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Lead No.: 14355153
Enter Date: 5-17-2006
For: Joe Sample
Acct. No.: 25
Insurance Type: Auto, Home, Health, Life, Ltc
Profile/Cost: / Free
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| Contact Information |
John Q Public
9800 S Meridian Blvd
Greenwood Village, CO 80112
Arapahoe County |
Home: 303-333-0001
Work: 303-333-0002
Email: John.Public@Insureme.com
Best Place to Call: Home |
Time at Curr. Res.: 5 yr., 2 mo.
Time at Prev. Res.: 3 yr., 4 mo.
Rent or Own: Own
Notes: |
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| Auto |
| Drivers |
| John Q Public |
| Gender: Male |
DOB: 5-1-1963 (43) |
Marital Status: Married |
| Occupation: Physician (5+ yrs.) |
Income: 100000 |
Smoke: No |
| License No: |
License State: CO |
License Issued: 5-1-1979 (16) |
| License Status: Current |
Defensive Driving: No |
Drivers Training: No |
| Non-Drinker: No |
Education Level: PhD. Degree |
| Violation Date |
Type |
Description |
| 4-10-2003 |
Speeding less than 10 MPH over |
I was in a hurry to get to work |
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| Accident Date |
Type |
At Fault |
Injury |
Property |
Description |
| 6-22-2003 |
Hit while stopped |
No |
3475 |
8200 |
Hit while waiting at a stop light |
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| Claim Date |
Type |
Amount |
Description |
| 6-12-2003 |
Hail damage |
2739 |
Roof, hood and windshield |
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| Jane Public |
| Gender: Female |
DOB: 9-11-1962 (43) |
Marital Status: Married |
| Occupation: Nurse/CNA (5+ yrs.) |
Income: 80000 |
Smoke: No |
| License No: |
License State: CO |
License Issued: 9-11-1978 (16) |
| License Status: Current |
Defensive Driving: No |
Drivers Training: No |
| Non-Drinker: Yes |
Education Level: Masters Degree |
| Violation Date |
Type |
Description |
| 11-30-2003 |
Illegal turn on red |
Did not notice the sign |
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| Accident Date |
Type |
At Fault |
Injury |
Property |
Description |
| 9-22-2004 |
Hit an obstruction. Single car accident |
No |
0 |
1225 |
Slid on ice and hit a tree |
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| Vehicles |
| 2005 CHEVROLET TRAILBLAZER LS/LT 4 Dr Wagon/SUV |
VIN: 1GNDT13S*5******* |
| Usage: Commute To/From Work (10 mi. each way) |
Alarm: Audible Alarm |
Air Bags: 4 |
| Annual Miles: 11250 |
Garage: Garage |
ABS: Yes |
| Cylinders: 6 |
Deductibles (comp/coll): 500/500 |
Auto Belts: Yes |
| Four Wheel Drive: Yes |
Doors: 4 |
Own: No |
| Primary Driver: John Q Public |
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| Current Automobile Insurance Coverage Information |
| Company: Dewey Cheatum and Howe (11 yr.) |
Renewal Date: 5-17-2006 |
Years Continuous: 11 |
| Liability: 100/300 |
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| Desired Automobile Insurance Coverage Information |
| BI: 100/300 |
PD: 100,000 |
UMBI: 100/300 |
| Options: |
Medical: 0 |
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| Personal Information |
| DOB: 5-1-1963 |
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| Home |
| 9800 S Meridian Blvd, Greenwood Village, CO 80112 (Arapahoe County) |
| Insurance Type: Homeowners |
Year Built: 1998 |
Deadbolt Locks: No |
| Renewal Date: 5-17-2006 |
Sq. Ft.: 2750 |
Smoke Alarm: Yes |
| Stories: 2 |
Bedrooms: 4 |
Fire Ex.: Yes |
| Const. Class: Standard |
Full Baths: 2 |
Fire Station < 5 Mi.: No |
| Exterior Walls: Stucco |
Half Baths: 1 |
Fire Hydrant < 1000 ft.: No |
| Garage Type: Built-in |
Fireplaces: 1 |
Central Air: No |
| Garage Size: 2 |
Decks: 1 |
Sump Pump: No |
| Basement: Finished |
Hot Tub: No |
Wood Burning Stove: No |
| Shingle Type: Asphalt |
In-Ground Pool: No |
Earthquake Coverage: No |
| Dog Breed: None |
Pool Fenced: No |
Sauna: No |
| Smoker In Household: No |
Sewer Protection: No |
Security System: Local |
| Coverage Requested |
| Appraisal Value: 330000 |
Dwelling Coverage: 310000 |
Deductible: 1000 |
| Liability Limit: 300,000 |
Current Ins.: Dewey Cheatum and Howe |
Current Ins. Exp. Date: 5-17-2006 |
| Claim Date |
Type |
Amount |
Description |
| 5-11-2005 |
Home |
5800 |
Water, Water heater broke and flooded basement |
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| Health |
| John Q Public (Self) |
| Gender: Male |
DOB: 5-1-1963 (43) |
Marital Status: Married |
| Occupation: Physician |
Height: 6ft. 0in. |
Smoke: No |
| Current Ins.: (None) |
Weight: 170 |
Non-Drinker: No |
| U.S. Resident: No |
Self Employed: No |
Denied Coverage: No, |
| Income: 100000 |
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| Pre-Existing Condition |
Description |
| Diabetes |
Type 2 |
| Heart Attack |
heart attack |
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| Jane Public (Spouse) |
| Gender: Female |
DOB: 9-11-1962 (43) |
Marital Status: Married |
| Occupation: Nurse/CNA |
Height: 5ft. 7in. |
Smoke: No |
| Current Ins.: (None) |
Weight: 130 |
Non-Drinker: Yes |
| U.S. Resident: No |
Self Employed: No |
Denied Coverage: No, |
| Income: 80000 |
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| Pre-Existing Condition |
Description |
| Asthma |
Not severe |
| Physician Treatment |
Check ups |
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| Life |
| John Q Public (Self) |
| Gender: Male |
DOB: 5-1-1963 (43) |
Marital Status: Married |
| Occupation: Physician |
Height: 6ft. 0in. |
Smoke: No |
| Current Ins.: (None) |
Weight: 170 |
Non-Drinker: No |
| Ins. Type: Whole-Life years |
Death Benefit: 300000 |
Income: 100000 |
| Extreme Activities: No |
| Pre-Existing Condition |
Description |
| Diabetes |
Type 2 |
| Heart Attack |
heart attack |
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| Jane Public (Spouse) |
| Gender: Female |
DOB: 9-11-1962 (43) |
Marital Status: Married |
| Occupation: Nurse/CNA |
Height: 5ft. 7in. |
Smoke: No |
| Current Ins.: (None) |
Weight: 130 |
Non-Drinker: Yes |
| Ins. Type: Whole-Life years |
Death Benefit: 200000 |
Income: 80000 |
| Extreme Activities: No |
| Pre-Existing Condition |
Description |
| Asthma |
Not severe |
| Physician Treatment |
Check ups |
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| LTC |
| John Q Public (Self) |
| Gender: Male |
DOB: 5-1-1963 (43) |
Marital Status: Married |
| Personal Net Worth: 10000 |
Current Ins.: |
| Occupation: Physician |
Height: 6ft. 0in. |
Smoke: No |
| Employed Outside Home: No |
Weight: 170 |
Non-Drinker: No |
| Lives With: Spouse |
Lives in Ret. Comm.: No |
Volunteers: No |
| Medicaid: No |
Repl. Ex. Coverage: No |
Been Denied Coverage: No |
| Has Special Parking/Driving Needs: No |
Cane/Crutches: No |
| Income: 100000 |
Needs Assistance With Daily Living: No |
| Pre-Existing Condition |
Description |
| Diabetes |
Type 2 |
| Heart Attack |
heart attack |
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| Jane Public (Spouse) |
| Gender: Female |
DOB: 9-11-1962 (43) |
Marital Status: Married |
| Personal Net Worth: 25000 |
Current Ins.: |
| Occupation: Nurse/CNA |
Height: 5ft. 7in. |
Smoke: No |
| Employed Outside Home: No |
Weight: 130 |
Non-Drinker: Yes |
| Lives With: Spouse |
Lives in Ret. Comm.: No |
Volunteers: No |
| Medicaid: No |
Repl. Ex. Coverage: No |
Been Denied Coverage: No |
| Has Special Parking/Driving Needs: No |
Cane/Crutches: No |
| Income: 80000 |
Needs Assistance With Daily Living: No |
| Pre-Existing Condition |
Description |
| Asthma |
Not severe |
| Physician Treatment |
Check ups |
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