Insurance Quote Request |
ABOUT THE OWNER / PRINCIPAL |
Company Name:
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First Name:
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Last Name: |
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Address: |
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City: |
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State: |
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Phone: |
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Zip Code: |
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E-mail: |
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Confirm E-mail: |
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ABOUT THE BUSINESS |
Name
of Business: |
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Location: |
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Business Type: |
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Art Sales: |
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Description of Business
(are you an art gallery or museum): |
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Year Started: |
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Years experience in industry: |
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Tax ID # |
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Business Information |
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Full Time Employees: |
Board Members:
(write '0' if none) |
Part-Time: |
Board Members are:
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Number of Partners/Execs: |
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Do you belong to
any professional associations? |
(if known) |
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Gross Receipts: |
Prior Year $
(if new business, write NEW and estimate an amount) |
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Current
Year $
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Estimates for Next
Year $
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Annual Payroll: |
$
(if none, write "none") |
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Claims: |
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Other: |
Do your customers sign a
contract or written agreement
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COMMERCIAL GENERAL LIABILITY SECTION |
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General Liability Limits: |
$
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Space Occupied (sq feet): |
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Year Building Built: |
(estimate is
acceptable) |
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Building Security System? |
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PROPERTY INSURANCE -
OPTIONAL |
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Business personal property
and equipment? |
$ |
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Fine Arts Coverage: |
$ |
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Building Insurance? |
Do you need coverage for the building itself? If so, please enter the amount
of coverage here. |
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*** |
Do you currently have insurance (if
yes, with which carrier)?
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Current Premium:
(this helps us compare rates)
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Do you have any other information
about your business, or comments that you would like to
share? Please place special requests here, such as extra coverage
for special items. |
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NO COVERAGE IS BOUND,
OFFERED, ISSUED THROUGH THIS ELECTRONIC COMMUNICATION, ALL POLICIES MUST BE
UNDERWRITTEN AND APPROVED BY THE CARRIER. DO NOT CANCEL YOUR CURRENT
INSURANCE. |
Copyright 2011 Stratum
Insurance Agency, LLC |
Art Gallery Insurance | Museum Insurance |
Cultural Center Insurance | General Liability Insurance | Business Owners
Policies | Professional Liability Insurance |
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