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*Sidney Sacks Agency Inc. - Main Office
Sidney Sacks Agency Inc. - Easton Office
Products
Home & Auto Insurance
Auto Insurance
Liability Coverage
Comprehensive Coverage
Collision Coverage
Uninsured & Underinsured Motorist Coverage
Diminishing Deductible
Accident Forgiveness
Minor Violation Forgiveness
Roadside Assistance
Specialty Auto Insurance
Towing
Rental Reimbursement
Personal Injury Protection (PIP)
Medical Payments Coverage
Home Insurance
Property Insurance
Homeowners Liability
Renters Insurance
Condo Insurance
Mobile Home Insurance
Scheduled Property Insurance
Landlords Insurance
In-Home Business Insurance
Other Personal Insurance
Identity Theft
Personal Umbrella Insurance
Data Backup
Farm Insurance
Crop Insurance
Farm Owners Insurance
Farm Livestock Insurance
Equine Insurance
Farm Equipment Insurance
Farm Dwelling Insurance
Farm Structures Insurance
Farm Auto Insurance
Farm Umbrella Insurance
Farm Liability Insurance
Life Insurance
Individual Life Insurance
Group Life Insurance
Long-Term Care Insurance
Health Insurance
Disability Insurance
Recreational Vehicle Insurance
Boat Insurance
Motorcycle Insurance
Motorhome Insurance
ATV Insurance
Snowmobile Insurance
Additional Insurance Services
Special Event Insurance
Other Services
Wedding Insurance and Special Event Insurance
Coverage for Specific Industries
Accounting Firm Insurance
Alarm Contractors Insurance
Insurance for Arborists
Bar Insurance
Box Truck Insurance
Builders Risk Insurance
Car Dealership Insurance
Cargo Insurance and Freight Insurance
Catering Insurance
Cleaning Business Insurance
Construction Insurance
Consulting Firm Insurance
Contractors Insurance
Specialty Trade Contractors Insurance
Craft Brewery Insurance
Dental Practice Insurance
Dump Truck Insurance
Educational Facility Insurance
Financial Institution Insurance
Food Truck Insurance
Fleet Insurance
Handyman Insurance
Garage Insurance
Healthcare Facility Insurance
Healthcare Practice Insurance
Law Firm Insurance
Life Science Insurance
Limousine Services Insurance
Liquor Liability Insurance
Livestock Insurance
Maintenance Contractors Insurance
Manufacturing Insurance
Marijuana Insurance
Maritime Employers Insurance
Media & Advertising Insurance
Medical Malpractice Insurance
Minibus Insurance
Non Profit Insurance
Nursing Home Insurance
Nursing Insurance
Orthotics & Prosthetics Insurance
Personal Trainer Insurance
Pharmacist Insurance
Pool & Spa Insurance
Printers & Publishers Insurance
Railroad Contractors Insurance
Real Estate Businesses Insurance
Restaurant Insurance
Retail Insurance
School Bus Contractors Insurance
Scrap Metal Insurance
Security Guards Insurance
Self-Storage Insurance
Septic Contractors Insurance
Snow Plow Insurance
Specialized Truck Equipment Insurance
Technology Services Insurance
Tractor Insurance
Tow Trucks Insurance
Uber Insurance
Water Well Drillers Insurance
Vape Manufacturers & E-Cigarette Retailers
Veterinary Insurance
Coverage for Your Business
Bonds
Business Catastrophe Insurance
Business Owners Policy (BOP)
Commercial Auto Insurance
Commercial General Liability
Commercial Property Insurance
Commercial Real Estate Insurance
Commercial Umbrella Insurance
Crime Insurance
Equipment Insurance
Errors and Omissions Insurance
Extortion Insurance
Fidelity Bonds
Leave Management
Loss Control Insurance
Inland Marine Insurance
Kidnapping Insurance
Marine Insurance
Mechanical Breakdown Insurance
Office Insurance
Product Liability Insurance
Professional Liability
Ransom Insurance
Shipping Insurance
Small Business Insurance
Small Business Liability Insurance
Storage Insurance
Surety Bonds
Technology Insurance
Trailer Insurance
Transportation Insurance
Trucking Insurance and Semi Truck Insurance
Workers Compensation
Van Insurance
Coverage for Your Employees
Small Business Retirement Plans
Employer-Sponsored Retirement
Group Benefits
Group Disability Insurance
Voluntary Benefits
Retiree Health Coverage
Group Health Insurance
Disability Insurance
Individual Life Insurance
Contact Us
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Auto
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Home
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Recreational
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Business Owners
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Workers Comp
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Please Complete, Sign and Return the Form Along With a Copy of Your Most Recent Professional Liability Policy Declaration Page.
Name:
Address:
City/ST/ZIP:
Phone Number:
Fax:
Email:
Dental Specialty:
Do you Administer IV/IM Sedation or General Anesthesia:
Yes
No
Are you a Partnership or a Corporation?:
Partnership
Corporation
# of Dentists:
Limits of Liability:
$1 Million/$3 Million
$2 Million/$6 Million
Type of Coverage:
Occurrence Form
Claims Made Form
Retroactive Date
Current Professional Liability Insurance Carrier:
Expiration Date of the Coverage:
Year Graduated From Dental School:
Any Professional Liability Claims in the Last 10 Years:
If Yes, Please Explain: