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Complete Annual Renewal

Let's ensure you have the right insurance in place.

It’s time to review your insurance.

There’s one guarantee in life and business. Things change. Our annual review is an opportunity to compare your existing coverage against your current needs to ensure your insurance remains appropriate to your situation.

Contact Us

Let’s review your insurance needs.

It’s important that we review your insurance needs to ensure you have the proper insurance coverage in place.

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This field is for validation purposes and should be left unchanged.
This field is for validation purposes and should be left unchanged.
Client Information
Your Name*
First Last
Your Email*
Your Phone Number
What insurance do you currently have with us?*
- Personal Insurance
- Business Insurance
Home Address*
Street Address Address Line 2 City State ZIP Code
Company Name*
Company Address*
Street Address Address Line 2 City State ZIP Code
Total Annual Sales*
Total Number of Employees*

Your Home(s)
Please think back over the last year when answering these questions.
Have you remodeled or made any major updates to an existing home(s)?*
- Yes
- No
(New roof, furnace, or electrical system)
Have you added a home security system?*
- Yes
- No
Have you started a home-based business?*
- Yes
- No
Have you purchased a secondary residence, including a condo or timeshare?*
- Yes
- No
Have you started participating as a service provider in the home sharing economy?*
- Yes
- No
(Airbnb, VRBO)
Please explain any changes to your home.

Your Automobiles and other “Vehicles”
Please think back over the last year when answering these questions.
Have you added an automobile, watercraft, or recreational vehicle?*
- Yes
- No
Have you added any new drivers?*
- Yes
- No
Have you added a vehicle provided by an employer?*
- Yes
- No
Have you had a child leave home to attend school or no longer considered a dependent?*
- Yes
- No
Have you started participating as a service provider in the ridesharing economy?*
- Yes
- No
(Uber, Lyft, Sidecar)
Please explain any changes to your automobiles and "other" vehicles.

Your Other Life Events
Please think back over the last year when answering these questions.
Have you added or changed ownership of any assets including titles, trusts or LLCs?*
- Yes
- No
Have you hired domestic help, nanny or housekeeper, either full or part-time?*
- Yes
- No
Have you purchased jewelry, art or other valuables that need to be added? Are there items that need to be changed or deleted?*
- Yes
- No
Have you had a significant change in net worth?*
- Yes
- No
Have you accepted a position on a board(s) of a profit or nonprofit organization(s)?*
- Yes
- No
Please explain any changes.

Your Business Structure
Please think back over the last year when answering these questions.
Have you changed the ownership structure of your business?*
- Yes
- No
Have you added new or changed your existing operations and/or products?*
- Yes
- No
Have you begun to buy supplies or sell your products overseas?*
- Yes
- No
Are you operating out of any new locations or have you closed locations?*
- Yes
- No
Please explain any changes to your business structure.

Your Personal Liability
Please think back over the last year when answering these questions.
Have you acquired, leased or sold a building, business property and/or equipment?*
- Yes
- No
Have there been any improvements and/or significant alterations to your building?*
- Yes
- No
Has your Inventory level changed significantly?*
- Yes
- No
Have you purchased, leased or sold any Vehicles?*
- Yes
- No
Please explain any changes to your personal liability.

Your Income Protection
Please think back over the last year when answering these questions.
Have your Businesses revenues changed by more than 10% since last year?*
- Yes
- No
Do you rely on a single supplier for more than 50% of your materials?*
- Yes
- No
Do you rely on a single buyer for more than 50% of your sales?*
- Yes
- No
Please explain any changes to your income protection.

Your Employees & Professional Liability Exposure
Please think back over the last year when answering these questions.
Do you have employees that regularly travel out of state or overseas for business?*
- Yes
- No
Do any employees use their own personal cars for business purposes?*
- Yes
- No
Do any Employees work outside your home state or work from their home regularly?*
- Yes
- No
Do you obtain Certificate of Insurance from all subcontractors, vendors and 1099 workers?*
- Yes
- No
Are any of the owners a member of any board of directors whether for profit or not?*
- Yes
- No
Please explain any changes to your employees and personal liability exposure.

Additional Protection
Would you like to discuss any additional insurance protection with us?*
- Yes
- No
Confirmation
Your initials*

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The next step is easy, call 570-785-3187 Or, Contact Us

About Fitzsimmons Insurance Agency

We’re an independent insurance agency offering a comprehensive suite of insurance solutions to protect you from the unexpected.

We don’t just sell insurance. We work closely with clients to help them make important and informed decisions every day when it comes to protection and their future.

We offer comprehensive insurance solutions in Forest City and throughout Northeastern Pennsylvania, including Carbondale, Scranton and Honesdale.

Contact Us

504 Main St
Forest City, PA 18421

Mailing Address:
504 Main St | PO Box C
Forest City, PA 18421

P: 570-785-3187
Fax: 570-785-3188

Hours: Mon – Fri: 9am to 5pm

Our Mission

At Fitzsimmons Insurance Agency, we strive to provide a true, concierge client experience which is unique in the insurance industry. We give clients the power of choice from top-rated national and regional insurance carriers.

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