Homeowners Risk Reduction Questionnaire

Policy Holder
Contact Name *
Email *
Phone Number
What is your Education Level?
Home Protection Checklist
Have you remodeled your home, built any outbuildings or garages or made any improvements to finish your basement? Yes  No
If yes, please indicate what you have done and the approximate cost.
Would you like to SAVE 10% - 25% on your Homeowners insurance by increasing your deductible? Yes - Send Quote  No
Do you have a Wood Burning or Pellet Stove? * Yes  No
Do you own a secondary residence that is not insured with Babineau Insurance? * Yes  No
Have you added or changed an alarm or security system at your home? * Yes  No
Have you updated the wiring, heating, roof or plumbing in your home in the past year? Plumbing  Heating  Roof  Electrical
Do you own any rental or investments properties not insured with Babineau Insurance? * Yes  No
Do you own tools, equipment or instruments used in your trade or profession? If yes, please describe. Yes  No
Cash is limited to $200 on the standard Homeowners policy!! * Yes, I Understand
New Personal Property
Enter a value for any newly acquired personal property.
Jewelry & Watches
Furs
Silver, silverware, goldware, pewter.
Firearms
Stamp and Coin Collections
Fine Arts and Breakable Items
Antiques or Collectibles
Valuable Cameras
Liability Information
Do you own a trampoline? * Yes  No
Do you have a tree house? * Yes  No
Do you have a skateboard ramp? * Yes  No
Do you own a Firearm? If yes, describe # & type. Yes  No
Do you have any pets? * None
Cat(s)
Dog(s)
Bird(s)
Snake(s)
Ferret(s)
Reptile(s)
If you have a dog, please indicate breed(s) and age.
Do you have an office, studio or business in your home? If Yes, please describe. Yes  No
Do you provide any Day Care at your home? * Yes  No
Do you own any of the following types of vehicles?
(check all that apply)
ATV's
Snowmobiles
Boats
Mopeds
Motorcycles
Additional Coverage
Additional Coverage Available!
Would you like a quote for Refrigerated Products Coverage? * Yes  No
Would you like a quote for limited coverage for Backup of sewers, drains and sump pumps? * Yes  No
Would you like a quote for Earthquake Coverage? * Yes  No
Would you like a quote for Flood Insurance? * Yes  No
Would you like a quote for a $1,000,000 Umbrella liability policy that would protect you in the event of a catastrophic event? * Yes  No
Do you want your home mortgage paid in the event of a death? (You're 30 times more likely to lose your home due to the death of your spouse) If Yes, please enter outstanding Mortgage Amount. Yes  No
* = Required Field