Amity Insurance, an innovator in the insurance industry since 1978.

We are dedicated to providing excellence in risk and insurance management

Contents and General Liability Form

 * indicates required field

Contact Name*

Firm Name*

Street Address

Suite

City

State*

Zip Code

Telephone*

Extension

Fax

Email*

Legal entity (select applicable)

Occupancy

Square footage occupied

Year built

Replacement cost of all contents excluding computers

Replacement cost of all computers/data processing equipment

Optional deductibles
 $500 $100

Attorney's average hourly billing rate
 Less than $150/hr $151 - $200/hr $201 or more per hour

Building construction (select applicable)

Sprinkler system
 Yes No

Burglar Alarm

Fire Alarm

Are you within 1,000 feet of shoreline?
 Yes No

Loss history past 3 years (include date, type, amount paid)
If no loses state NONE.