Transcription of COMMERCIAL UMBRELLA APPLICATION
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Example: bachelor of science
COMMERCIAL UMBRELLA APPLICATION
COMMERCIAL UMBRELLA APPLICATION . Quotation New Business Box 48 Cottonwood, Minnesota 56229. EFFECTIVE DATE: _____ POLICY TERM: 1 YEAR. APPLICANT AND MAIL ADDRESS AGENCY AND MAIL ADDRESS AGT. Phone No.: Phone No.: Fax No.: UMBRELLA LIMIT (Non-binding): $1,000,000 $2,000,000 $3,000,000 $4,000,000 $5,000,000. DIRECT BILL INSTRUCTIONS: Insured Other_____ SELF-INSURED RETENTION: $10,000. New Business - 1 months premium required with APPLICATION . THE NAMED INSURED IS: Individual Corporation Partnership Other_____. A. LOCATION OF PREMISES: Location (Include 911 Address) County No. 1. No. 2. No. 3. B. DESCRIPTION OF OPERATIONS: Location On Premises Off Premises No.
commercial umbrella application quotation new business effective date: _____ policy term: 1 year applicant and mail address agency and mail address agt. no._____
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