PROVIDER INSURANCE: RENEWAL SURVEY FOR HOMEOWNERS

1. Provider's Policy Renewal Survey for Homeowners

Is your insurance policy up for renewal? If so, please take a moment to complete this two minute survey so that we can get right to work on saving you money. Does the Provider Insurance Group write all of your personal insurance policies? Did you know there are companion discounts when writing all of your coverage with one company?

If you are taking this survey because you received our voice mail message, Thank you! Your responses will give us the tools we need to help keep you properly protected, at the right price.

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1. YOUR NAME:

YOUR NAME:

2. ENTER YOUR PREFERRED EMAIL ADDRESS:

ENTER YOUR PREFERRED EMAIL ADDRESS:

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3. PHONE NUMBER:

PHONE NUMBER:

4. PERSONAL RESIDENCE

	YES	NO
Have you made any changes to your home? (for example: additions, upgrades to the roof, electrical, plumbing or heating systems?	*PERSONAL RESIDENCE Have you made any changes to your home? (for example: additions, upgrades to the roof, electrical, plumbing or heating systems? YES	Have you made any changes to your home? (for example: additions, upgrades to the roof, electrical, plumbing or heating systems? NO
Have you added central air conditioning or central vacuum in your home?	Have you added central air conditioning or central vacuum in your home? YES	Have you added central air conditioning or central vacuum in your home? NO
Have you installed a pool?	Have you installed a pool? YES	Have you installed a pool? NO
Do you want to review the insurance replacement value of your home?	Do you want to review the insurance replacement value of your home? YES	Do you want to review the insurance replacement value of your home? NO
Do you have flood or earthquake insurance for your residence?	Do you have flood or earthquake insurance for your residence? YES	Do you have flood or earthquake insurance for your residence? NO
Do you own or have you purchased a secondary residence, seasonal or rental property in the past year?	Do you own or have you purchased a secondary residence, seasonal or rental property in the past year? YES	Do you own or have you purchased a secondary residence, seasonal or rental property in the past year? NO
Would you like to be presented with various deductible options and the estimated savings for these options?	Would you like to be presented with various deductible options and the estimated savings for these options? YES	Would you like to be presented with various deductible options and the estimated savings for these options? NO

Comments:

5. TRAVEL

	YES	NO
Is your home protected by a central station burglar alarm or other protective device?(for example: Central Station Burglar and Fire Alarm, Deadbolts, Fire Extinguishers or Indoor Sprinklers.)	*TRAVEL Is your home protected by a central station burglar alarm or other protective device?(for example: Central Station Burglar and Fire Alarm, Deadbolts, Fire Extinguishers or Indoor Sprinklers.) YES	Is your home protected by a central station burglar alarm or other protective device?(for example: Central Station Burglar and Fire Alarm, Deadbolts, Fire Extinguishers or Indoor Sprinklers.) NO

Comments

6. PERSONAL LIABILITY

	YES	NO
Do you employ domestic staff such as a housekeeper or nanny?	*PERSONAL LIABILITY Do you employ domestic staff such as a housekeeper or nanny? YES	Do you employ domestic staff such as a housekeeper or nanny? NO
Do you serve as a director, officer or member of the board for a public, private and/or non-profit organization?	Do you serve as a director, officer or member of the board for a public, private and/or non-profit organization? YES	Do you serve as a director, officer or member of the board for a public, private and/or non-profit organization? NO
Do you conduct business from your home?	Do you conduct business from your home? YES	Do you conduct business from your home? NO
Do you have coverage for the business?	Do you have coverage for the business? YES	Do you have coverage for the business? NO
Have you updated your liability limits regularly to reflect your personal net worth?	Have you updated your liability limits regularly to reflect your personal net worth? YES	Have you updated your liability limits regularly to reflect your personal net worth? NO
Do you have a Personal Umbrella Policy?	Do you have a Personal Umbrella Policy? YES	Do you have a Personal Umbrella Policy? NO
Do you have any teen drivers?	Do you have any teen drivers? YES	Do you have any teen drivers? NO

Comments:

7. VALUABLE POSSESSIONS

	YES	NO
Do you collect jewelry, fine art, silver or other fine possessions?	*VALUABLE POSSESSIONS Do you collect jewelry, fine art, silver or other fine possessions? YES	Do you collect jewelry, fine art, silver or other fine possessions? NO
Do you have dedicated insurance coverage for the items you collect: Valuable Articles Policy?	Do you have dedicated insurance coverage for the items you collect: Valuable Articles Policy? YES	Do you have dedicated insurance coverage for the items you collect: Valuable Articles Policy? NO

Comments:

8. IDENTITY TEFT

	YES	NO
Does your liability policy include coverage for identity theft?	*IDENTITY TEFT Does your liability policy include coverage for identity theft? YES	Does your liability policy include coverage for identity theft? NO
Do you know the appropriate steps to take if you are a victim of identity theft?	Do you know the appropriate steps to take if you are a victim of identity theft? YES	Do you know the appropriate steps to take if you are a victim of identity theft? NO

Comments:

9. WOULD YOU LIKE A QUOTE ON POLICIES OUR AGENCY CURRENTLY DOES NOT WRITE?

WOULD YOU LIKE A QUOTE ON POLICIES OUR AGENCY CURRENTLY DOES NOT WRITE? Yes

Comments:

10. RETIREMENT/DISABILITY

	Yes	No
If you were hurt or unable to work, do you have adequate financial means to pay your household bills for an extended time period?	*RETIREMENT/DISABILITY If you were hurt or unable to work, do you have adequate financial means to pay your household bills for an extended time period? Yes	If you were hurt or unable to work, do you have adequate financial means to pay your household bills for an extended time period? No
If not, would you like to be contacted for a disability quote?	If not, would you like to be contacted for a disability quote? Yes	If not, would you like to be contacted for a disability quote? No
If you are about to retire, have you considered insurance for long term care?	If you are about to retire, have you considered insurance for long term care? Yes	If you are about to retire, have you considered insurance for long term care? No
Do you want to be contacted about a long term care quote?	Do you want to be contacted about a long term care quote? Yes	Do you want to be contacted about a long term care quote? No

Comments:

11. LIFE INSURANCE

	Yes	No
Do you have life insurance?	*LIFE INSURANCE Do you have life insurance? Yes	Do you have life insurance? No
If not, do you want to be contacted about a quote?	If not, do you want to be contacted about a quote? Yes	If not, do you want to be contacted about a quote? No

Comments:

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Thank you for taking our survey! Your account manager will will contact you within the next 48 hours.
We appreciate your business, and we look forward to servicing your accounts in the coming year. If you have immediate needs please call us at 800.658.7956. We are also available 24/7 at www.providerig.com

Did you know that Provider Insurance Group provides a host of commercial insurance products to protect your business?
These include but are not limited to: Property, Liability, Workers Compensation, Health Insurance and other Employee Benefits.

Contact us for a comprehensive review of all your business insurances.

PROVIDER INSURANCE: RENEWAL SURVEY FOR HOMEOWNERS

1. Provider's Policy Renewal Survey for Homeowners

*1. YOUR NAME:

2. ENTER YOUR PREFERRED EMAIL ADDRESS:

*3. PHONE NUMBER:

4. PERSONAL RESIDENCE

5. TRAVEL

6. PERSONAL LIABILITY

7. VALUABLE POSSESSIONS

8. IDENTITY TEFT

9. WOULD YOU LIKE A QUOTE ON POLICIES OUR AGENCY CURRENTLY DOES NOT WRITE?

10. RETIREMENT/DISABILITY

11. LIFE INSURANCE

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1. YOUR NAME:

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3. PHONE NUMBER: