Property & Liability Coverage Questionnaire
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Please feel free to contact us with any additional quesitons.
The Morse Agency
879 24th Ave SE
Minneapolis, MN 55414
(800) 557-0550
Fax (612) 331-9140
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Applicant Business Name
*
Mailing Address
*
City
*
State
*
Zip Code
*
Phone Number
*
Website
Primary Contact Name
E-mail
*
Does the applicant entity have 501(c3) status
*
Yes
No
Annual Expenses
*
Full-time staff
*
Part-time staff
*
Describe program mission and specific programs
*
Any losses in the last 3 years
*
Yes
No
Prior carrier and premium
*
Proposed effective date start
*
Coverage Requested
*
Property
Data Processing
Crime
Specified Property
General Liability
Social Worker
Sexual Abuse
Building amount
*
Contents amount
*
Computer value
*
Has the applicant been in business for less than three (3) years
*
Yes
No