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See if you qualify - Fill out below or Download Supplemental Questionnaire and Fax Back
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Contact Name:
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FEIN:
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Phone:
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Fax:
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Email:
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Estimated Payroll & Gross Sales Information
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Total Estimated Sales:
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Tree Prunning Payroll:
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Landscape Payroll:
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Millwright Payroll:
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Clerical Payroll:
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Outside Sales Persons Payroll:
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General Information
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Number of Certified Arborists on staff:
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Certified Tree Care Safety Professionals (CTSP):
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Active Safety Program in place?
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Yes
No |
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Do the officers/owners perform tree pruning or landscape work?
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Yes
No |
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VEHICLE INFORMATION
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Please Provide Year, Make, Model, Complete VIN Info & Cost New for each Vehicle to be Insured:
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Please Provide Name (AS IT APPEARS ON THE LICENSE), DOB & LICENSE # FOR EACH DRIVER
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Desired Physical Damage Deductible:
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EQUIPMENT INFORMATION
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Please provide the Year, Make, Model, Serial Number and Current Value for each piece of equipment to be insured:
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SMALL TOOLS
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Total value of tools valued at less than $1,000 each (i.e. Chain Saws, Ropes, Saddles/Harnesses etc.)
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PROPERTY INFORMATION
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Do you own the buildings used for the business?
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Yes
No |
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Business Personal Property
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Please provide: Year Built, Square Footage & Construction Type of the building you occupy:
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Is Building Sprinklered?
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Yes
No |
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Building Limit:
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Business Personal Property Limit:
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LOSS
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Prior Claims Information:
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PRIOR CARRIER
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Effective Dates:
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Policy Number(s):
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Coverage:
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GL Property Auto and Equipment |
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Premium:
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ADDITIONAL INFORMATION
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Requesting Limits Higher than $1MM
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Yes
No |
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Untitled Page
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