Date of Application
Proposed Effective Date:
Name of Winery
Contact Name:
*
Mailing Address:
*
City:
*
State:
Zip:
Email:
*
Phone:
*
Fax:
Years in Business:
The Winery Owner is an:
Individual
Corporation
Partnership
LLC
FEIN or Social Security #:
In addition to the the information above we will need copies of the following:
- If less than 3 years in business, owners resume.
- If currently insured, 3 years of carrier loss runs.
- Plot Plan.
- Photographs of all buildings.
Attach here:
The winery is interested in receiving a quote for the following types of coverages:
General Liability
Property
Auto
Liquor Liability
Umbrella
Workers Compensation
Security Code
*