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Home > Insurance > Family Risk Questionnaire (FRQ)
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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?

Are you interested in increasing your liability limits?

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

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

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

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

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

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)?

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

Is your vehicle used for business?

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

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

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

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

Homeowners, Renters, and Condo Owners Coverage
If you do not currently carry homeowner’s coverage with us, would you like a quote?

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

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

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?

Is your property part of a homeowner’s association?

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

If so, what kind?
Does your home have a monitored fire and/or burglar alarm system?

Have you updated the roof of your home?

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

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?

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

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

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

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?

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

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

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

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

Are you interested in higher limits of liability?

Would you like a quotation for personal injury coverage?

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

Do you own any vacant land?

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.)

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

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

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?

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

Do you own any watercraft?

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

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

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

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?

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

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?

Do you retain household employees?

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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