• Completed and signed Acord Workers’ Compensation Application
• Currently valued loss runs (five years preferred)
• Five-year payroll history
• Financials
• Current experience mod worksheet

ADDITIONAL INFORMATION WHICH WILL ASSIST IN THE QUOTING PROCESS

• Details on large claims will be requested. If a deductible is involved, please indicate whether the amounts shown are gross of the deductible ("ground up"), or net of the deductible. We welcome data in an electronic format.
• If the insured owns, operates or leases aircraft, an Industrial Aid Aircraft application will need to be completed.
• Please elaborate on any change in operations over the last five years to explain payroll or loss history.
• Any elaboration on safety program already in place is appreciated.
  It should be appropriate for size of account and exposures. We will pre-inspect where needed.