HOME COVERAGES PROVIDERS QUOTE CLAIMS LINKS Umbrella Policy Quote Request Name * (The named insured may be a maximum of two individuals, provided both individuals reside in the same household. This policy cannot be issued in the name of an estate, trust or LLC. ) Primary Residence Address * City * State * AK AL AR AS AZ CA CO CT DC DE FL GA GU HI IA ID IL IN KS KY LA MA MD ME MH MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR PW RI SC SD TN TX UT VA VI VT WA WI WV WY Zip Code * Mailing Address (if different from primary address) Address * City * State * AK AL AR AS AZ CA CO CT DC DE FL GA GU HI IA ID IL IN KS KY LA MA MD ME MH MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR PW RI SC SD TN TX UT VA VI VT WA WI WV WY Zip Code * Phone No * Email Address * 1. How many motorized vehicles licensed for road use (i.e., motorhomes, motorcycles, cars, etc.) are owned, rented, leased, or regularly operated by you or any member of your household? 0 (Preferred) 1 (Preferred) 2 (Preferred) 3 (Preferred) 4 (Standard) 5 (Standard II) 6 (Standard II) 7 or more (Not Eligible) Include company vehicles provided for your use, or for use by a member of your household. All vehicles licensed for road use need to be counted regardless of individual insurance. (Full Timers should count their RV as a vehicle and not a residence. Do not count antique/classic/collectible vehicles covered under a collector automobile policy. See Question 10. 2. How many residential properties are owned or rented by you or any member of your household? * 0 (Preferred) 1 (Preferred) 2 (Standard) 3 (Standard) 4 (Standard) 5 (Standard II) 6 (Standard II) 7 or more (Not Eligible) Only 1-4 family units are eligible. Primary residences must have liability coverage under a policy containing comprehensive personal liability (including homeowners or farmowners). Seasonal, secondary or rental properties may have liability coverage under a comprehensive personal liability or premises liability policy. Do not include residential properties that are covered under a commercial general liability policy. Residential properties covered under a commercial general liability policy are excluded from coverage. 3. How many watercraft, other than canoes, jet skis, waverunners or other personal watercraft, are owned or regularly operated by you or any member of your household? * 0 (Preferred) 1 (Standard) 2 (Standard) 3 (Standard II) 4 or more (Not eligible) Only 1-4 family units are eligible. Primary residences must have liability coverage under a policy containing comprehensive personal liability (including homeowners or farmowners). Seasonal, secondary or rental properties may have liability coverage under a comprehensive personal liability or premises liability policy. Do not include residential properties that are covered under a commercial general liability policy. Residential properties covered under a commercial general liability policy are excluded from coverage. 4. How many jet skis, waverunners or other personal watercraft are owned or regularly operated by you or any member of your household? * 0 (Preferred) 1 (Standard) 2 (Standard) 3 (Standard II) 4 or more (Not eligible) Count only those watercraft between 14 and 45 feet and with a maximum speed less than 51 mph. Watercraft exceeding these limitations are excluded from coverage. 5. What is the number of drivers ? (Refer to the definition of ‘Driver’ on Page 3.) * 0 (Preferred) 1 (Preferred) 2 (Preferred) 3 (Standard) 4 (Standard) 5 (Standard) 6 (Standard) 7 or more (Not Eligible) 6. How many drivers are under the age of 22? In Kansas and Massachusetts, count only those drivers with six years or less driving experience. * 0 (Preferred) 1 (Standard) 2 (Standard) 3 (Standard II) 4 or more (Not eligible) Driving with a permit is not considered driving experience and should therefore not be included within the six years as driving experience. 7. How many drivers are age 70 and over ? Response not considered when determining the rating tier for applicants in Maine. * 0 (Preferred) 1 (Standard) 2 (Standard) 3 (Standard) 4 (Standard) 5 or more (Not Eligible) 8. How many moving violations have all drivers had within the last 3 years? * 0 (Preferred) 1 (Standard) 2 (Standard) 3 (Standard II) 4 (Standard II) 5 or more (Not eligible) 9. How many at fault accidents have all drivers had in the last 3 years? 0 (Preferred) 1 (Standard) 2 (Standard II) 3 or more (Not eligible) At fault accident includes any single or multi-car accident chargeable under a primary auto policy, any accident resulting in any payment for bodily injury or property damage, any single car accident resulting in a payment to an insured (unless caused by an animal), and/or any accident resulting in a citation to you or a member of your household with or without a conviction or final adjudication. 10. How many antique, classic and/or collectible vehicles are owned by you or any member of your household? 0 1 3 4 5 6 7 8 9 10 Include private passenger vehicles licensed for road use, more than 20 years old, driven not more than 2,500 miles annually, owned for limited pleasure use, car shows and club events that are covered under a collector automobile policy. A $25 charge per antique/classic/collector vehicle applies. 11. What are your auto Liability Limits? * 100,000/300,000 250,000/500,000 other * Submit Copyright © 2009-2021 Hi Sage Insurance - All Rights Reserved Hi Sage Marketing, Inc. - 650 Metcalf Street - Escondido, CA 92025 (858) 536-9144 or Toll Free (800) 887-8467 Site Design by: Cal-West Data Disclaimer: Coveragees may vary by state and company. The descriptions are of general nature and do not modify the policy which controls all coverages and definitions of coverages. Powered by WordPress & Atahualpa