Additional Information
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Basic Information
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Location Information
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Property Information
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Estimated Replacement Values
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General Liabilities/Professional Optometrist Liability
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- $1,000,000 Each Occurrence/$3,000,000 aggregate Products Completed Operations Limit
- $2,000,000 Each Occurrence/$4,000,000 aggregate Products Completed Operations Limit
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Please list any Additional Insured you are required to show on the policy.
Interest: building owners, equipment lease, etc. Include the names and addresses of addtional insured.
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Professional Liability Limit Options
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The Optometrist Professional Liability coverage is subject to the following limits of insurance. Limits apply to each Doctor.
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- $1,000,000 Each Occurrence/$3,000,000 aggregate Products
- $2,000,000 Each Occurrence/$4,000,000 aggregate Products
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Automobile Liability
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Workers Compensation
(complete only if coverage is desired)
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Excluding monopolistic states -- North Dakota, Ohio, Washington, West Virginia, Wyoming, and Maine. Stop Gap Coverage.
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(If yes, please note that minimum payrolls will be applicable depending on the state required.) NOTE: If you do not answer this question, Worker's Compensation coverage will be automaticly afforded and premium will be charged.
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Umbrella
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$1,000,000
$2,000,000
$3,000,000
$4,000,000
$5,000,000
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