Application for TCA Insurance Program
Please print all information. Make checks payable to J. A. BASH &
COMPANY and mail with this completed application to:
J.A. Bash & Company, 300 Mt. Lebanon Boulevard, Suite 225,
Member Name
__________________________________________________________ TCA# ______________
Address
__________________________________________________________
A. Blanket Coverage -
Maximum value under $200, 000 total and $5,000 per item
Limit $ _______________ x .0075 = $ __________ Blanket Coverage Premium
B. Inventory Coverage - Please submit schedule
Limit $ _______________ x .0060 = $ __________ Inventory Coverage
Premium
Note: all premiums should be rounded to the nearest
dollar.
TCA Fees: Blanket Form - $10;
Schedule form under $50,000 - $25; All other - $35
Premium Calculated Above
($100 minimum) $ ___________+ TCA Fee ____________ = $ _____________ Total Premium and TCA fee
Premium savings may be available if you accept a
higher deductible or have an acceptable security system. Call or write for
details.
Policy is effective upon receipt of application! payment and approval by Peerless Insurance.