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Quote Request Form
To obtain a quotation for Employment Practices Liability coverage,
please open the quote
request form in Adobe Acrobat, print, and fill out. Return the
completed form to our office via mail or fax to:
Tegner-Miller Insurance Brokers
ATTN: Jan Grant, Commercial Insurance Dept.
P.O. Box 511
Santa Monica, CA 90406
Fax: 310-453-7971
ATTN: Jan Grant, Commercial Insurance Dept.
If you have any questions, or need assistance completing the form,
please contact our office at 800-775-TMIB.
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