< Home 
 
 
*Name:
*Name of Organization:
*Phone: *Email Address:
Fax:
*Address:
Address:
Line 2
Location:    
Part Occupied: Other Occupancies:
# of Members: Mikvah:
Property Section:
Building Limits: Deductible:
Contents Limits: Deductible:
Business Income: Extra Expense:
Year Built: No. of Stories:
# of Apts:
(if any)
Sq. Ft. of Building:
Mortgagee: Sq. Ft. Occupied:
Burglar Alarm:    
Fire Alarm: Fire Protection:
Fine Arts:
Torahs: Deductible:
Silverware: Deductible:
Commercial General Liability:
General Aggregate: Each Occurance:
Day Care Operation: # of Kids: Ages:
After School Program: # of Students: Ages:
Elementary School: # of Kids: Ages:
Any Additional Liability Coverages:
Prior Carrier:    
Company: Expiration Date:
Annual Premium: Losses:
   
   
  Proficient Services, proficientservices.com, All Rights Reserved 2005