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Application for NMRA Model Collection Insurance Program
Please PRINT all information. Make Checks payable to J.A. Bash & Company and mail this completed application to:
J.A. Bash & Company, 300 Mt. Lebanon Boulevard, Suite 225, Pittsburgh, PA 15234-1509.
Member Name NMRA Number
_________________________________________________ ____________
Street ________________________________________
City ______________ State _____ Zip Code _________ - ________
A: Blanket Coverage - Maximum Value under $200 000 total and $5000 per item.
Limit $ ______________ x .0075 = $ _____________ Blanket Coverage Premium
B: Inventory Coverage - Please submit schedule.
Limit $ ______________ x .0060 = $ _____________ Inventory Coverage Premium
C. Layout Coverage (Excluding rolling stock)
Limit $ ______________ x .0060 = $ _____________ Layout Coverage Premium
NOTE: Round all premiums to the nearest dollar.
Premium calculated above as A+B+C ($100 Minimum) $ ___________
plus $10.00 NMRA Fee equals Total Premium $ ___________
Premium savings may be available if you accept a higher deductible or have an acceptable security system. Call or write for details. Policy is effective upon receipt of application, payment and approved by Peerless Insurance.
Page last updated April 13, 2004
Copyright (c) 1995-2004 National Model Railroad Association. All Rights Reserved.
"NMRA", "National Model Railroad Association" and "National Train Show®"
are registered trademarks of the National Model Railroad Association, Inc.
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