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Home > Insurance > Family Risk Questionnaire (FRQ)

Family Risk Questionnaire (FRQ)

The renewal date of your insurance coverage with our office is fast approaching, and it is important that we keep our information current. By taking a few minutes to fill out and return this questionnaire, you can help us keep your coverage up-to-date and prevent gaps in coverage. If we do not hear back from you, we will assume that there have been no changes.

Thank you in advance for taking the time to review and complete this questionnaire! If you have requested a quote on any of the items below or have made changes or corrections, we will contact you for further discussion.

**If you would prefer to access the FRQ via hardcopy please click the PDF link. Otherwise, you may begin the FRQ below.

Family Risk Questionnaire (FRQ) Family Risk Questionnaire (FRQ).pdf

Compensation Disclaimer Compensation Disclaimer.pdf

Personal Information

First Name *

Last Name *

Street Address *

City *

State / Province *

ZIP / Postal Code *

E-Mail Address *

Automobile Coverage

If you do not currently carry auto coverage with us, would you like a quote?

Yes
No

Are you interested in increasing your liability limits?

Yes
No

Would you like us to review your uninsured / underinsured motorist limits?

Yes
No

Would you like a quote for inclusion of electronic devices not permanently installed?

Yes
No

Do you have any vehicles furnished for your regular use that you do not own, such as a company car?

Yes
No

Have any vehicle titles been changed to another party or to a trust?

Yes
No

Vehicles not listed on your policy may be EXCLUDED from coverage. Do you own any vehicles not listed on your policy that should be?

Yes
No

Drivers not listed on your policy may be EXCLUDED from coverage. Are there any household members not listed on your policy? Are there any non-household members who regularly use your vehicle(s)?

Yes
No

If your vehicle is financed (or leased), is the lienholder or leasing company properly listed on the policy?

Yes
No

Is your vehicle used for business?

Yes
No

Is your vehicle used to drive for Uber, Lyft, or another ridesharing company?

Yes
No

Is your vehicle used to deliver pizza, food, groceries, etc.?

Yes
No

Would you like a quotation for rental reimbursement coverage or towing & labor coverage in the event your vehicle is damaged in an accident?

Yes
No

Do you have any recreational vehicles (motorbikes, motor homes, golf cars, Mopeds, ATVs, snowmobiles, etc.) that should be insured?

Yes
No

Homeowners, Renters, and Condo Owners Coverage

If you do not currently carry homeowner’s coverage with us, would you like a quote?

Yes
No

Has the insured property been deeded to another party or to a trust?

Yes
No

If you have a mortgage, is the mortgage information shown on your policy correctly listed?

Yes
No

Due to inflation and increased costs of construction, property values should be examined annually. Are your home and personal belongings coverages insured for 100% replacement value?

Yes
No

Is your property part of a homeowner’s association?

Yes
No

Do you or any residents in your household have any pets?

Yes
No

If so, what kind?

Does your home have a monitored fire and/or burglar alarm system?

Yes
No

Have you updated the roof of your home?

Yes
No

If so, when?

Have you updated the electrical wiring, plumbing, and/or heating/AC?

Yes
No

Do you have any valuables such as: jewelry, silver, furs, camera equipment, money, fine arts, firearms, or other items that should be insured separately due to limited or no coverage on your policy?

Yes
No

Would you like a quotation for backup of sewer and drain coverage?

Yes
No

Flood coverage is NOT included on standard homeowner’s policies. Would you like a quotation for this important coverage?

Yes
No

Wind coverage MAY or MAY NOT be included on standard homeowner’s policies. Would you like a quotation for this important coverage?

Yes
No

Catastrophic limits may or may not match the limits you carry on your property. If you already have flood or wind coverage in place, would you like a quotation for limits in EXCESS of what you currently carry?

Yes
No

Earthquake coverage is NOT included on standard homeowner’s policies. Would you like a quotation for this important coverage?

Yes
No

Ordinance and law coverage is NOT usually included on standard homeowner’s policies. Would you like a quotation for this important coverage?

Yes
No

Mold remediation is NOT usually included or may be limited on standard homeowner’s policies. Would you like a quotation for this important coverage?

Yes
No

Identity theft coverage may be available. If available, would you like a quote?

Yes
No

Are you interested in higher limits of liability?

Yes
No

Would you like a quotation for personal injury coverage?

Yes
No

Do you own a secondary home, rental income property, or any other property?

Yes
No

Do you own any vacant land?

Yes
No

Do you work, maintain, or operate a business, give private lessons in your home? (Includes but not limited to baby-sitting, lawn mowing, Tupperware, Mary Kay, Avon, etc.)

Yes
No

Are you presently involved in any form of farming or ranching?

Yes
No

Do you rent any portion of your home to others on a regular or temporary basis?

Yes
No

Children living away from home, including away at school, MAY NOT be covered. Do you have any children living away from home or away at school?

Yes
No

Do you own any aircraft, model aircraft or hobby aircraft (e.g. drone)?

Yes
No

Do you own any watercraft?

Yes
No

Do you have any electric, battery, or gas powered children vehicles? If yes, would you like a quotation for coverage?

Yes
No

Do you or any resident of the household hold any elected or appointed position or serve on a Board of Director?

Yes
No

If you are a Condominium Owner, have the condo association by-laws changed or has the deductible under the master association policy changed?

Yes
No

If you do not currently have Loss Assessment coverage or are not carrying the maximum limit, would you like a quote or a quote to increase?

Yes
No

Other Coverage

Is there anything else that has changed, or that you think may affect your insurance coverage?

Yes
No

If yes, please explain

Would you be interested in an umbrella policy that extends your automobile and homeowner’s liability coverage to $1 million or more?

Yes
No

Do you retain household employees?

Yes
No

If yes, please explain

Notes/Comments:

Submission Validation

Required

Important Notice
Any submissions or payments made via this website do not constitute a binding agreement to your policy or coverages. Changes and payments to policies are not effective or binding until you, or any party involved, receive official notice from either your insurance agent, or your insurance company. If you have any questions, please feel free to contact us.

Per the terms of our online privacy policy we will not resell your information to any third-party.

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