Submission Requirements
Workers' Compensation
- Completed Acord 130
- Current Experience Mod Worksheet
- Loss Runs (minimum 3 years required)
- Healthcare Supplemental
- 2 years of Reviewed / Audited Financials (for Loss Sensitive Programs)
Professional/CGL
- Completed Acord 125 & 126
- Healthcare Supplemental Application
- 5 Years of current valued loss runs
- Current state license and Last State survey with Plan of Correction if Applicable
- Last audited financials or Pro Forma
Property
- Completed Acord 125 & 140
- Completed SOV on excel (Attached)
- Property Supplemental app with complete COPE
- 5 Years of currently valued loss runs
- Latest sprinkler inspection report
Commercial Automobile
- Completed Acord to include
- Vehicle Categorization: Location, Number of Vehicles by Type, Radius Driven, Annual Mileage
- Vehicle Identification Number, Motor Vehicle Reports by Driver including Driver Age and Experience
- 5 Years of current valued loss runs
- Risk Management tools utilized (Telematics, Anti-theft)
Commercial Umbrella
- Completed Acord to include General Liability exposure (Sales, Revenue, Square Footage)
- Commercial Auto (Number of Vehicles, by Type, Radius Driven, Annual Mileage, MVRs for each driver)
- Identification of Underlying Carrier and Limits maintained for General Liability, Commercial Auto, Employers Liability, 5 Years of current valued loss runs
Applications To Download
Within this section you'll discover dedicated applications tailored for Hospitals, Senior Living and Miscellaneous Medical classes. Furthermore, we've provided a clear breakdown of the supplementary information needed for each submission.
Applications To Appointment
Click the document below to download