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IDAL Insurance Application

For questions regarding this, call 866-916-9420.

"*" indicates required fields

Applicant Information

Category*
Are you a current member of IDAL?*
Business Type
If different from the Business Name above
Address*

The current policy does not provide claims coverage in the following New York Counties: Bronx, Kings, Nassau, New York, Queens, and Richmond.

Insurance Information

MM slash DD slash YYYY
Do you perform any work other than what is necessary and Incidental to Decorative Painting, Decorative Plastering, and Wall Stenciling?*
Do you require proof of insurance for all subcontracted employees you hire? (1099 employees)*
Please enter a number from 0 to 100.
During the Past three years has any company ever cancelled, declined, or refused to renew similar coverage?*
Any Claims in the last 3 Years?*
MM slash DD slash YYYY
Do you perform regular/straight painting (painting that is not considered decorative nor base coats to decorative finishes)?
Please enter a number from 0 to 100.
Do you perform any exterior work that exceeds (6) stories or 72 feet above ground level?

E-Signature

Citadel Insurance Authorization*
Consent*
The applicant represents that the above statements and facts are true and that no material facts have been suppressed or misstated and further acknowledges that the answers provided herein are based on reasonable inquiry and/or investigation.

Completion of this form does not bind coverage. Applicant’s acceptance of the company’s quotation is required prior to binding coverage and policy issuance.

All written statements and materials furnished to the company in conjunction with this application are hereby incorporated by reference into this application and made a part hereof.
Clear Signature
MM slash DD slash YYYY
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