M
ikkelsen
I
nsurance
S
ervices
Information needed for Youth Baseball and Softball Accident/Liability Insurance quote
(California Only)
! Please complete all blanks. (
Our Privacy Statement
)
Name:
League name:
Address:
City:
CA
Zip Code:
Phone:
Softball & T-Ball:
- or Baseball:
Total Number of Teams:
Total Number of Participants:
Number of Teams in Age group 9 & Under:
Number of Teams in Age group 10 - 12:
Number of Teams in Age group 13 - 15:
Number of Teams in Age group 16 - 18:
Liability Limits:
-0-
$1,000,000
$2,000,000
$3,000,000
$4,000,000
$5,000,000
(Accident policy with at lest $10,000 benefit required.)
Hired and Non-owned Auto. Yes/No?
Limits - Medical Expenses/AD & D:
$5,000/$2,500
$10,000/$10,000
$15,000/$10,000
$25,000/$10,000
Deductible:
$0
$25
$50
$100
Additional information:
E-mail address:
Be sure all questions are answered. We are unable to respond to requests with incomplete information.
For a
FREE
quote
please complete the form and press "Send" or if you prefer, you may print it and Fax it to us at:
209-839-8632
Copyright © 1999-'06 - Mikkelsen Insurance Services
