Personal Umbrella Questionnaire

In order to ensure the accuracy of your excess liability policy, we routinely monitor the exposures which exist in your household. It is very important that your listed exposures are accurate or a gap in your insurance protection can occur; gaps that could have serious implications in the event of a loss. Please take a moment to fill out the information below:


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Your Name(Required)
Does anyone in your household hold any positions as a PAID board member for a profit or non-profit organization?(Required)
Is anyone in your household self-employed?(Required)
Umbrella policies require that specific minimum limits be maintained on the various underlying policies. If Walsh Duffield does not handle all of your underlying policies ( auto, home, recreational vehicles etc.), we hereby request that you please provide a current copy of the coverage pages for the policies insured elsewhere. This includes policies for any drivers in your household that have coverage outside of Walsh Duffield. It is very important to verify your current liability limits are satisfactory. If they are lower than the required limits, you will be held financially responsible for any gap in liability coverage.


Personal Insurance Review

A review of your insurance program is available to you at any time by calling any one of our Customer Care Associates.  If this questionnaire is not completed annually, your policy will renew with the information we have on file.  If you need assistance with this request please do not hesitate to contact our agency. Thank you for your continued business as we value and appreciate it!

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Please note, coverage cannot be bound or amended without written verification by an agency representative.