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TechAdvantage™ Equipment Breakdown Quotation Request

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Location no. 1
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Prospect Information

If Yes:
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Proposed Coverage

Coverage/Description Limit of Liability Deductible/Waiting Period
Property Damage:
Business Interruption
Loss of Profits:
Rent/Rental Value:
Gross Earnings:
Actual Loss Sustained:
Other:
Extra Expense:
Spoilage:
Other Coverages
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$ 100,000.00
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$ 50,000.00
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$ 10,000.00

Broker/Insurance Co. Information

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* indicates a required field
** Some coverage applies only when Business Interruption coverage is purchased.

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