- Completed and signed Acord Workers’ Compensation Application
- Currently valued loss runs (five years preferred)
- Five-year payroll history
- Financials
- Current experience mod worksheet
ADDITIONAL INFORMATION WHICH WILL ASSIST IN THE QUOTING PROCESS
- Details on large claims will be requested. If a deductible is involved, please indicate whether the amounts shown are gross of the deductible ("ground up"), or net of the deductible. We welcome data in an electronic format.
- If the insured owns, operates or leases aircraft, an Industrial Aid Aircraft application will need to be completed.
- Please elaborate on any change in operations over the last five years to explain payroll or loss history.
- Any elaboration on safety program already in place is appreciated.
- It should be appropriate for size of account and exposures. We will pre-inspect where needed.