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

Business Insurance Coverage
 
General Information
Technology Application
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Name:
DBA:
Street:
City:
State: Zip Code:
 

Tel. No:
Fax No:
Email Address:
Domain Name:
If more space is needed, fill out a blank sheet & attach to back
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Business Description:
Current Pricing (expiring company premiums):
Losses in the past 5 years:
No
Yes (Describe below)
Limit of liability desired for
errors & omissions:
  Errors & omissions
deductible:
Gross receipts for the following activities:
Training & Education: Hardware Sales:
Graphic/Web Design:   Software Sales:
Computer/Internet Consulting:   Pkg. Software Development:
Electronic Data Processing:   Software Development:
Computer Security:   Website Hosting:
Businesss Internet
Connectivity: 		  Personal Internet
Connectivity:
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
If more space is needed, fill out a blank sheet & attach to back
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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:
Total dollar value:   Computer value:
Security system
installed: 		  Mobile equipment
total dollar value:
nBusiness Liability Section
Estimated gross receipts:
Estimated annual payroll:
Required (lease or landlord) business liability limits:
If more space is needed, fill out a blank sheet & attach to back
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Do you install, service, or demonstrate products/equipment:
Yes (Describe below)
No
Are foriegn 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
 
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
 
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.
© Copyright 2008 Curtis Moring Insurance Agency, Inc. 123 Camino De La Reina, Suite 202 East,
San Diego, California 92108. Site design by SFDesign '03. All rights reserved.