Title Page
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Conducted on
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Prepared by
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Brokerage
Untitled Page
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Named Insured
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Do you have acord applications or another application ready?
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What Lines of Business are needed?
- Other Specialty Insurance
- Commercial Property
- General Liability
- Workers' Compensation
- Commercial Auto
- Commercial Umbrella
Other Specialty Insurance
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What other Insurance product is needed?
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Effective date?
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Expiration date?
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Does current coverage exist?
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Please attach copy of current coverage
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Please attach current loss runs for this coverage
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Please describe what limits are needed
Commercial Property
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Is there current coverage?
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Please attach copy of current policy
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Please attach current loss runs
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Please provide a schedule of the locations needing coverage and what limits they require
General Liability
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Is there current coverage?
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Please attach copy of current policy
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Please attach current loss runs
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Please describe the risk's operations
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Provide risk's website
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What is risk's Gross Revenue?
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What is risk's estimated Annual Payroll?
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What is the Sqft of the business?
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What limits of coverage are they looking for?
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Are there any contractual requirements? Describe or attach contract
Workers' Compensation
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Is there current coverage?
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Please attach copy of current policy
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Please attach current loss runs
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Please provide # of employees and payroll by WC class
Commercial Auto
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Is there current coverage?
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Please attach copy of current policy
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Please attach current loss runs
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Please attach current MVR's
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Please provide a schedule vehicles and drivers
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Please provide details on the coverage limits they are requesting
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Please provide current MVR's
Commercial Umbrella
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Is there current coverage?
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Please attach copy of current policy
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Please attach current loss runs
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Please provide info on limits needed and coverages that they'd like to place as underlying
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Please attach all acord applications
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Please attach all current loss runs
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Check this box to alert SC Care Underwriter
