|
Member:___________________________________________________________________
Mailing
Address_____________________________________________________________
Phone #______________________Fax
#___________________
Email____________________________________________________________________
How many years have you been in
business?____
Years of experience in this industry?____
How many gun shows do you produce
annually?____________________________
How many shows other than gun shows do you produce
annually?______________________
( If you need insurance coverage
for these events please call us for rates.)
Have you in the last five years had ANY
incident at any of your gun shows that led to a loss/claim or could have
led to a loss/claim? Yes_______No__________
If yes, please describe and list amount paid or
reserved by insurance company for any loss/claim:
_________________________________________________________________________
(use
separate sheet if necessary)
What have you done to prevent the above types of
claims from happening again?_____________
________________________________________________(use
separate sheet if necessary)
Participation
in the NAAS Insurance program
Requirements:
1)
Member
agrees to adhere to the NAAS code of ethics
2)
Member
agrees to read and implement the NAAS safety procedures for each and
every show.
3)
Member
agrees to read and utilize the insurance loss control information
provided by Steeves, Smith & Assoc., Inc.
4)
Member
must disclose any loss information for the last three years. Including
losses/incidents that have not been paid on. Member may also submit what
actions have been taken to prevent future losses.
5)
Member
must have a satisfactory loss ratio (premium paid vs losses paid or
reserved) of under 50% for the prior three years and five years for any
serious loss such as resulting in death or disability.
I have read the above information and answered all
questions truthfully.
Shoff
Darby Co., 6527 Main St., Trumbull, CT. 06611
T#1-800-840-7762 F#203-268-0687
|