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Baxter & Associates, LLC
4400 Bayou Blvd, Suite 52-B
Pensacola, FL 32503

TEL 800.641.8865
FAX 888.287.8894
CRNA Malpractic Insurance
Request for Quote Inquiry
Name:
Street Address:  
City:
Phone Number:
Email Address:
In which County do you practice?  
Do you currently have coverage?   Yes No
If you currently have coverage, what is your policy’s retroactive date?  
Who is your current Insurer?  
How many hours per week do you practice on average?  
Limits of Liability you would like quoted.  Please check all that apply  
$100,000/$300,000
$200,000/$600,000
$250,000/$750,000
$500,000/$1,500,000
$1,000,000/$3,000,000
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