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Commercial Umbrella-Excess Indication - AIG - Starstone
Agency Name:
Phone:
Agency Contact:
Fax:
E-mail Address:
Applicant Business:
Address:
City:
State:
Zip:
Policy Details
Coverage Limit Requested:
1,000,000
2,000,000
3,000,000
4,000,000
5,000,000
6,000,000
7,000,000
8,000,000
9,000,000
10,000,000
Effective Date:
Check Underlying Coverages:
Auto
General Liability
Workers Comp
Hired and Non Owned Only
General Liability Premium:
General Liability Class:
Number of Autos:
Workers' Comp. Premium
:
Description Of Operations
Description Of Operations:
Annual Sales:
Annual Payroll:
Pre-Qualifying Questions
All underlying policies are on occurrence forms?
Yes
No
Are all policies rated A-V or higher by A.M. Best?
Yes
No
Any losses in the past three years for coverages being provided?
Yes
No
Does fleet exceed 10 Extra Heavy Trucks or 25 total vehicles?
Yes
No
Notes