Section D Property Insurance - $20,000 Contents, $5,000 Crime Coverage Annual Premium $250 plus applicable tax Pour Résidents du Québec Seulement Je confirme que ma demande pour la présente assurance ainsi que la proposition, tout autre document et correspondance soit en anglais. For Québec Residents only I hereby request that all documentation and correspondence pertaining to this policy be issued in English Name/ Nom: Signature: Date: Section A: General Information 1. Name of Applicant: 2. Full Postal Address: 3. Location Address (if different from mailing) 4. Contact Name: Phone # email: Section B: Commercial General Liability Insurance for Bodily Injury or Property Damage suffered by others as a result of your negligence in relation to premises and operations of the EDA. A combined Bodily Injury/Property Damage Deductible of $1,000 applies Exclusions Please note the Commercial General Liability Policy does not cover Liquor Liability nor libel, slander or defamation of character in any manner. 1. Addresses for all Premises owned, rented or controlled by the applicant Location 1 Location 2 Location 3 2. Square Footage Occupied by you for each location Location 1 Location 2 Location 3
Section D Property Insurance - $20,000 Contents, $5,000 Crime Coverage Annual Premium $250 plus applicable tax Pour Résidents du Québec Seulement Je confirme que ma demande pour la présente assurance ainsi que la proposition, tout autre document et correspondance soit en anglais. For Québec Residents only I hereby request that all documentation and correspondence pertaining to this policy be issued in English Name/ Nom: Signature: Date: Section A: General Information 1. Name of Applicant: 2. Full Postal Address: 3. Location Address (if different from mailing) 4. Contact Name: Phone # email: Section B: Commercial General Liability Insurance for Bodily Injury or Property Damage suffered by others as a result of your negligence in relation to premises and operations of the EDA. A combined Bodily Injury/Property Damage Deductible of $1,000 applies Exclusions Please note the Commercial General Liability Policy does not cover Liquor Liability nor libel, slander or defamation of character in any manner. 1. Addresses for all Premises owned, rented or controlled by the applicant Location 1 Location 2 Location 3 2. Square Footage Occupied by you for each location Location 1 Location 2 Location 3
Insurance-EDA-Application-May-6-2015-EN.docx