Home Quote Sheet (Website Link)

Home Insurance Questionnaire
How did you Hear About Us?*
(Friend/Family Member, Realtor/Mortgage Broker, Builder/ Online ETC.) We love to say thank you to those who recommend us!
First Named Insured*

First NameLast Name
Birth Date*

MonthDayYear
Best Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Occupation*
Martial Status*
Second Named Insured*

First NameLast Name
Second Named Insured Date of Birth*

MonthDayYear
Second Named Insured Phone Number*
Please enter a valid phone number.
Second Named Insured Email*
example@example.com
Second Named Insured Occupation*
Number of household residents*
Address to Be Insured*

Street Address

Street Address Line 2

CityState

Zip Code
Is this home a new purchase or your current home?*
Number of years at this address*
Is your home currently insured?*
Current Insurance Carrier*
Please Upload Copy of Your Existing Policy or Upcoming Renewal

**HUGE Brownie Points for doing this as it helps us out a ton and saves you a lot of additional questions**
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Have you been cancelled or non-renewed by your insurance company?*
Please select the reason you were cancelled or non-renewed:*

Non-PaymentCarrier Leaving the StateExposure ManagementClaims HistoryFailure to Meet Underwriting Requirement (Roof Age, Repairs ..)Other
Please Upload Copy of Your Cancellation Letter or Notice of Non-renewal

**EXTRA EXTRA Brownie Points for doing this new carrier will need it and saves you a lot of additional questions**
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Prior Address*

Street Address

Street Address Line 2

CityState

Zip Code
Prior Home Status*
How is the home being used?*
Will any part of this residence ever be rented (Full time, Part time or Short Term-VRBO/AIRBNB)?*
Is the property deeded in anyone else's name or in an LLC or Trust?*
Name of Additional Deeded Owner, Trust Or LLC*
Within last 5 yrs, have you had any home or renters claims or losses at this or any other property? *
If Yes, Please Provide Details:*
*Approximate Date and what happen
Do you have any active or open lawsuits against an insurance company at this time? *
Within last 5 yrs, have you had any bankruptcy, foreclosure, shortsale or repossession? *
Have you ever been convicted for fraud, arson or felony? *
Is there any home daycare or other home business with client traffic, inventory or equipment?*
Is this property located on more than 5 acres *
How many acres?*

Home Quote Sheet
Is this new address an New Construction Home?*
Year Built*
Year Roof was last replaced*
Does the roof have an patching, wear, curling/warping or broken shingles?*
Do you have a Wind Mitigation Inspection *
If yes, please upload Wind Mitigation Inspection

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Do you have a FOUR POINT Inspection?*
If yes, please upload FOUR POINT:

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Age of HVAC*
Age of Hot Water Heater *
Any PEX or Polybutylene plumbing in the home that you're aware of? *
Any planned addition or renovation in the near future?*
Does this home have EFIS siding*
Does this home have Asbestos Siding? *
Is this new house a bankruptcy/foreclosure/short sale? *
Builders Name*
Floor Plan and Elevation*
Is the Home a Gated or Single Entry Community *

Earliest Expected Closing Date
**Best guess is fine
Do you expect to move in within the first 30 days of closing? *
Are you financing the home or paying cash?*
Are you working with one of these preferred lenders?*
Purchase Price?*
Loan Amount*
What is your best estimate of the total replacement value of your house, not including contents, if you had to rebuild it as brand new construction today? (your best guess is fine)*
Square Feet*
Number of Bedrooms*
Number of Bathrooms*
One story home or two story?*
Is the foundation on a slab or crawlspace?*
What is the Exterior Wall type of your home?*
What is the Exterior Construction of your home? (Frame)*
What is the Exterior Construction of your home? (Masonry)*
Main Roof Shape*
Roof Material *
Does your home have a Garage or Carport *
Size of Garage*
Size of Carport*
Anywhere outside the house where there are 3 or more steps/stairs without a handrail?*
Any decks, patios or porches 1 foot or more above the ground without a railing?*
Are there any tree limbs directly over or touching the roof or trees leaning towards the home?*
Any broken, cracked or lifted areas in the driveway or sidewalks that could cause a trip or fall?*
Is there a wood burning stove or just a fireplace in the home?*

Please review the following optional coverages that you may want to consider adding if you dont have them. Please rate each as to how important it may be to have that coverage or not.
Hidden water damage over time

Most home insurance companies only cover sudden and accidental water damage. Most home insurance companies DO NOT cover water damage that occours over an extended period of time - think something like a shower pan leak, slow pipe leak in wall, slab leak, etc. SOME companies do cover water damage over time as long as it is hidden from your view behind walls, floors or ceilings.
How much is it worth to have coverage for hidden water damage that happens over time?*
When thinking about how important this is, keep in mind your tolerance for the risk, ability to cover a significant uncovered water damage claim, as well as what you know about your house.
Wind Driven Rain

Home insurance companies cover rain/water that enters into your house AS LONG AS there is something else that first causes an opening which lets the water in. For example, water damages the inside of your house becuase it came in through the hole created by a tree limb. MOST companies DO NOT COVER water damage that enters your house without something else causing a visible hole - in other words, they dont cover wind driven rain that is forced into your home through your doors, window seals, roof, etc unless something else causes an opening.
How much is it worth to have coverage for damage from water that is forced into your home by wind/rain? *
Most companies exclude water damage that comes into your house without something else first causing an opening (like a tree limb putting a hole in your roof).
Water/Sewer Backup & Sump pump overflow

Water/sewage that backs up into your home through sinks/drains/toilets/showers/etc is not covered by a standard homeowners policy. There is an optional coverage called Water/Sewer Backup which you can add to make sure it's covered if it happens. Generally, it costs about $2 per month
Would you prefer to have Water/Sewer Backup coverage on your policy? *
Personal Injury Coverage (lible, slander, defamation of character, wrongful imprisonment, invasion of privacy)

Your policy includes basic coverage for personal liability (think slip and fall). However, it specifically excludes if you (or a resident family member) are sued for liable, slander, defamation of character, wrongful imprisonment, or invasion of privacy. All of those are unlikely, of course, but frivolous lawsuits and strange situations can and do happen. There is an enhanced liability coverage called "Personal Injury" that ADDS BACK those coverages to your liability protection. The Personal Injury Endorsement is the way to give yourself the best chance at having coverage if you're sued. That broadened coverage is generally about $1.25 per month.
Would you prefer to have the broadened Personal Injury coverage (so that there is no exclusion for liable, slander, defamation, wrongful imprisonment, invasion of privacy?)*
Replacement Cost Contents Coverage

Your contents coverage (listed as Coverage C on your policy) is what pays for losses to all the 'stuff' in your house. If you were to turn your house upside down, everything that would fall out is considered contents. Examples would be things like clothing, furniture, pots & pans, dishes, electronics, etc.

Replacement Cost for your contents is VERY LIKELY already included in your policy (because it is SUPER important). Replacement coverage is "Go buy it brand new at Target" coverage.

Actual Cash Value coverage on contents is less expensive becuase, after a covered claim your contents are only paid AFTER a signficant deduction for depreciation is taken from the value. ACV or deprecated coverage is essentially, "Go get it used on Craigslist or Goodwill".

Without replacement cost coverage, any covered damage to contents would be paid MINUS a significant deduction for depreciation. Generally, eliminating Replacement Cost Contents saves about $12-18 per month.
Would you prefer to have Replacement Cost Coverage for your contents or Actual Cash Value coverage for your contents?*
SPECIAL Contents Coverage

Your contents are covered for damage from the standard, 16 named perils. Those named perils are:

Fire or lightning, Windstorm or hail, Explosion, Riot/Civil Commotion, Aircraft, Vehicles, Smoke, Vandalism/Malicious mischief, Theft, Falling objects, Weight of ice/snow/sleet, Accidental discharge or overflow of water or steam, Sudden and accidental tearing/cracking/burning/bulging, Freezing, Sudden and accidental damage from artificially generated electrical current, Volcanic Eruption

However, this does not encompass EVERYTHING that could happen. Some examples of damage that would NOT be covered by the standard policy are:

-You spill a paint can on your couch and oriental rug and do $7,000 in damage.

-You drop your big screen TV while trying to move it.

-You're horsing around with your kids and knock over your entertainment center doing $9,000 in damage.

-Your A/C goes out while you're on vacation for a month and when you return your furniture and clothes are all covered in mold.

Special Personal Property Coverage, sometimes called 'all perils coverage', provides coverage for any sudden and accidental physical damage to your contents as long as the loss is not specifically excluded.

Special Personal Property coverage is usually $8-14 per month (and sometimes it's already included with another coverage package you have)
Would you prefer to have Special Contents Coverage for your contents or basic coverage for your contents?*
Flood Coverage

Flooding is completely excluded from your homeowners policy. Flooding is definied as: A general and temporary condition of partial or complete inundation of two or more acres of normally dry land area or of two or more properties, at least one of which is your property.

Flood insurance can cost anywhere from $8-60 per month depending on the coverage, deductibles, and the level of your house.
Are you at all interested in flood insurance?*
Is there anything else you want to make SURE is covered by your policy? *
If yes, let us know below so we can be sure we address it
Who is your auto insurance carrier?*
Are you interested in also saving money on your auto insurance?*
**Average SAVINGS by bundling is 10-20% depending on the carrier.
If Yes, Please upload a copy of your existing auto insurance policy.

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Thank you for taking the time to complete this questionnaire.

We look forward to working with you!
Please verify that you are human*
I understand and have read the full disclosure below
In connection with your quote and/or application for insurance, we may review your credit report or obtain or use a credit-based Insurance Score based on the information contained in that credit report. We may use a third party in connection with the development of your Insurance Score. (please see below for more details)

Remember, no coverages can be bound, changed, or cancelled until you get confirmation from a licensed agent of the McGinniss Himmel Insurance Agency, LLC. This form allows us to more accuratly and quickly help get you taken care of but submission of this form does not confirm or change your coverage. We OFTEN can respond to these within 2-4 hours, but please allow us 24 hours to review and contact you with options and confirmation of coverage.

Please read this notice carefully. This notice contains important information you should know.

Insurance companies may use insurance scoring, in part, to determine the rate you are charged for insurance. A credit report will be ordered on you and the resulting Insurance Score may be used as an additional criteria for rating purposes.
Information about you and your credit experiences, such as payment history, the number and type of accounts with late payments, collection actions, outstanding debt, and the age of your accounts is collected from your credit report. Using a
statistical program, specialized companies compare this information to the credit performance of consumers with similar profiles. An insurance scoring system assigns points for each factor and a final score is determined.
It is in your best interest to check your credit history in order to determine the accuracy. If there is adverse information in your credit record, credit reporting companies are required to provide you with this information. A copy of your credit
report can be obtained by contacting LexisNexis Consumer Service Center at 1-888-497-0011 or online at www.consumerdisclosure.com.
Insurance companies cannot use credit history or an Insurance Score for any arbitrary, capricious or unfairly discriminatory reason. Additionally, credit history or an Insurance Score based wholly or partly on residence, sex, race, color, creed, occupation, income, physical handicap or disability of an applicant or insured is prohibited.
The Florida Department of Financial Services offers free financial literacy programs to assist you with insurance-related questions, including how credit works and how credit scores are calculated. To learn more, visit www.MyFloridaCFO.com.

Text Messaging information: By interacting with our agency you consent to receive SMS messages from McGinniss Himmel Insurance Agency LLC at (850) 329-6996 or (863) 607-4440 about Account Notifications, Customer Care, Delivery Notifications, and Marketing. Message frequency may vary, and standard messaging and data rates may apply. Reply STOP to unsubscribe or HELP for assistance. For more details, see our Terms and Conditions and Privacy Policy on https://www.insurancemh.com
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Home Insurance Questionnaire

Home Quote Sheet

Thank you for taking the time to complete this questionnaire.