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952-479-5877
2431 Galpin Ct #140
Chanhassen, MN 55317
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Active Insurance Solutions
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Policies to be Shopped/Quoted
Auto Insurance
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Auto Insurance
Are there any changes to the vehicles or coverages you are requesting relative to what you have on your existing policy today?
Yes
No
Please provide details
Are there youthful drivers currently in the household?
Yes
No
Any changes in Good Grade discount or eligibility for Youthful Drivers in the Household?
Yes
No
Are any of the youthful drivers at school (more than 100 miles away) without a vehicle during the school year?
Yes
No
Please provide details
Any upcoming changes for Youthful Drivers in the household?
Yes
No
Are you anticipating adding any youthful drivers within the coming 12 months?
Yes
No
Does anyone in the household currently drive for Uber/Lyft or do Food Delivery?
Yes
No
Please provide details
Any other comments, questions, or relevant information we should have as we look to secure new quotes for you?
Home Insurance - Existing
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Yes
No
Home Insurance
Confirm Property Address
Any renovations completed since we wrote your current policy for you (additions, finishing basement, adding bathrooms, etc.).
Yes
No
Please provide details
Any businesses conducted out of your home (in-home day care, beauty salon, etc.)?
Yes
No
Please provide details
Dogs in Household?
Yes
No
What breed?
Wood Burning Stove?
Yes
No
Trampoline?
Yes
No
Fence in Backyard?
Yes
No
Netted?
Yes
No
Pool on Premises?
Yes
No
Diving board?
Yes
No
Fenced?
Yes
No
Central Burglary Alarm System?
Yes
No
Central Fire Alarm System?
Yes
No
Any updates to the roof since we wrote your most recent policy for you?
Yes
No
Year Replaced
Is the roof shingle on the home in discussion considered to be Class 3 or Class 4 (impact/hail resistant)?
Yes
No
Unknown
Any updates to the furnace since we wrote your most recent policy for you?
Yes
No
Year Replaced
Any updates to the plumbing since we wrote your most recent policy for you?
Yes
No
Year Replaced
Any updates to the electrical since we wrote your most recent policy for you?
Yes
No
Year Replaced
Any valuables recently acquired that you are interested in scheduling for more comprehensive protection (jewelry, fine arts, firearms, etc.)?
Yes
No
Please provide details
Do you currently have an Umbrella policy with us?
Yes
No
If not, are you interested in receiving a quote?
Yes
No
Do you have separate life insurance policies in place outside of any that is included/provided through your employer?
Yes
No
Are you interested in receiving life insurance quotes?
Yes
No
Any other comments, questions, or relevant information we should have as we look to secure new quotes for you?
Home Insurance - New
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Yes
No
New Home Insurance
Confirm New Purchase Address
Estimated Closing Date
What are your plans for the prior residence? (Selling Home, Moving Out, Converting to Rental Property, Secondary Home, etc.)?
Any businesses conducted out of your home (in-home day care, beauty salon, etc.)?
Yes
No
Please provide details
Dogs in Household?
Yes
No
What breed?
Wood Burning Stove?
Yes
No
Trampoline?
Yes
No
Fence in Backyard?
Yes
No
Netted?
Yes
No
Pool on Premises?
Yes
No
Diving board?
Yes
No
Fenced?
Yes
No
Central Burglary Alarm System?
Yes
No
Central Fire Alarm System?
Yes
No
Any updates to the roof since we wrote your most recent policy for you?
Yes
No
Year Replaced
Is the roof shingle on the home in discussion considered to be Class 3 or Class 4 (impact/hail resistant)?
Yes
No
Unknown
Any updates to the furnace since we wrote your most recent policy for you?
Yes
No
Year Replaced
Any updates to the plumbing since we wrote your most recent policy for you?
Yes
No
Year Replaced
Any updates to the electrical since we wrote your most recent policy for you?
Yes
No
Year Replaced
Any valuables recently acquired that you are interested in scheduling for more comprehensive protection (jewelry, fine arts, firearms, etc.)?
Yes
No
Please provide details
Do you currently have an Umbrella policy with us?
Yes
No
If not, are you interested in receiving a quote?
Yes
No
Do you have separate life insurance policies in place outside of any that is included/provided through your employer?
Yes
No
Are you interested in receiving life insurance quotes?
Yes
No
Any other comments, questions, or relevant information we should have as we look to secure new quotes for you?
Renters Insurance
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Yes
No
Renters Insurance
Confirm Property Address
Any businesses conducted out of your apartment/condo (in-home day care, beauty salon, etc.)?
Yes
No
Please provide details
Dogs in Household?
Yes
No
What breed?
Any valuables recently acquired that you are interested in scheduling for more comprehensive protection (jewelry, fine arts, firearms, etc.)?
Yes
No
Please provide details
Do you currently have an Umbrella policy with us?
Yes
No
If not, are you interested in receiving a quote?
Yes
No
Who manages your life insurance policies outside of your employer?
If you do not have life insurance currently, are you interested in receiving some quotes?
Yes
No
Any other comments, questions, or relevant information we should have as we look to secure new quotes for you?
Requested Agent
Steve Loraus
Ben Feldman
Jake Frankel
Erin Mansfield
Tucker Hoffman
Tricia Hemann
No preference
Is it ok for Active Insurance Solutions to use text messages to communicate with you, as outlined in
our agency text message rules and regulations
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Yes
No
I understand that insurance coverage is not bound or altered until I receive confirmation by an authorized representative of Active Insurance Solutions
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