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