CMI Non-Profit Insurance Application

Curtis Moring Insurance Agency, Inc. Think CMI for all your insurance needs.

Business Insurance Coverage

General Information

Non-Profit Application

Name of Business:

DBA:

Street:

City:

State:		Zip Code:

Tel. No:

Fax No:

Email Address:

Contact Person:

Years in Business:

Corporation:

Yes

If other type,specify:

Nature of business:

If more space is needed, fill out a blank sheet & attach to back

TOP

nBusiness Auto Section

Describe how & what purpose vechicle is used:

Number of vechicles:
Number of drivers:
Make of vehicle:
Model of vehicle:
Vehicle ID number:

nBusiness Property Section

Building construction type:

Number of
building occupants:

Business contents
total dollar value:

Age of building:

Refrigeration value:

Number of stories:

Spoilage value:

Total square footage:

Stock value:

Building
total dollar value:

Computer equipment
total dollar value:

Security system
installed:

Yes

Mobile equipment
total dollar value:

nBusiness Liability Section

Estimated gross receipts:

Estimated annual payroll:

Required (lease or landlord) business liability limits:

Do you install, service, or demonstrate products/equipment:
Yes (Describe below)		No

Are foreign products sold, distributed, or used as components:
Yes (Describe below)		No

Is coverage of any vendors required:
Yes (Describe below)		No

Are there guarantees, warranties, or hold harmless agreements:
Yes (Describe below)		No

Does any named insured sell to other named insured:
Yes (Describe below)		No

nDirectors/Officers Section

Are articles of incorporation avaiable:
Yes	No

Does the company have a Board of Directors:
Yes	No

Are audited financial statements available:
Yes	No

	Curtis Moring Insurance Agency, Inc.

	License #0719355


	123 Camino de la Reina, Suite 202 East
	San Diego, CA 92108

	(800) 321-0677
	p: (619) 718-7575
	f: (619) 718-7565

	email:
	information
	webmaster

This form is not an insurance policy or an insurance contract. Your agreement to these terms does not create an insurance contract or agreement. These terms must be accepted by the insurance company before there is any contract or coverage.

Serving California consumers since 1963. PRIVACY POLICY.