Special Events Insurance

Prior Coverage

Carrier Name:

Policy Number:

Expiration Date:

One Day Event only chooses the top rated policies for you and we guarantee our coverage will meet all your venue's requirements!

Obama care

CIGNA Domestic

CIGNA International

CIGNA Global Plans

info@insure123.com

408-286-1111

408-997-7890

CA Lic#

0697055

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If you have any questions call us at 408.286.1111 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:
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Copyright 2005-2015 Jeewanjee Insurance Agency All rights reserved California Lic # 0697055
1494 Hamilton Ave #101, San Jose, CA 95125