:: Standard Lines Submit Business


Fax or Email		Standard Acord Applications can be faxed or emailed directly to the underwriters listed on the left of this page

Online Submissions		BOP Application Commercial Auto Application Workers' Compensation Application

Broker of Record		• Submit a written request on insured letterhead - Signed by insured - Must include current policy number - Must list both Producer's agency name AND Black White & Associates - Golden Eagle, Safeco, and CNA require updated Acord Applications with the BOR • Sample BOR Letter

Minimum Information Required To Quote		Commercial Application • Effective Date • Applicant Name • Applicant Mailing Address • Applicant Phone Number • Applicant Location Address • Year Business Started • Appliant Entity Type • Nature of Business/Description of Operations • General Information Commercial General Liability • Annual Sales per Location • For contracting risks, annual payroll per location • General Information Property Application • Premises # / Address • Premises Information - Subject of Insurance • Amount • Deductible • Construction Type • Protection Class • Number of Stories • Year Built • Total Area • Building Improvements • Other Occupancies (if multiple occupancies exist) • Burglar Alarm • Fire Protection • % Sprinklered Workers Compensation Application • WC Limits Requested • ISO Class Code / Description • Number of Employess in each Class Code • Estimated Annual Remuneration • Individuals Included / Excluded Commercial Auto Application • Liability Limits • Covered Auto Symbols • Medical Payments / Limits • UM / UIM / Limits • Hired / Non-Owned • Towing / Labor Business Auto Application • Driver Name • Driver Date of Birth • Driver License Number • Vehicle Year • Vehicle Make • Vehicle Model • VIN • Cost New • Vehicle Use • Indicate Coverages / Deductibles - Comp/Coll, UM/UIM, Medpay

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