New Business Items Needed for Underwriting/Quoting

1. Supplemental Questionnaires

• Completed Acord Commercial Insurance Application
• Completed Acord Workers Compensation Applications
  • (Note that the Trust caps each individual's payroll at a maximum of $75,000 per year so please adjust payrolls accordingly, including executive officers, owners and members of an LLC)
• Completed Supplemental Workers' Compensation & Auto Questionnaire
• Ambulance Companies - Emergency Medical Services Questionnaire
• Child Daycare - Supplemental Child Daycare Questionnaire
• Home Care Companies - Home Care Supplemental Questionnaire
• Long Term Care & Assisted Living Organizations - Supplemental Long Term Care / Assisted Living Questionnaire
• Medical Services - Supplemental Medical Services Quesionnaire
• Museums - Supplemental Museum Questionnaire
• Non-Emergency & Public Transport - Supplemental Non-Emergency & Public Transport Questionnaire
• Schools - Supplemental School Questionnaire

2. 5 plus years of Hard Copy Loss Runs - including current
3. Workers' Compensation  Acord Apps
4. NCCI Experience Modification and detail pages 
5. How long have they been in business, what experience do they have in the industry?
6. Loss Control contact information (Name, Title, email and phone#)

Items required before Binding/Issuance

• Payment Policy & Contact Form - need prior to binding
• Medical Care Plan Application - should be here at binding, can follow up w/in a week
• Deposit Premium Check - only applies to New Business
  • If we are within 1 to 2 days of effective date - and check is not here by binding, broker needs to send to us a copy of the check being mailed. 
  • If we are a few days to the effective date - insured must pay deposit invoice upon receipt.

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