Submit a risk directly to our insurance brokers and underwriters by providing the necessary information. Submission requirements will vary by the class of business.
Submission requirements will vary by class of business and coverage requested:
ACORD Forms – Minimally needed to start the process
Supplemental Application or provide current carrier’s application – Find an Application >
3-5 years Currently Valued Loss Runs
Submit a risk or inquiry by selecting the region where you are located:
Northeast Submissions
Southeast Submissions
South Central Submissions
Mid-West Submissions
West Submissions
Specialty Program Submissions:
Submission requirements will vary by class of business and coverage requested:
ACORD Forms
Supplemental Application or provide current carrier’s application – Find an Application >
3-5 years currently valued loss runs
Your request will be submitted to the appropriate Program specialist.
Submission requirements will vary by class of business:
ACORD 130 Application
Supplemental Application or provide current carrier’s application – Find an Application >
NCCI E-Mod Worksheet
3-5 Years currently valued Loss Runs
Your request will be submitted to a Workers’ Compensation specialist dedicated to your territory.
Submission requirements:
ACORD Forms
Diligent effort form
State affidavit (if applicable)
Fire marshal report required if previous fire claim
Your request will be submitted to a Personal Lines specialist dedicated to your territory.
Access our Personal Lines Quote Sheet >
PERSONAL LINES SUBMISSIONS
Phone Quoting: 877-275-9578
Submission requirements will vary by class of business:
Accident & Health
Supplemental Application
3-5 Years Currently Valued Loss Runs
Occupational Accident
Supplemental Application
3 Years Current Value Loss Runs (if available)
Independent Contractor – Owner Operator Census
Complete Description of Insured Operations
Target Pricing
Copy of Sub-Contractor Agreement