subject_line
Insurance Brokerage:
Lloyd Sadd Insurance Brokers Ltd.
Broker Contact:
Jo Gionet
Email:
jgionet@lloydsadd.com
Phone:
403-444-0966
Fax:
403-333-0956
Named Insured (Full Legal Entity Name(s)):
*
0/255 characters
Principals name(s):
*
Contact Information
Mailing Address
*
Phone Number
*
City
*
State/Province/Region
*
Email Address
*
DQ Location
DQ Location Street Address
*
Zip/Postal Code
*
City
*
Description of operations
DQ - Grill & Chill
DQ - Cool Treats
OJ
State/Province/Region
*
Number of years the insured has been in business at this location:
Prior operating experience/number of years at other locations:
Is the DQ a seasonal operation?
Yes
No
Financial Institute Providing Financing Information:
Institution Name
Street Address
City
State/Province/Region
Zip/Postal Code
Country
Current Insurance Information:
Existing Insurer Name:
Expiry Date:
+
Expiring Premium:
Policy #
Has the insured been cancelled/declined insurance (including boiler)?
*
Yes
No
If yes, please provide details: i.e. reason
*
Previous Claims (last 3 years):
*
Yes
No
If yes please attach full details, dates and payments