Personal Umbrella Insurance

You don't have to be a millionaire to be sued like one. Million-dollar judgments against individuals for negligence are still relatively rare. However, receiving a lawsuit with a million-dollar demand is more common. If you receive such a court summons and you have only $100,000 of coverage, you may lose a lot of sleep.

Umbrella policies offer inexpensive "peace of mind" for most types of negligence claims. Automobile accidents are probably the most common source of serious claims. This policy supplements your basic automobile liability with extra million-dollar layers of protection. It also covers other types of catastrophic claims such as a neighbor's child drowning in your pool or the delivery man being seriously injured by falling over your child's toys.

Personal Umbrella Quote Request

Please take a moment to fill out the form below and one of our local insurance agents will contact you with a free, no-obligation quote. This information will be kept confidential and will be used for quote purposes only.

* Required fields.

Personal Information
Full Name: *
Address:
City:
State:	Zip:
Phone: *
Best Time To Call:	AM   PM
E-mail Address: *

General Information
Any Driver with Mental - Physical Impairments?	Yes   No
Any Premises, Vehicles, Watercraft, Aircraft Used for Business?	Yes   No
Do You Engage in Any Type of Farming Operation?	Yes   No
Do You Hold Any Non-Remunerative Positions?	Yes   No
Any Aircraft Owned, Leased, Chartered or Furnished for Regular Use?	Yes   No
Do You Employ Any Residence Employees? (i.e. Housekeeper)	Yes   No
Any Non-Owned Property Exceeding $1,000 in Value in Your Care, Custody or Control?	Yes   No
Any Non-Owned Business or Professional Activities Included in the Primary Policies?	Yes   No
Does Any Primary Policy Have Reduced Limits of Liability or Eliminate Coverage for Specific Exposures?	Yes   No
Was Any Coverage Declined, Cancelled or Non-Renewed within the Past 5 Years?	Yes   No
Any Motorcycles, Mopeds or All Terrain Vehicles Owned?	Yes   No
Any Youthful Drivers Under the Age of 25?	Yes   No
Any Other Business Activities Conducted from Your Residence or Premises?	Yes   No
Please Explain Any "Yes" Answers from Above:

Driver Information
(Include all licensed drivers in your household.)
Driver #1	Driver's Name
			Years Licensed:
Relation	Date of Birth	Sex	Marital Status	Drivers Education
		Male Female	Married Single	Yes No

Driver #2	Driver's Name
			Years Licensed:
Relation	Date of Birth	Sex	Marital Status	Drivers Education
		Male Female	Married Single	Yes No

Driver #3	Driver's Name
			Years Licensed:
Relation	Date of Birth	Sex	Marital Status	Drivers Education
		Male Female	Married Single	Yes No

Driver #4	Driver's Name
			Years Licensed:
Relation	Date of Birth	Sex	Marital Status	Drivers Education
		Male Female	Married Single	Yes No

Driving History
Please list anyconvictions for any driver convicted of moving traffic violations in the past 3 years.
Driver	Date	Type of Conviction	Fines	Over Limit
			$	mph
			$	mph
			$	mph
			$	mph

Please list any driver who has had license suspensions, revocations or DUI convictions below.
Driver	License Suspended / Revoked	DUI Conviction For:
	Suspended   Revoked	Alcohol   Drugs
	Suspended   Revoked	Alcohol   Drugs
	Suspended   Revoked	Alcohol   Drugs
	Suspended   Revoked	Alcohol   Drugs

Vehicle Information (All cars you or your family members own or lease)
Car #1	Year	Make	Model	Body Type
Car #2	Year	Make	Model	Body Type
Car #3	Year	Make	Model	Body Type
Car #4	Year	Make	Model	Body Type

Miscellaneous
Number of Single Family Dwellings You Own:
Number of Multi-Unit Buildings You Own:
Number of Vacant Property (land) You Own:
Number of Autos You Own:
Number of Motorcycles You Own:
Number of Watercraft You Own:
Number of Recreational Vehicles You Own:
Current Insurance Company:
Expiration Of Current Insurance Policy:
Liability Limits Requested:	$1,000,000 $2,000,000 $3,000,000 $4,000,000 $5,000,000
Losses-Claims in the last 5 years:	none One Two Three Four Five
If yes, date, amount paid, and description of each loss-claim:

Additional Comments or Questions

Enter Security Code:

Please click the "Submit Quote Request" button to send your quote request. No coverage is in effect until bound by an insurance carrier. This is a request for quotation only.