F. DARRELL LINDSEY

State Licensed Agent/Broker

In Cooperation With

The Combined Industry

Purchasing Group

Association of America

THE

APPLICATION

PROCESS

THANK YOU!

The Purchasing Group Association, and either F. Darrell Lindsey and/or Rob L. Lindsey, the state licensed persons responsible for responding and providing insurance related services, for the insurance programs being made available by the Industry Association’s to their members, is a referral service only without compensation.

Please identify the application KIT appropriate for the coverage you are requesting to be quoted.

The application form, and any attached supplemental questionnaires, must be completed with no blank spaces; N/A can be entered as applicable, and then returned by FAX or mail to the address provided.

The questions relating to; prior claims, payroll, gross receipts, prior insurance, and about your basic business operations should be in your own words.   This information is critical to the underwriting and rating of LIABILITY Insurance.   For other insurance, all questions are important and must be completed.

                                                                        Respectfully,

                                                                        F. Darrell Lindsey

                                                                        State Licensed Agent/Broker

CLICK on the application noted below that applies:

            ● Business Director’s and Officers LIABILITY

            ● Executive LIABILITY and Indemnification Coverage

            ● Personal Director’s LIABILITY