Send the following documents to Tammy King at firstname.lastname@example.org
1. Completed Acord 130 application (download here) and a supplemental application if it applies (download here)– including company name, address, codes, classification & payrolls, officers’ names and titles and whether they are included or excluded for coverage. If included, under what class code, prior carrier information including annual premium, answers to all yes and no questions.
2. 5 years loss runs
3. Current experience mod worksheet (if available)
Submissions are accepted 90 days prior to the effective date.
If applicant is applying under emerging contractor program, completed supplemental application is required as well as copies of business plan and safety plans and resumes of key personnel.