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Risk and Gap Finder

The goal at Coverra Insurance Services is to provide comprehensive insurance coverage to you. Because aspects of your life change from year to year, we use this form to discuss and assure that you are properly covered. As always, covering you comes first.

Do you have collectibles: antiques, fine art, stamps, coins, etc.?	Yes No Quote
Do you have costly sporting equipment or firearms?	Yes No Quote
Do you have valuable jewelry or furs?	Yes No Quote
Do you have valuable photography equipment?	Yes No Quote
Do you have a business in your home?	Yes No Quote
Do clients or customers come to your home?	Yes No Quote
Do you keep a large amount of others' business property in your home?	Yes No Quote
Do you own professional tools or equipment?	Yes No Quote
Do you keep samples or items for sale in your home?	Yes No Quote
Do you baby-sit or have child day care in your home?	Yes No Quote
Do you own rental or income property?	Yes No Quote
Do you have a secondary residence?	Yes No Quote
Do you own investment property?	Yes No Quote
Do you own recreational vehicles: boat, jet-ski, camper, cycle, etc.?	Yes No Quote
Have you remodeled your home? Have plans to do so?	Yes No Quote
Do you have "umbrella" liability coverage?	Yes No Quote
Do you have a trampoline? Safety Net?	Yes No Quote
Do you have an above ground or in ground swimming pool?	Yes No Quote
Do you have detached structures: gazebos, storage barn?	Yes No Quote
Do you have a satellite dish?	Yes No Quote
Do you have pets?	Yes No Quote
Do you have roomers or boarders?	Yes No Quote
Do you have domestic help, babysitters, landscapers, and house cleaners	Yes No Quote
Do you have a wood burning stove?	Yes No Quote
Do you have a fireplace?	Yes No Quote
Have you had your chimney professionally cleaned and inspected within the last 12 months?	Yes No Quote
Do you have flood insurance?	Yes No Quote
Do you have earthquake insurance?	Yes No Quote
Are you interested in protecting yourself from identity theft?	Yes No Quote
Is your home insured correctly should you sustain a total loss?	Yes No Quote
Do you have Health Insurance?	Yes No Quote
Do you have Life Insurance?	Yes No Quote
Do you have Disability Insurance?	Yes No Quote

Insured Name:	Date:
Preferred contact: Email or Phone
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