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Auto Insurance Risk Analysis


Please answer the following questions and click "Submit" at the bottom of this form to have it e-mailed to us. There's also a space for comments at the bottom. We'll review your checklist and contact you regarding any coverage changes you've chosen or may want to consider.

Personal Information
First Name
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Last Name
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Street
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City
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State
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ZIP / Postal Code
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Primary Phone Number
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E-Mail Address
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Help Us Customize Your Coverage
Do any of your vehicles have the following items?
CB radios, two-way radios, installed cell phones?
Optional

CB radios, two-way radios, installed cell phones?
Optional

DVD or VCR?
Optional

Stereo equipment that is not permanently installed?
Optional

Snowplows, pickup toppers, or other equipment not part of the original manufacture?
Optional

General Questions
Are all the vehicles insured on your policy titled or leased to you and/or your spouse?
Optional

Are any of your vehicles used to deliver property, such as pizzas, food, newspapers, etc.?
Optional

Do you use your vehicle in a ride service, such as Uber, Lyft, Sidecar, or others?
Optional

Are you provided with a company car?
Optional

If yes, you may be able to add "Extended Non-Owned" coverage to your personal auto policy. This will give you liability coverage for use of the company car over and above the coverage provided by your employer's auto policy. This can be important if a co-employee is injured while riding with you in the company car and sues you (lawsuits between co-employees are normally excluded from a business auto policy), or if you have a lawsuit that exceeds the amount of coverage on your employer's policy (or it lapsed), or your employer's auto insurance company claims you were using the car outside the scope of permission granted by your employer and denies coverage.
Add Extended Non-Owned coverage?
Optional

Do you want Rental Reimbursement on any vehicles?
Optional

Enter year, make, and model of vehicles to have Rental Reimbursement:
Optional
Contact our office immediately if any vehicles insured on your auto policy are not titled or leased to a "named insured".
Personal Injury Protection (PIP) is required for all vehicles registered in Michigan. It pays your medical bills resulting from an auto accident and loss of wages up to 85% of your gross income for up to three years. The current maximum payable for wage loss is $5,452/month ($65,424/year).
Increase Wage Loss above $5,452 per month?
Optional

Extend Wage Loss benefit beyond 3 years?
Optional

Our Recommended Minimum Limits
Bodily Injury Liability: $500,000 per person/$500,000 per accident. Increase your policy to these limits?
Optional

Property Damage Liability: $500,000 per accident: Increase your policy to these limits?
Optional

Uninsured Motorist: $500,000 per person/$500,000 per accident: Increase your policy to these limits?
Optional

Under-Insured Motorist: $500,000 per person/$500,000 per accident: Increase your policy to these limits?
Optional

Submission Validation
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Important Notice
Any submissions or payments made via this website do not constitute a binding agreement to your policy or coverages. Changes and payments to policies are not effective or binding until you, or any party involved, receive official notice from either your insurance agent, or your insurance company. If you have any questions, please feel free to contact us.

Per the terms of our online privacy policy we will not resell your information to any third-party.
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Boer Insurance Group | 2535 Five Mile Road NE, Grand Rapids, MI 49525 | Ph: 616-363-7766 | Fx: 616-363-6626
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