Minnesota Property & Liability Coverage Questionnaire

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



	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