The following information is required before quoting an account:

• Completed ACORD application indicating the preferred payment option
• Three to five years of the most recent and complete premium, payroll, and hard copy loss information (loss information must be valued within the last 90 days)
• Current experience modification worksheet and experience modification history
• Written explanation of all losses greater than $10,000
• Most recent year-end and interim financial statements (if available)
• Details of loss control and safety programs
• Details of any changes to the risk that occurred within the past twelve 12 months or written confirmation that there were none
• Any additional information necessary for underwriting approval

Binding Coverage

• In order to bind coverage, the following must be done:
• We must receive a written request to bind coverage with the desired effective date and a copy of the check on or before the requested effective date. A fax is acceptable. We will not backdate an effective date. Binding authority cannot be extended to our agents.
• The initial payment (down payment or deposit) made payable to United Business Insurance Company needs to be forwarded to our office at the time of binding.
• The applications and deposit must be received in our office within 5 day of the requested effective date. Your binder may be in jeopardy if the requested information is not received. We reserve the right to change the effective date if the required money and information is not received by the due date.

Policy Issuance

The following information must be received within 5 days of the inception date in order for the policy to be issued in a timely manner:

• ACORD application properly completed and signed by the insured and producer with the producer’s social security number
• Deposit/down payment check made payable to United Business Insurance Company
• Signed Policyholder Agreement
• Applicable mandatory forms
• Current hard copy experience mod worksheet
• Specific required information requested by Underwriting

All policies will be mailed directly to the agent. The agent will be responsible for reviewing and distributing the policy to the insured.