Application for NMRA Insurance Program

 

Please print all information.  Make checks payable to J. A. BASH & COMPANY and mail with this completed application to:

J.A. Bash & Company, 300 Mt. Lebanon Boulevard, Suite 225, Pittsburgh, PA 15234-1509

 

Member Name __________________________________________________________                 NMRA#   ______________

 

Address            __________________________________________________________

 

A.  Blanket Coverage - Maximum value under $200, 000 total and $5,000 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

 

A+B+C ($100 minimum) $ _______________ + $10.00 NMRA Fee = $ ______________  Total Premium and NMRA Fee

 

Note: all premiums should be rounded to the nearest dollar.

 

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 approval by Peerless Insurance.