APPLICATION:
GENERAL LIABILITY / ERRORS & OMISSIONS
This application does
not bind the applicant nor the Company to complete the
insurance, but it is agreed that the information
contained herein shall be the basis of the contract
should a policy be issued.
APPLICABLE IN THE STATE OF NEW YORK:
Any person who
knowingly and with intent to defraud any insurance
company or other person files an application for
insurance or statement of claim containing any
materially false information, or conceals for the
purpose of misleading, information concerning any fact
material thereto, commits a fraudulent insurance act,
which is a crime, shall also be subject to a civil
penalty not to exceed five thousand dollars and that
stated value of the claim for each such violation.
FRAUD PREVENTION - OHIO WARNING:
Any person who, with
intent to defraud or knowing that he is facilitating a
fraud against an insurer, submits an application or
files a claim containing false or deceptive statement is
guilty of insurance fraud.
IMPORTANT NOTICE:
As part of our
underwriting procedure, a routine inquiry may be made to
obtain applicable information concerning character,
general reputation, personal characteristics and mode of
living. Upon written request, additional information as
to the nature and scope of the report, if one is made,
will be provided
You may either enter your information online (see our
Privacy Policy) or download a .PDF format of our
application form and then fax or send it to us. We will
respond promptly with a personalized phone consultation
to discuss your quotation and your company's insurance
needs.
To begin the online application,
CLICK
HERE
Note: We use ssl encryption to protect your data and
privacy. We care about your privacy! See our privacy
notice here.
Please
CLICK HERE to download our application form in .PDF
format (Adobe Acrobat Reader required; you may download
the Adobe Reader free
HERE). Print the form and fax it to us at the number
listed for a quick and accurate quote.
