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Steve Boyett and Associates, Inc.

sboyett@steveboyettassoc.com

Mailing Address: 330 Franklin Rd, 135A - 526 Brentwood, TN 37027 Street Addreess: 9544 Equestrian Lane Brentwood, TN 37027
Phone: Cell: Fax:	(303) 679-9575 (303) 717-6860 (303) 265-9794

Art Gallery Application

We would like to provide you with a free, no-obligation Art Gallery Insurance quote. Please provide as much information possible for the most accurate quote. This information will be kept confidential and will be used for quote purposes only.

General Information
Applicant Name:
Business Name:
Mailing Street Address:
City:	State: Zip:
Phone#:	Cell#: Fax#:
Website Address:	http://www.
Email Address:

Location Information
Primary Location Address:
City:	State: Zip:
Primary Building Construction:	Frame Stucco Brick Metal Other
Building Square Feet:	# of Stories:
What Floor Do You Occupy:	Your Square Feet:
Central Burglary Alarm System:	Yes No
Central Fire Alarm:	Yes No
Collection Kept in Vault:	Yes No
Vehicle Alarm is Present:	Yes No
Interior Sprinkler System:	Yes No

Secondary Location Address:
City:	State: Zip:
Secondary Building Construction:	Frame Stucco Brick Metal Other
Building Square Feet:	# of Stories:
What Floor Do You Occupy:	Your Square Feet:
Central Burglary Alarm System:	Yes No
Central Fire Alarm:	Yes No
Collection Kept in Vault:	Yes No
Vehicle Alarm is Present:	Yes No
Interior Sprinkler System:	Yes No

Coverage Information

Primary Effective Date:

Expiration Date:

Number of Years in Business:

Describe All Claims Relative to Your Business in the Past 3 Years:

Any Coverage Declined or Cancelled in the Past 3 Years:

Yes No

If "Yes" above, please explain below:

Please Indicate Shows and Exhibits That You Will Attend in the Next 12 Months:

1.	Date:
2.	Date:
3.	Date:
4.	Date:
5.	Date:
6.	Date:

Inventory Value to be Insured:

Consigned Value to be Insured:

Gross Profits for the Past 5 Years:

: $

Do You Use a Consignment Agreement:

Yes No

Is split with artist more than 50%:

Yes No

Are Accurate Inventory Records Kept on Each Item
in the Inventory Including Cost Basis and Sale Price:

Yes No

Applicant's Statement
I have read the above application and any attachments. I declare that the information in them is true, complete and correct to the best of my knowledge and belief. This information is being offered to the company as an inducement to issue the policy for which I am applying. Please check box if you agree with the above statement...
Applicant's Signature:
Application Date:

Please click on the "Submit Quote" button to send your quote request.
One of our representatives will respond to your submission as soon as possible.

	Important Note: This website provides only a simplified description of coverages and is not a statement of contract. Coverage may not apply in all states. For complete details of coverages, conditions, limits and losses not covered, be sure to read the policy, including all endorsements.