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Welcome to Mullen Insurance Agency Inc.

 

 

Complete and submit this supplement along with the General Liability Quick Quote Request.

Agency Information                  

I am:

Agency Name:   

Producer Name:

Agent/Producer Phone

              required!            Email Address:    (retail customer or agent)

Applicant Information            
Name:

DBA:
Address:  
City: Phone:
County: Fax:
State: Must be based in Texas.    
Zip:

Additional Information
   Any of the Following?  Please Describe any "Yes" answers in detail below.
Accident & Health Policy in force?  Swimming Pools
Dogs on premises? Unanchored equipment?
Off-premises field trips? Unfenced playground?
Special classes taught (dance, gymnastics, swimming, ect)? Other-describe 
Does applicant have a procedure for picking up children?                 
Does applicant have a procedure to identify adults picking up children?                     
Does applicant have a procedure for administration of medications?                                    
Does applicant do background checks on all employees?               
Does applicant have playground equipment on the premises?  If yes, list below.                     
Does applicant serve meals or snacks?  If yes, detail below how handled.                                    

Details