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Homeowners Evaluation - Florida
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What is your first name? *
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What is your first name? *
What is your last name? *
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What is your last name? *
What is your preferred phone number? *
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What is your preferred phone number? *
What is your email address? *
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What is your email address? *
Please enter the street address for the home we are evaluating. *
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Please enter the street address for the home we are evaluating. *
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Does your home have a monitored alarm system?
Does your home have a monitored alarm system?
Yes
No
Which components are included in your monitored alarm system?
Which components are included in your monitored alarm system?
Fire/Smoke Alarm
Burglar/Motion Alarm
Low Temperature Alarm
Water Leak Detection
Cellular Backup
Explosive Gas Leak Detection
Other
What other alarm components does your alarm system have?
What other alarm components does your alarm system have?
What risk management strategies do you employ at this residence?
What risk management strategies do you employ at this residence?
Permanently Installed Back-up Generator
Hurricane rated shutters / window protection
Automatic water shut-off valve
Gated home/perimeter fencing
Lightning protection system
Gated community
24-hour monitored video surveillance
Full-time live-in caretaker
Indoor sprinkler system
Seismic shut-off valve
Flood vents
Other
Enter a brief description of the risk management strategy you have at your home.
Enter a brief description of the risk management strategy you have at your home.
Is your home owned by a trust, LLC or other legal entity?
Is your home owned by a trust, LLC or other legal entity?
Yes
No
Please provide the name of the trust, LLC or other legal entity your home is owned by.
Please provide the name of the trust, LLC or other legal entity your home is owned by.
Any updates/renovations/additions planned or recently completed?
Any updates/renovations/additions planned or recently completed?
Yes
No
Please tell us about the renovations.
Please tell us about the renovations.
Have you updated any of these?
Have you updated any of these?
Electrical
Plumbing
Heating
Windows and/or doors
Roof
Water Heater
No updates
Other
Please enter a brief description of any other updates you have done to your home. *
*
Please enter a brief description of any other updates you have done to your home. *
Please enter a brief description of the other area we should discuss. *
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Please enter a brief description of the other area we should discuss. *
Does this home include solar panels? *
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Does this home include solar panels? *
Yes
No
Solar Panel Information
How is the power generated by the solar panels being used? (Check all that apply)
How is the power generated by the solar panels being used? (Check all that apply)
Home Power Generation
Pool Heating
Other
How many solar panels are there?
How many solar panels are there?
Where are the solar panels located? (Check all that apply)
Where are the solar panels located? (Check all that apply)
Roof of the Main Dwelling
Roof of a Secondary Structure
Ground Mounted
Other
Do you own or lease the solar panels?
Do you own or lease the solar panels?
Own
Lease
Are you responsible for insuring the panels?
Are you responsible for insuring the panels?
Yes
No
What is the value of the solar panels? *
*
What is the value of the solar panels? *
Property Structures
Please select the other structures on this property.
Pool
Pool house
Fence
Detached garage
Guest house
Jungle gym
Dock
Stone walls
Barn
Shed
Tennis court
Other
Other Property Structures
Enter a brief description of the other structure(s) on this property.
Please select the items below that are present or will be present at this home. (Select all that apply)
Please select the items below that are present or will be present at this home. (Select all that apply)
Trampoline
Dog
Pool Addition
None
What breed of dog do you have?
What breed of dog do you have?
Please tell us about the pool addition.
Please tell us about the pool addition.
Is your home part of an association?
Is your home part of an association?
Yes
No
Have you received updated association insurance documents that you can upload to us?
Have you received updated association insurance documents that you can upload to us?
Yes
No
Please upload the updated association insurance documents, if available.
Please upload the updated association insurance documents, if available.
Drop files here or
Select files
Max. file size: 15 MB.
Do you operate a business out of your home?
Do you operate a business out of your home?
Yes
No
Please tell us about your in-home business.
Please tell us about your in-home business.
Any significant acquisitions in the past 12 months that we should know about?
Any significant acquisitions in the past 12 months that we should know about?
Jewelry
Fine Art
Silverware
Wine
Antiques
Firearms
Collectibles
Other
What other valuable acquisitions should we know about?
What other valuable acquisitions should we know about?
Do you have any new appraisals for your valuables that you can upload to us?
Do you have any new appraisals for your valuables that you can upload to us?
Yes
No
Feel free to upload your appraisals to us.
Feel free to upload your appraisals to us.
Drop files here or
Select files
Max. file size: 128 MB.
Do you have a mortgage on your home?
Do you have a mortgage on your home?
Yes
No
Please enter the following information about your mortgage.
Please enter the following information about your mortgage.
Bank Name
Loan #
Insurance Escrowed?
Do you have a 2nd mortgage or Home Equity Line of Credit?
Do you have a 2nd mortgage or Home Equity Line of Credit?
Yes
No
What is the name of the company you have a 2nd mortgage or Home Equity Loan through?
What is the name of the company you have a 2nd mortgage or Home Equity Loan through?
Please choose the correct occupancy of this property.
Please choose the correct occupancy of this property.
Primary residence (not rented)
Secondary / Seasonal residence (not rented)
Secondary / Seasonal residence (some rental exposure)
Rental property / Tenant occupied
How many months per year is the home owner occupied?
How many months per year is the home owner occupied?
Is this property a short-term rental?
Is this property a short-term rental?
Yes
No
Do you have a Property Management Company?
Do you have a Property Management Company?
Yes
No
What is the name of the property management company?
What is the name of the property management company?
Who is your contact at the property management company?
Who is your contact at the property management company?
What is the phone number for the property management company?
What is the phone number for the property management company?
What is the email address for the property management company?
What is the email address for the property management company?
Would you like to discuss obtaining new flood coverage or higher flood coverage limits for your home?
Would you like to discuss obtaining new flood coverage or higher flood coverage limits for your home?
Yes
No
Anything else you want to discuss regarding your homeowners insurance?
Anything else you want to discuss regarding your homeowners insurance?
What other areas should we discuss?
What other areas should we discuss?
Building a house
Buying/Selling property
Change of marital status
Child going to college
Property held for rental
Starting a business
Planning a big trip
None
Other
Consent
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Disclaimer: This online questionnaire is a tool used to gather information. It is not an application for insurance. No insurance coverage will be bound or put into effect by submitting this form.
Consumer disclosure: By checking the box below you authorize the Agency who supplied this form to you to contact you via phone, email, and text messaging; to save and share with business partners the information you provided; to obtain consumer reports that may include credit-based reports (where legally allowed), public records, claims history, and driving records so that they can give you accurate insurance quotes.
I agree *
Kris Pontell
4076961333
www.pontellinsurance.com
kris@pontellinsurance.com
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