Homeowners & Umbrella Personal Information Name* Current address Phone number* Email* Occupation Current home insurance I currently have a home insurance policy Insurance company Coverage amount Renewal date # of claims in last five years Home information Same as my current address Year built Type---Basic TractCustomStandardUpgraded / Remodeled Stories---1.5-story (split)1-story2-story Construction ---Frame or StuccoMasonryMasonry Veneer Foundation ---BasementCrawl SpaceSlab Age of electric Age of plumbing Age of heating Basic interior features Living space square feet # of full baths # of half baths # of chimneys # of hearths Additional interior features Finished basementCentral air conditioningSecurity system Basic exterior features Garage Type ---AttachedBasementBuilt-inCarportDetached Garage Size ---Four-carSingle-carThree-carTwo-car Roof Type ---Asphalt ShingleOtherTile or SlateWood Shingle Roof Age Additional exterior features DeckScreened-in porchOutdoor pool Additional information I'd like my jewelry to be coveredI have a dog Umbrella Coverage Coverage information Requested Coverage $ Number of drivers under 25 years old Assets Personal vehicles that you own, excluding antiques Business vehicles that your company provides you Antique vehicles Boats Personal watercraft Motorcycles Off-road vehicles Properties that you occupy Rental units that you own Comments Olathe, Kansas Office 14812 W 117th St Olathe, KS 66062 Phone: 913-782-1404 Fax: 913-583-5046 Email: general@ggisource.com Hours: 8:30 AM - 5:00 PM M-F Contact Us Type of Insurance: ---PersonalBusinessDental Practice