Boiler Inspection Form

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Old Paradigm

Client comes to an insurance agent or broker for new policy or renewal.
Agent or broker is knowledgeable about insurance needs and provides information about companies and policies.
Focus is on product and carrier alternatives — and pricing.

New Paradigm

Client has a heightened awareness of the risks they face
Client needs insurance, but in the context of financial wellbeing in a world that has become increasingly precarious.
Client expects the agent or broker to understand their needs as well as their anxieties.

Old Paradigm

Client comes to an insurance agent or broker for new policy or renewal.
Agent or broker is knowledgeable about insurance needs and provides information about companies and policies.
Focus is on product and carrier alternatives — and pricing.

New Paradigm

Client has a heightened awareness of the risks they face
Client needs insurance, but in the context of financial wellbeing in a world that has become increasingly precarious.
Client expects the agent or broker to understand their needs as well as their anxieties.

Name Insured

Policy Number

Please provide an active policy number if available. Failure to provide an active policy number may delay completion of this request.

Location Name

Location Contact

Contact Email

Contact Phone Number

Location Complete Address*

Street Number

Street Name

City

State

Zip Code

*Please provide the exact physical building address (no P.O.Box numbers) including the city, state and zip code.

County Name where object is located

Country

Zip

Boiler and/or Vessel Jurisdictional Identification Number

Inspection need by date