It’s time to review your insurance. Annual Renewal It’s important that we review your insurance needs to ensure you have the proper insurance coverage in place. Step 1 of 10 10% Disclaimer* I agreeThis information is not an offer to sell insurance. Insurance coverage cannot be bound or changed via submission of this online form/application, e-mail, voicemail, facsimile, text, or social media platform. No binder, insurance policy, evidence of property coverage, change, addition, and/or deletion to insurance coverage goes into effect unless and until confirmed directly with a licensed agent. Note: any proposal of insurance we may present to you will be based upon the values developed and exposures to loss disclosed to us on this online form/application and/or in communications with us. All coverages are subject to the terms, conditions, and exclusions of the actual policy issued. Not all policies or coverages are available in every state. This website does not make any representations that coverage does or does not exist for any claim or loss, or type of claim or loss, under any policy. Whether coverage exists or does not exist for any claim or loss under any policy depends on the facts and circumstances involved in the claim or loss and all applicable policy wording. All claim determinations are made by the carriers not the agency. “Certificates are issued as a matter of information only and confer no rights upon the certificate holder. Any certificate issued does not amend, extend, or alter the coverage afforded by the insured policies.” Every effort will be made to respond to certificate requests by close of business on day request is received. Certificates requiring special verbiage or underwriting approval may take additional processing time. Furthermore, all agency certificates, binders, or evidence of coverage will be issued in compliance with Insurance Commissioners directive 11-EX-2. Coverage may not be amended by agency and is only a synopsis of that which is contained by the policy limits. Please contact our office at (706) 738-0411 to discuss specific coverage details and your insurance needs. To protect your privacy, please do not send us your confidential personal information by unprotected e-mail. Instead, discuss that personal information with us by phone or send it to us by secured fax at (706) 738-0371. Statements on this website as to polices and coverages and other content provide general information only and we provide no warranty as to their accuracy. Clients\prospects should consult with their licensed agent as to how these coverages pertain to their individual situation. Any hypertext links to other sites or vendors are provided as a convenience only. The agency has no control over those sites or vendors and cannot, therefore, endorse nor guarantee the accuracy of any information provided by those sites or the services provided by those vendors. Information provided on this website does not constitute professional advice. If you have legal, tax or financial planning questions, you should consult with a qualified professional such as an attorney. NAME* First Last EMAIL* PHONEWHAT INSURANCE DO YOU CURRENTLY HAVE WITH US?* Personal Insurance Business Insurance HOME ADDRESS* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code COMPANY NAME* COMPANY ADDRESS* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code TOTAL ANNUAL SALES*TOTAL NUMBER OF EMPLOYEES* Your Home(s)Please think back over the last year when answering these questions.HAVE YOU REMODELED OR MADE ANY MAJOR UPDATES TO AN EXISTING HOME(S)?* Yes No (New roof, furnace, or electrical system)HAVE YOU ADDED A HOME SECURITY SYSTEM?* Yes No HAVE YOU STARTED A HOME-BASED BUSINESS?* Yes No HAVE YOU PURCHASED A SECONDARY RESIDENCE, INCLUDING A CONDO OR TIMESHARE?* Yes No HAVE YOU STARTED PARTICIPATING AS A SERVICE PROVIDER IN THE HOME SHARING ECONOMY?* Yes No (Airbnb, VRBO)PLEASE EXPLAIN ANY CHANGES TO YOUR HOME. Your Automobiles and other “Vehicles”Please think back over the last year when answering these questions.HAVE YOU ADDED AN AUTOMOBILE, WATERCRAFT, OR RECREATIONAL VEHICLE?* Yes No HAVE YOU ADDED ANY NEW DRIVERS?* Yes No HAVE YOU ADDED A VEHICLE PROVIDED BY AN EMPLOYER?* Yes No HAVE YOU HAD A CHILD LEAVE HOME TO ATTEND SCHOOL OR NO LONGER CONSIDERED A DEPENDENT?* Yes No HAVE YOU STARTED PARTICIPATING AS A SERVICE PROVIDER IN THE RIDESHARING ECONOMY?* Yes No (Uber, Lyft, Sidecar)PLEASE EXPLAIN ANY CHANGES TO YOUR AUTOMOBILES AND "OTHER" VEHICLES. Your Other Life EventsPlease think back over the last year when answering these questions.HAVE YOU ADDED OR CHANGED OWNERSHIP OF ANY ASSETS INCLUDING TITLES, TRUSTS OR LLCS?* Yes No HAVE YOU HIRED DOMESTIC HELP, NANNY OR HOUSEKEEPER, EITHER FULL OR PART-TIME?* Yes No HAVE YOU PURCHASED JEWELRY, ART OR OTHER VALUABLES THAT NEED TO BE ADDED? ARE THERE ITEMS THAT NEED TO BE CHANGED OR DELETED?* Yes No HAVE YOU HAD A SIGNIFICANT CHANGE IN NET WORTH?* Yes No HAVE YOU ACCEPTED A POSITION ON A BOARD(S) OF A PROFIT OR NONPROFIT ORGANIZATION(S)?* Yes No PLEASE EXPLAIN ANY CHANGES. Your Business StructurePlease think back over the last year when answering these questions.HAVE YOU CHANGED THE OWNERSHIP STRUCTURE OF YOUR BUSINESS?* Yes No HAVE YOU ADDED NEW OR CHANGED YOUR EXISTING OPERATIONS AND/OR PRODUCTS?* Yes No HAVE YOU BEGUN TO BUY SUPPLIES OR SELL YOUR PRODUCTS OVERSEAS?* Yes No ARE YOU OPERATING OUT OF ANY NEW LOCATIONS OR HAVE YOU CLOSED LOCATIONS?* Yes No PLEASE EXPLAIN ANY CHANGES TO YOUR BUSINESS STRUCTURE. Your Personal LiabilityPlease think back over the last year when answering these questions.HAS YOUR INVENTORY LEVEL CHANGED SIGNIFICANTLY?* Yes No HAVE YOU ACQUIRED, LEASED OR SOLD A BUILDING, BUSINESS PROPERTY AND/OR EQUIPMENT?* Yes No HAVE THERE BEEN ANY IMPROVEMENTS AND/OR SIGNIFICANT ALTERATIONS TO YOUR BUILDING?* Yes No HAVE YOU PURCHASED, LEASED OR SOLD ANY VEHICLES?* Yes No PLEASE EXPLAIN ANY CHANGES TO YOUR PERSONAL LIABILITY. Your Income ProtectionPlease think back over the last year when answering these questions.HAVE YOUR BUSINESSES REVENUES CHANGED BY MORE THAN 10% SINCE LAST YEAR?* Yes No DO YOU RELY ON A SINGLE SUPPLIER FOR MORE THAN 50% OF YOUR MATERIALS?* Yes No DO YOU RELY ON A SINGLE BUYER FOR MORE THAN 50% OF YOUR SALES?* Yes No PLEASE EXPLAIN ANY CHANGES TO YOUR INCOME PROTECTION. Your Employees & Professional Liability ExposurePlease think back over the last year when answering these questions.DO YOU HAVE EMPLOYEES THAT REGULARLY TRAVEL OUT OF STATE OR OVERSEAS FOR BUSINESS?* Yes No DO ANY EMPLOYEES USE THEIR OWN PERSONAL CARS FOR BUSINESS PURPOSES?* Yes No DO ANY EMPLOYEES WORK OUTSIDE YOUR HOME STATE OR WORK FROM THEIR HOME REGULARLY?* Yes No DO YOU OBTAIN CERTIFICATE OF INSURANCE FROM ALL SUBCONTRACTORS, VENDORS AND 1099 WORKERS?* Yes No ARE ANY OF THE OWNERS A MEMBER OF ANY BOARD OF DIRECTORS WHETHER FOR PROFIT OR NOT?* Yes No PLEASE EXPLAIN ANY CHANGES TO YOUR EMPLOYEES AND PERSONAL LIABILITY EXPOSURE. Additional ProtectionWe're a full service agency providing solutions for personal, business and specialty Insurance needs for our clients.WOULD YOU LIKE TO DISCUSS ANY ADDITIONAL INSURANCE PROTECTION WITH OUR FIRM?* Yes No ConfirmationYOUR INITIALS* Δ
