any of your employees regularly travel to other states or countries for business?

Yes

No

Do any of your employees travel for business in their personal vehicles?

Yes

No

Has your company leased, purchased, or sold any automobiles or other vehicles?

Yes

No

Do you require all vendors, subcontractors, and 1099 workers to provide certificates of insurance?

Yes

No

Are there any other insurance coverage issues you would like to discuss today?

Yes

No

Phone

This field is for validation purposes and should be left unchanged.

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Annual Insurance Review

Newburgh

Self Insurance Services, LLC
7925 Bell Oaks Dr
Suite A
Newburgh, Indiana 47630

Phone: (812) 490-7283

Office Hours:

Mon-Fri: 8:00am-4:30pm
Sat-Sun: Closed

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Evansville

Self Insurance Services, LLC
4 NW 2nd St
Suites 4,5,6,
Evansville, Indiana 47708

Phone: (812) 490-7283

Office Hours:

Mon-Fri: 8:00am-4:00pm
Sat-Sun: Closed

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Self Insurance Services, LLC provides auto, home, and business insurance to all of Indiana, including Newburgh and Evansville.

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