Special Events Insurance

Prior Coverage

Carrier Name:

Policy Number:

Expiration Date:

In a Rush, Complete this questionnaire and call us at 408-286-1111 ext 106

Obama care

info@g1g.net

408-286-1111 ext 106

408-997-7890

CA Lic#

0697055

Sign In

User Name11

Password

New User
Forgot password?

News

CEO Zain Jeewanjee
Interview on WomenNow TV

Personal Article Floater

Please answer all questions to prevent a delay in processing your quote request.
If you have any questions call us at 800.257.7718 for help or fax at 408.997.7890

Contact Information

Name of Insured:

Address:

(street)

(City)

(zip)

Contact Person:

(First)

(Last)

Telephone:

Fax:

Cell Phone:

Email Address:

Qualification Questions

Any Brush Location with less than 150ft clearance? :

Yes No

Any claims in the past five years? :

Yes No

Any coverage cancelled or denied in the past three years? :

Yes No

Primary Location Details

Address of Primary Location:

(street)

(City)

(zip)

Year Built:

If schedule equipment is over $100,000, advide name of central statation alaram company at primary address:

Location in a Brush Area?:

Yes No

Has location been retrofitted?:

Yes No

Coverage Options
Coverage Start Date:
Coverage End Date:
Category		Limit to Insure
Jewelry (In Bank Vault):
Jewelry (Out of Bank Vault):
Fine Arts (non-Fragile):
Fine Arts (Fragile):
Furs:
Cameras, Projection machines, films, etc :
Sporting Event:
Music Instruments:
Silverware:
Postage Stamps:
Rare Coins & Collections:
Computers & Media:
Wine:
Golf Carts:
Bicycles:
Guns/Firearms:
Miscellaneous Collections:

Home \| About Us \| Who We Are \| Privacy Policy \| Contact \| Sign In \|
Copyright 2005 Jeewanjee Insurance Agency All rights reserved California Lic # 0697055
Website Maintained by: W3Eye Inc.