"Our success is not because of the coverage we offer. It's because of the people who write the policies."


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:
Effective Date:
Check Underlying Coverages:
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