RV Quote Request | Somerset Insurance Solutions

Effective Date*

When you need coverage to start

Primary Insured*

First Last

Gender*

Male
Female

Date of Birth*

Marital Status*

Single
Married

Drivers License*

For non-California drivers licenses, please indicate which state or country. For example: 012 345 678 (New York) or 2563487 (British Columbia).

Occupation*

Many insurance companies offer professional discounts. ie. engineer, scientist, physician, educator, CPA, Good Student w/ GPA 3.0+, etc.

Parking Address*

Street Address Address Line 2 City State ZIP Code

Insurance rates are based on a vehicle’s parking/garaging address.

Household Drivers*

How many licensed drivers are in the household?

Current Insurance Company

ie. State Farm, Allstate, Geico

RV

Year*

ie. 1985, 1999, 2011

Make*

ie. Winnebago, Coachmen

Model*

ie. Vista, Freelander

RV Length (in feet)*

ie. 22′, 30 ft

VIN*

The vehicle identification number (VIN) can be found on the driver side dashboard, door jam sticker and/or vehicle registration document (17-characters).

Purchase Date*

Estimate OK.

Vehicle Ownership*

Paid in full (no payments)
Financed (loan oustanding)

Do you live in the RV full time?*

Yes
No

Estimated Market Value ($)*

Annual Mileage*

How many miles do you estimate to drive each year? Average commuter drives between 10,000-13,000 miles per year.

Odometer Reading*

Total number of miles the vehicle has been driven. Estimate OK.

Insurance Coverage Options

Bodily Injury Liability (per person/per occurence)*

$50,000/$100,000
$100,000/$300,000
$250,000/$500,000
$500,000/$500,000

This covers medical expenses for others if you are determined to be “at-fault” for an accident. Uninsured/under insured bodily injury liability coverage will automatically be added.

Property Damage Liability*

$50,000
$100,000 (Recommended)
$500,000

Covers vehicle and property damage repair/replacement costs when insured is found to be negligent or at-fault.

Medical Payments*

$1,000
$5,000
$10,000
No Coverage

Medical payments differ from bodily injury coverage. The driver does not need to be found liable or at-fault for damages. Often referred to as “first dollar coverage.”

Comprehensive Deductible*

$100
$500
$1,000
No Coverage (Decline)

Amount insured must pay before repairs/replacement costs are covered by insurance company. Typical comprehensive claims include vandalism, theft, falling objects and glass damage.

Collision Deductible*

$100
$500
$1,000
No Coverage (Decline)

In the event insured is found to be negligent or at-fault, the selected deductible must be paid before repair/replacement costs for insured’s vehicle are covered by the insurance company.

Optional Coverage*

None
Towing and Roadside Assistance

Other Household Drivers

Driver 2*

Provide information in this format:
First and Last Name
Gender
Date of Birth
Drivers License #
Relationship (ie. spouse, child, relative, roommate)
Occupation (ie. Engineer, Attorney, Teacher, Student)

Driver 3*

Provide information in this format:
First and Last Name
Gender
Date of Birth
Drivers License #
Relationship (ie. spouse, child, relative, roommate)
Occupation (ie. Engineer, Attorney, Teacher, Student)

Driver 4*

Provide information in this format:
First and Last Name
Gender
Date of Birth
Drivers License #
Relationship (ie. spouse, child, relative, roommate)
Occupation (ie. Engineer, Attorney, Teacher, Student)

Driver 5*

Provide information in this format:
First and Last Name
Gender
Date of Birth
Drivers License #
Relationship (ie. spouse, child, relative, roommate)
Occupation (ie. Engineer, Attorney, Teacher, Student)

Additional Information

Upload Photos of RV*

Drop files here or

Accepted file types: jpg, png, pdf, Max. file size: 50 MB, Max. files: 6.

ie. Include four photos: front, rear, driver side, passenger side

Comments

ie. Please include any upgrades or existing damage to the RV.

Email*

Enter Email Confirm Email

Personalized proposal will be sent to this email address.

Phone*