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Annual Insurance Review

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Auto / Car Insurance

Do any licensed children qualify for a good student discount? (Grades of at least B or higher) Yes No N/A

Have you purchased or sold a vehicle lately that will require a policy update? Yes No N/A

Do you insure all of your vehicles through Kirby Roth Insurance? Yes No N/A

In the event a claim is filed, do you have another car to use? Yes No N/A

Is there any additional equipment added to your vehicle other than manufacturer-installed items? Yes No N/A

Have you recently purchased any of the following? Check all that apply Motorcycle ATV Vintage/Classic Auto Golf Cart Motor Home Trailer Snowmobile Camper

Homeowners Insurance

Have you made any additions or completed a remodeling project for your home? Yes No N/A

Do you conduct any types of business from your home? Yes No N/A

Are any valuables in your basement potentially exposed to water damage? Yes No N/A

Have you recently purchased any of the following? Check all that apply Computers Jewelry Firearms Condo Collectibles Boat Fine Art Rental Property Second home/Vacation property Additional structures on property

Additional Info

Are you interested in: Identity theft protection Umbrella insurance to protect against large personal liability lawsuits Life insurance review/consultation An Annuity Savings Plan, such as IRA or Roth Changing your deductible, possibly saving you money Electronic-payment options for your insurance bill

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604 Seward St | Seward, NE 68443
P: 402-643-4591 | F: 402-643-4592

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