| $6MM - $10MM Special Acceptance Questionnaire |
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This form to be submitted for RENEWAL REQUESTS ONLY.
New quotes should be submitted during online quote process.
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All $6 - $10 Million quotes require special acceptance.
You must complete / print this page +
Fax with current MVRs to 510-655-3076
You will be notified via email of acceptance status.
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Initial
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None of the applicants applying for this insurance are any of the following:
Professional Entertainers-Actors, Actresses, Directors, Producers, Writers, TV/Radio Personalities. Or
Athletics-All Professional Athletes, Coaches, Managers & Owners, NCAA Division I Athletes or Coaches that regularly appear on television. Or
Public Officials-Elected/appointed officials to any state or federal office, Elected officials to cities, counties, courts Populations over 50,000. Or
Famous People-Top Executives of Fortune 500 companies, Persons appearing regularly in the media due to their wealth or profession.
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Initial
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None of the applicants applying for this insurance have had
four (4) or more losses or total losses over $25,000
within the past three years, or currently has an open claim.
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