Submission Content

• A completed (all section including priorloss experience and questions) ACORD Workers' Compensation Application #130 signed by the applicant and producer dated within 90 days of the effective date.
• Prior carrier loss runs for the past 5 years but no less than 3 years, valued within 90 days of the proposed effective date.
• A detailed description of all claims with a total incurred amount of $25,000 or more.
• The most current experience modification worksheet or snapshot.
• The most current certificates of insurance from all sub contractors.
• New Venture applicats, defined as a business in operation less than one year
• The most current certificates of insurance from all sub contractors.
• New Venture applicants, defined as a business in operation less than one year that has never operated before under a different name and owner, require signed documentation in file from owner, head partner or principal of the corporation certifying 5 years or more operational experience in the same or similar industry.
• Minimum 3 years in business is required for all contracting applicants