Skip to content

Mello INSURANCE SOLUTION

WE’RE 100% DEDICATED
TO SMALL BUSINESS.

TOOLS & EQUIPMENT FORM

Insured Name: *

Email *

Street Address:

City:

State:

Zip Code:

Proposed Effective Date:

Project Type:

New Construction Remodel/Renovation Remodel/ Renovation with Existing structure coverage

Structure Type:

Residential Commercial

Construction Type:

Frame Joisted Masonry Non-Combustible Modified Fire resistive Fire resistive

Total Square Footage of Completed Project:

Number of Stories:

Proposed Effective Date:

Estimated Completion Date:

Total Estimated Completed Value:

Distance to the Nearest Fire Hydrant:

Distance to the Nearest Fire Station:

Jobsite Security:

Private Security Patrol Fence Lights Security Camera(s)/Video Watchman None Other

Jobsite Security:

Type of Entity:

Type of Business:

Contractor Name:

Contractor License Number:

Contractor's Years of Experience:

Contractor's Address:

City:

State:

Zip code:

Loss Payee:

Mortgagee:

Additional Insured

Erick De Mello

3611 Prince Street, Escondido CA 92025

Erick@melloinsuranceusa.com