SUBMISSION REQUIREMENTS

• Acord Application (130)
• Four Years of Loss Runs (unless a new operation)
• Current Experience Mod Worksheet
• Supplemental Questionnaire

SUBMISSION APPLICATIONS

• Contractors Supplemental Application
• Garage Supplemental Application
• Healthcare Supplemental Application
• Hotel Supplemental Application
• Manufacturers Supplemental Application
• Restaurant Supplemental Application
• Wholesale Supplemental Application

Submit to scott_french@coveragefirst.com (preferred) or
Fax: 918/289-2932

* Must be approved agency through Coverage First