General Liability Supplemental Application

Basic Information

GENERAL INFORMATION

If you answer yes, we may require additional information.

Annual Budget Annual Payroll Annual Sales Number of Employees Number of Volunteers
Source(s) of Funding % of Total Budget

If yes, please explain:

If yes, please explain:

If yes, please explain:

If yes, please explain:

If yes, describe the type of property accepted including usage (e.g., residential home for rental)

If yes, describe the type of property accepted including usage (e.g., residential home for rental)

If yes, explain how Applicant uses these donated vehicles (e.g., used in Applicant’s daily operations, sold to a
third party; repaired by Applicant and resold, etc.)

If yes, please describe

If yes, please explain

If Social Services Professional Coverage is desired, please complete the “Social Services Professional” Supplemental Application