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42841 Lake Babcock Dr, Ste 110
(239) 456-4540
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Mallory Briggs
Jennifer Bray Calkins
Alberto Cortes
Karen Culbertson
Ruth Villanueva
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Home
Insurance
Home Insurance
Auto Insurance
Golf Cart Insurance
Watercraft
Flood Insurance
About
Team
Mallory Briggs
Jennifer Bray Calkins
Alberto Cortes
Karen Culbertson
Ruth Villanueva
Our Carriers
Careers
Contact
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Contact Information
Name
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First
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Vehicles
How many motorized vehicles licensed for road use in your household?
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0
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How many antique, classic and/or collectible vehicles are in your household?
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0
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Vehicles – Drivers
What is the total number of drivers? (Include drivers with a learner's permit or valid driver's license)
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How many drivers are under the age of 22? (Include drivers with a learner's permit)
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Any Drivers Age 70 or 80 or Older?
No
70 or older
80 or older
How many drivers have been licensed less than one year, have a learner's permit, or have a non- U.S. driver's license?
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Vehicles – Accidents, Violations, etc.
How many moving violations have ALL drivers had within the last 3 years? Include DWI/DUI violations within the last 5 years.
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0
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How many at-fault accidents have all drivers had in the last 3 years?
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0
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How many driving incidents have all drivers ages 21 and under had within the last 3 years?
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How many driving incidents have all drivers ages 80 and over had within the last 3 years?
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0
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How many alcohol/drug related driving incidents have all drivers had in the last 5 years?
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0
.
Watercraft
How many watercraft, OTHER than personal watercraft (WaveRunners, Jet Skis, etc.), are in your household?
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How many personal watercraft (Jet Skis, WaveRunners etc.) in your household?
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Residential Property
How many residential properties in your household?
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0
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How many acres of land owned or leased (including partial ownership)?
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How many residential properties owned or rented by you or any member of your household are located outside U.S. (including U.S. territories and possessions), Canada, or Puerto Rico?
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0
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Additional
What underlying homeowners liability or comprehensive personal liability limits do you agree to maintain?
100,000
300,000
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