Integrity Assurance AssessmentAssessment 2021Name First Last Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email PhonePersonal AutoDo you own any vehicles that we do not insure? Yes NoIf you answered "Yes," please note that you will possibly reduce your premium by having ALL of your vehicles insured in the same place. That would also reduce the possibility of GAPS in your coverage. It would be in your best interest to have a discussion with your agent concerning this.Are there any new drivers in your household? Yes NoIn order to avoid problems at the time of an accident, it is vitally important that ALL DRIVERS residing in your household are accounted for on your policy. It would be in your best interest to have a discussion with your agent concerning this.Do any of your vehicles include "after-market" accessories or customization that increases the value of the vehicle? Yes NoIn order to avoid problems at the time of an accident, and to make sure the value of your vehicle is fully protected, it is important that you document and insure any and all accessories and/or customization for your vehicle.Are you interested in learning more about, or adding to your policy any of the following coverages? Roadside Assistance/Emergency Service/Towing Rental Reimbursement Loan/Lease GAP coverage Additional Personal Injury Protection (PIP)Roadside Assist: Whether you locked yourself out of your vehicle, have a flat tire, or are broke down on the side of the road, this coverage will pay when you call for help.Rental Reimbursement: When your vehicle is in the shop for a covered repair, having this coverage will pay some or all of the cost of renting a replacement vehicle.Loan/Lease GAP Coverage: Protects you when your vehicle is totaled by paying the difference between the value of the vehicle and the balance still owed on the loan.Additional PIP: Basic PIP is mandatory in a No-Fault State. You have the option of increasing your limit to provide higher benefits for your medical expenses and lost wages.pDo you participate in any Transportation Networks with your vehicle, such as UBER/LYFT? Yes NoUBER/LYFT:The TNC insurance landscape is continuously evolving to meet the safety needs of drivers and passengers. Be sure to consult with Integrity Insurance Agency to further discuss your coverage options and to make sure you're adequately protected.Do you use your vehicle for ANY business purpose, including delivery services such as GrubHub? Yes NoBusiness Use: Personal auto insurance doesn't provide adequate coverage for any accidents that occur while you are driving for business purposes. Be sure to consult with Integrity Insurance Agency to further discuss your coverage options and to make sure you're adequately protected.Has the loan status on any of your vehicles changed in the past year? Yes NoIf you have paid a vehicle off, be sure to let us know so we can remove the lienholder from your policy.Notes:Homeowners/RentersDo you own any of the following items of Personal Property? Antiques, fine arts, silverware, or collections Jewelry Furs Value Camera Equipment or Musical Instruments Large amounts of Cash in your home Coin or Stamp Collection Guns None of the aboveYour policy contains Sub-Limits for Theft of these items. Please be sure to consult with Integrity Insurance Agency to further discuss your coverage options and to make sure you're adequately protected.Have you made any major improvements, home additions, or added outbuildings in the past year? Yes NoIf you answered "Yes," please be sure to consult with Integrity Insurance Agency to further discuss your coverage options and to make sure you're adequately protected.Do you own any of the following? Second/Seasonal Home Rental Property Vacant Land Farm Property None of the aboveIf you selected any of the above property types, please be sure to consult with Integrity Insurance Agency to further discuss your coverage options and to make sure you're adequately protected.Do you participate in any House Sharing such as AirBNB? Yes NoAirbnb does offer its hosts two forms of protection through its host guarantee program and host protection insurance. While hosts may be inclined to rely exclusively on these programs to manage their risks, there are significant gaps related to these offerings. Be sure to consider ALL of the risks. Please be sure to consult with Integrity Insurance Agency to further discuss your coverage options and to make sure you're adequately protected.Do you conduct any business or give private lessons in your home? Yes NoIf you answered "Yes," Please be sure to consult with Integrity Insurance Agency to further discuss your coverage options and to make sure you're adequately protected.Do you own any of the following recreational items? Boat/JetSki/Wave Runner Motorbikes ATV Golf Cart Snowmobile Quad/Side-by-Side/Gator DroneOperating a recreational-type vehicle or device is fun and exciting, but accidents happen. While you may not be concerned about the value of your boat or ATV or DRONE, you need to be concerned about the liability that comes with simply operating such items. Please consult with Integrity Insurance Agency to further discuss your coverage options and make sure you're adequately protected.Are you interested in learning more about, or adding any of the following optional coverages, which are not included in the standard policy? Water Sewer Backup Service Line Coverage Equipment Breakdown Flood EarthquakeThese coverages ARE NOT included in your standard homeowner's Policy. Please be sure to consult with Integrity Insurance Agency to further discuss your coverage options and to make sure you're adequately protected.Would you be interested in an Umbrella policy that extends your Auto & Homeowners Liability coverage an additional $1M or more? Yes NoIf you answered "Yes," a personal umbrella policy provides an extra layer of insurance coverage over your standard liability policies. It protects your personal assets by kicking in when your standard liability coverage is exhausted. Please consult with Integrity Insurance Agency to further discuss your coverage options and make sure you're adequately protected.Notes:Life/Health/FinancialDoes everyone know where your important documents, such as Will, financial documents and insurance policies are located? Yes NoDo you have an up-to-date Will? (LegalShield) Yes NoHas anyone ever helped you determine exactly how much Life Insurance you need? Yes NoDo you have Mortgage Redemption Insurance, which pays off your house in the event of your death? Yes NoAre all members of you family protected by Life Insurance? Yes NoDo you have Disability Income Insurance in case you become sick or disabled? Yes NoDo you have Long Term Care Insurance? Yes NoDo you have any idea how much money you need when you retire? Yes NoDo you have a retirement or pension plan? Yes NoWhat are YOUR greatest concerns right now in regards to your overall Financial Plan? 51995