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


Commercial Umbrella-Excess Indication - Starstone - AIG

Agency Name:
Phone:
Agency Contact: Fax:
E-mail Address:
Applicant Business:
Address:
City:
State: Zip:
 

Policy Details

Coverage Limit Requested:
Effective Date:

Expiration Date:

What Underlying Coverages Are We Writing Over:
General Liability premium:
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
All underlying policies are written with carriers rated A- V or higher by A.M. Best: Yes No
Have there been any losses in the past three years for any of the coverages being provided?: Yes No
Does the auto fleet exceed 10 Extra Heavy Trucks or 25 total vehicles?: Yes No
Notes