TAYLOR & TAYLOR ASSOCIATES

ASMP Prosurance Application

To apply for the Prosurance Package please take a few minutes to complete this application. All questions followed by (*) must be answered.

ABOUT YOU:

Your Name:*
Years in Business:
Annual Receipts:
Are you a member of ASMP? *	Yes No
If not, when do you plan on becoming an ASMP Member as this insurance program is for ASMP Members ONLY?

ABOUT YOUR PREMISES:

Address:

No. & Street: * Apt No.:

City: * State: *

Zip Code: *

Premises/Location (If Different From Mailing Address) *:

No. & Street: * Apt No.:

City: * State: *

Zip Code: *

Years in Business at this Location:

Building Construction:

Number of Stories:

Approximate age of Building:

If your Building is over 25 Years of age, when were the following items last updated?

Electrical:		Heating:
Roof:		Plumbing:
Do you own this Building?		Yes No
Square footage occupied by you:
What other occupants are in your Building?		Commercial Residential
Is your Building undergoing renovation?		Yes No

ABOUT YOUR PREMISES PROTECTION AND SECURITY:

Do you have a camera safe? Yes No

Do you have an automatic Sprinkler System at your premises? Yes No

What type of Burglar Alarm do you have?

Name of Alarm Company:

What type of door lock(s) do you have? Cylinder Deadbolt

Type of window protection:

Is premises located within 1,000 feet of the shoreline? Yes No

ABOUT YOUR INSURANCE IN THE RECENT PAST:

During the past 3 years, has any insurance been Canceled
Declined
Non Renewed

If yes, please explain:

Name of your previous insurance carrier?

Have you had any losses or claims over the past (3) three years? Yes No

If yes, please describe. (Include date and amount of damages)

WHAT ARE THE LIMITS OF INSURANCE YOU ARE REQUESTING?

Business Personal Property?

Camera Equipment?

Computer Equipment?

ASMP PROSURANCE Includes:

Commercial General Liability $1,000,000

Film & Valuable Papers $__15,000

Rented Props, Sets and Wardrobe $___5,000

Portfolio 25 Images At $100 each

Non-owned/Hired Car Auto Liability $1,000,000

ERRORS & OMISSIONS LIABILITY:

Protects against copyright and trademark infringement claims arising from the photographers photographic and visual images. Click here for the application

ABOUT CONTACTING YOU:

Your Phone Number

Your Fax Number

Your Email Address

COMMENTS:

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Thank You!

� 2003, 2007 Taylor & Taylor Associates Inc. / Taylor & Taylor Ltd.

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