Personal Chef Program Application

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Application for Property and Liability Coverage. Please note: This coverage is only available to members of the American Personal Chef Association.

Your Information

* indicates required field

First Name: *

Last Name: *

Business Name *

Business Type *

Address (no P.O, boxes) *

Address 2

City *

State *

Zip Code *

Phone *

Fax

Note: Your quote will be returned to you via email in a word document.

Describe your operations *

Length of time in business *

Number of employees *

Website address

Estimated annual gross receipts *

Policy effective date

Business Personal Property Amount *

Business Personal Property includes equipment you use for your business-pots, pans, utensils, stoves, desks and office equipment. It does not include your car or home.

Number of business owned automobiles

Quote an Umbrella Policy?

No
Yes

The umbrella policy is an optional coverage that gives you an additional $1 million of liability protection. It would apply in the case of a catastrophic type of loss where your business owners policy limit of $1 million per occurence is exceeded.

About Your Home

This information is used as a rating basis by the insurance carrier, we understand that you do not work out of your home but the information is needed to determine a rate for your business.

Address (if different than above)

Home City

Home State

Home Zip

Year Built *

County

If home is older than 25 years, please describe any updates

Number of Stories

Construction Type

Alarm System

No
Yes

Approximate Value *

Feedback

Describe any claims brought against your business in the past 3 years including date and amount paid

Comments

Your Information

About Your Home

Feedback

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