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Coverage neededZIP code

Quote details

Desired coverage start dateCurrent insurance companyCurrent coverage limits and deductiblesClaims or losses in the past five years — dates and amounts

Coverage informationGaraging or storage addressAll vehicles / equipment: year, make, model, VIN or hull ID, value, ownership / lenderAll drivers / operators: name, birth date, license number and state, experienceAccidents, tickets, suspensions, or violations — dates and detailsPersonal / business use, annual mileage, and operating radiusRequested liability limits, comprehensive / collision deductibles, and additional coverages

Coverage informationLegal business name and DBABusiness addressDescribe all business operations and servicesYears in business and owner experienceAnnual revenueAnnual payrollNumber of employeesSubcontractor work, annual cost, and insurance requirementsCoverage requested, limits, equipment / property values, and contract requirements

Coverage informationUSDOT and MC numbers, if applicableOwn authority / leased operator / new ventureNumber of vehiclesOperating states and maximum radiusCargo types, maximum cargo value, and hauling percentagesRequired filings and broker / shipper / customer limits

Coverage informationFull property addressProperty type and occupancy: owned / rented / vacant / tenant occupiedYear builtSquare footageConstruction type and number of storiesRoof type, age, and replacement yearPlumbing, electrical, HVAC updates and datesDwelling replacement value, belongings value, liability limit, and deductiblesPools, pets, outbuildings, security, prior damage, and other property details

Coverage informationDate of birthPolicy type and term lengthDesired coverage amountTobacco / nicotine use and last useHealth conditions, medications, height and weightExisting life coverageBeneficiary relationship and purpose of coverage

Coverage informationEveryone needing coverage: names, birth dates, relationship, ZIP, and tobacco useIndividual / family / Marketplace / Medicare / employer planEstimated annual household income and tax household sizeDesired start date, qualifying life event and date, or Medicare eligibilityDoctors, hospitals, dentists, and providers you want to keepPrescriptions, dosages, and frequencyCurrent coverage and employer coverage availability

Coverage informationEach pet: name, species, breed, birth date, sex, and ZIPPre-existing conditions, medications, and veterinary historyRequested annual limit, reimbursement percentage, deductible, and wellness coverage

Coverage informationUnderlying home / renters / auto / boat policies, carriers, limits, and renewal datesHousehold members, drivers, vehicles, properties, rentals, pools, and other exposuresRequested umbrella limit

Coverage informationRecords held, business systems, online revenue, and prior cyber incidentsMFA, backups, encryption, employee training, and security controls

Coverage informationProfessional services, qualifications, client types, and largest contractsPrior professional liability coverage and retroactive date

Anything else HIA should know?

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