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CGA Associates Boiler Application
We would like to provide you with a free, no-obligation insurance quote. Please provide as much information possible for the most accurate quote. This information will be kept confidential and will be used for quote purposes only.

STEP 1 of 2

Submitting Information
Name of Insured:
Date Proposed Effected:
Address:
City:   State:   ZIP:
Email:
County:
Number of Boilers:
Inspection Contact: Phone #:
Nature of Business:
(choose one)  Building Owner    Tenant
( Please complete the Cold Storage or Manufacturing with Production Machinery section, if applicable )
100% Building Replacement Cost (per location)
Age of Buildings:
Renovated:
100% Contents Replacement Cost (per location)
Limits Desired:
Property Damage:  
Business Interruption:
Annual Business Income Value(s)    Net   Gross
Package Deductible $1000 $2500 $5000 Other
Any B & M losses in the last 5 years? yes  no
Comments on Loss Info:

 

 
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