commercial insurance_BISYS COMMERCIAL INSURANCE SERVICESPRODUCER APPOINTMENT PROFILE ..._1_

							Crump Submission Checklist-
DELOS BUSINESS AUTO PROGRAM
*Please include this coversheet with each submission



Fax to: Business Auto (Misc. Classes)                             Email (Preferred) : priority@5starsp.com
Submission                                                        Fax Number:          321-757-6147
Submission for:                                                   Agency Name:


Producer/Contact Name:                                            Agency Phone Number:


Comments:


Before sending your submission, please use this checklist to ensure you have included all required documentation.
For faster service, please include a copy of this completed form.

                   Documentation Required To Quote

______              ACORD 125 Applicant Info
______              ACORD 137 (State specific) Coverage/Limits Section
______              ACORD 129 or Vehicle List
______              ACORD 127 or Driver List
______              Company Specific Supplemental Applications
______              ACORD 61-70 (State specific only) UM/UIM and PIP forms
______              Personal Use Questionnaire for each pickup truck or private passenger vehicle
______              Current MVR's (no more than 90 days old)
______              Currently valued insurance company loss runs for 5 years-including current year (must be valued within the last 90 days)

______              Insured’s FEIN is listed on the application (SSN for individuals)

______              Brief description of the risk ____________________________________________________________________

______              Current Carrier and Target Premium: ____________________________________________________________
______              Insured’s email address: ______________________________________________________________________


                    Documentation Required To Bind

______              ACORD 125, 137, State specific UM/UIM and PIP Applications Signed and Dated by the Insured and Agent

______              Company Specific Supplemental Applications Signed and Dated by the Insured and the Agent



                    Documentation Required Within 30 Days of Binding

______              Vehicle Inspection Report, power unit or trailer 15 years or older


Please send submissions at least 2 weeks prior to policy effective date to allow for quote processing



                                                  5Star Business Auto Program
                                           A division of Crump Insurance Services
                                                     158 N. Harbor City Blvd
                                                      Melbourne, FL 32935
                                                                                                                             Updated as of 4/24/2009