Data Upload Form

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This is for EXISTING CUSTOMERS ONLY. This form is meant to share data with our back office that is not related to a CSA request.

Signed Client or Lead?
Data you are uploading for the CSA
Commercial Insurance Information Request to Quote Policies
 
Please provide the following information:
 
• Provide a current copy of each policy reflecting "Coverages, Limits, Classifications/Class Codes, Rates, Exposures & Premiums" are most important pages on all policies (you can take pictures with your phone if that's easiest and attach):
   o General/Professional/Pollution & Umbrella Liability Policies
   o Property/Inland Marine o Business Auto Policy, including:
         ▪ Full schedule of vehicles (year, make, model, vin #)
         ▪ Drivers List (full names, DL #, DOB)
   o Workers Compensation Policy showing: Class codes/job descriptions, current payrolls & rates
 
• Provide a current/past completed application or Complete attached application
 
*Additional information may be needed depending on type of risk

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