Commercial Lines Credit/Debit Request

Who Is Requesting Credit | Debit(Required)

Please Enter Your Email(Required)

Customer Name (Business)

Primary Contact Name

First Last

Line Of Business(Required)

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CPKGE, BOP, GL

Business Auto

Workers Compensation

Business Owner | Commercial Package | GL (Maximum Credit Or Debit = 50%)

Select The Characteristics That Fit Your Client(Required)

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Structural Features -10% to 10%

Premises -15% to 15%

Employees -15% to 15%

Equipment -10% to 10%

Exposure Of Premises -15% to 15%

Cooperation Of Management -15% to 15%

Protection Not Otherwise Recognized -15% to 15%

Characteristics No Otherwise Classified -10% to 10%

Structural Features – Credit Or Debit -10% to 10%

Debit Or Credit Request

Please enter a number from -10 to 10.

Structural Features – Narrative

You need to “tell the story” of why this account justifies the Credit Or Debit you want for this particular Risk Characteristic

Premises – Credit Or Debit (-15% to 15%)

Debit Or Credit Request

Please enter a number from -15 to 15.

Premises – Narrative

You need to “tell the story” of why this account justifies the Credit Or Debit you want for this particular Risk Characteristic

Employees – Credit Or Debit (-15% to 15%)

Debit Or Credit Request

Please enter a number from -15 to 15.

Employees – Narrative

You need to “tell the story” of why this account justifies the Credit Or Debit you want for this particular Risk Characteristic

Equipment – Credit Or Debit (-10% to 10%)

Debit Or Credit Request

Please enter a number from -10 to 10.

Equipment – Narrative

You need to “tell the story” of why this account justifies the Credit Or Debit you want for this particular Risk Characteristic

Exposure Of Premises – Credit Or Debit (-15% to 15%)

Debit Or Credit Request

Please enter a number from -15 to 15.

Exposure Of Premises – Narrative

You need to “tell the story” of why this account justifies the Credit Or Debit you want for this particular Risk Characteristic

Cooperation Of Management – Credit Or Debit (-15% to 15%)

Debit Or Credit Request

Please enter a number from -15 to 15.

Cooperation Of Management – Narrative

You need to “tell the story” of why this account justifies the Credit Or Debit you want for this particular Risk Characteristic

Protection Not Otherwise Recognized – Credit Or Debit (-15% to 15%)

Debit Or Credit Request

Please enter a number from -15 to 15.

Protection Not Otherwise Recognized – Narrative

You need to “tell the story” of why this account justifies the Credit Or Debit you want for this particular Risk Characteristic

Characteristics Not Otherwise Classified – Credit Or Debit (-10% to 10%)

Debit Or Credit Request

Please enter a number from -10 to 10.

Characteristics Not Otherwise Classified – Narrative

You need to “tell the story” of why this account justifies the Credit Or Debit you want for this particular Risk Characteristic

Business Auto (Maximum Credit Or Debit = 50%)

Select The Characteristics That Fit Your Client(Required)

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Ownership -10% to 10%

Equipment -10% to 10%

Safety Equipment & Promotion -10% to 10%

Drivers -10% to 10%

General Loss Ratio Trend -10% to 10%

Nature Of Losses -15% to 15%

Ownership – Credit Or Debit (-10% to 10%)

Debit Or Credit Request

Please enter a number from -10 to 10.

Ownership – Narrative

You need to “tell the story” of why this account justifies the Credit Or Debit you want for this particular Risk Characteristic Degree of control exercised by owners, managers, etc. This includes cooperation with insurance company, adjusters, reporting firms, loss control and engineers

Equipment – Credit Or Debit (-10% to 10%)

Debit Or Credit Request

Please enter a number from -10 to 10.

Equipment – Narrative

You need to “tell the story” of why this account justifies the Credit Or Debit you want for this particular Risk Characteristic Age and condition of equipment, efficiency or owner-maintained repair and maintenance departments, frequency of equipment inspections Degree of control exercised by owners, managers, etc. This includes cooperation with insurance company, adjusters, reporting firms, loss control and engineers

Safety Equipment and Safety Promotion – Credit Or Debit (-10% to 10%)

Debit Or Credit Request

Please enter a number from -10 to 10.

Safety Equipment and Safety Promotion – Narrative

You need to “tell the story” of why this account justifies the Credit Or Debit you want for this particular Risk Characteristic Amount and types of safety equipment, safety courses, safety meetings Degree of control exercised by owners, managers, etc. This includes cooperation with insurance company, adjusters, reporting firms, loss control and engineers

Drivers – Credit Or Debit (-10% to 10%)

Debit Or Credit Request

Please enter a number from -10 to 10.

Drivers – Narrative

You need to “tell the story” of why this account justifies the Credit Or Debit you want for this particular Risk Characteristic Age, training, prescreening and review of driving records Degree of control exercised by owners, managers, etc. This includes cooperation with insurance company, adjusters, reporting firms, loss control and engineers

General Loss Ratio Trend – Credit Or Debit (-15% to 15%)

Debit Or Credit Request

Please enter a number from -15 to 15.

General Loss Ratio Trend – Narrative

You need to “tell the story” of why this account justifies the Credit Or Debit you want for this particular Risk Characteristic Improvement or deterioration of risk over time Degree of control exercised by owners, managers, etc. This includes cooperation with insurance company, adjusters, reporting firms, loss control and engineers

Nature Of Losses – Credit Or Debit (-15% to 15%)

Debit Or Credit Request

Please enter a number from -15 to 15.

Nature Of Losses – Narrative

You need to “tell the story” of why this account justifies the Credit Or Debit you want for this particular Risk Characteristic Type of losses, including an examination of the degree of negligence Degree of control exercised by owners, managers, etc. This includes cooperation with insurance company, adjusters, reporting firms, loss control and engineers

Workers Compensation (Maximum Credit Or Debit = 45%)

Select The Characteristics That Fit Your Client(Required)

Select All

Premises -10% to 10%

Classification Peculiarities -10% to 10%

Medical Facilities -10% to 10%

Safety Devises -10% to 10%

Employee Selection, Training, Supervision -10% to 10%

Management Cooperation with Insurance Carrier -10% to 10%

Management Safety Organization -10% to 10%

Premises – Credit Or Debit (-10% to 10%)

Debit Or Credit Request

Please enter a number from -10 to 10.

Premises – Narrative

You need to “tell the story” of why this account justifies the Credit Or Debit you want for this particular Risk Characteristic Physical condition, preventative maintenance, hazards controlled, housekeeping Degree of control exercised by owners, managers, etc. This includes cooperation with insurance company, adjusters, reporting firms, loss control and engineers

Classification Peculiarities – Credit Or Debit (-10% to 10%)

Debit Or Credit Request

Please enter a number from -10 to 10.

Classification Peculiarities – Narrative

Medical Facilities – Credit Or Debit (-10% to 10%)

Debit Or Credit Request

Please enter a number from -10 to 10.

Medical Facilities – Narrative

You need to “tell the story” of why this account justifies the Credit Or Debit you want for this particular Risk Characteristic. First aid or medical assistance, emergency or disaster plans, return-to-work policy, alcohol or substance abuse programs, industrial hygiene and ergonomics Physical condition, preventative maintenance, hazards controlled, housekeeping Degree of control exercised by owners, managers, etc. This includes cooperation with insurance company, adjusters, reporting firms, loss control and engineers

Safety Devices – Credit Or Debit (-10% to 10%)

Debit Or Credit Request

Please enter a number from -10 to 10.

Safety Devices – Narrative

You need to “tell the story” of why this account justifies the Credit Or Debit you want for this particular Risk Characteristic. Type and condition, guarding, personal protective equipment, maintenance Physical condition, preventative maintenance, hazards controlled, housekeeping Degree of control exercised by owners, managers, etc. This includes cooperation with insurance company, adjusters, reporting firms, loss control and engineers

Employee Selection, Training, Supervision – Credit Or Debit (-10% to 10%)

Debit Or Credit Request

Please enter a number from -10 to 10.

Employee Selection, Training, Supervision – Narrative

You need to “tell the story” of why this account justifies the Credit Or Debit you want for this particular Risk Characteristic Employee selection, training, experience, motivation, supervision practices Physical condition, preventative maintenance, hazards controlled, housekeeping Degree of control exercised by owners, managers, etc. This includes cooperation with insurance company, adjusters, reporting firms, loss control and engineers

Management Cooperation With Insurance Carrier – Credit Or Debit (-10% to 10%)

Debit Or Credit Request

Please enter a number from -10 to 10.

Premises – Narrative

You need to “tell the story” of why this account justifies the Credit Or Debit you want for this particular Risk Characteristic Commitment to workplace safety, involvement in loss control programs, cooperation with insurer Physical condition, preventative maintenance, hazards controlled, housekeeping Degree of control exercised by owners, managers, etc. This includes cooperation with insurance company, adjusters, reporting firms, loss control and engineers

Management Safety Organization – Credit Or Debit (-10% to 10%)

Debit Or Credit Request

Please enter a number from -10 to 10.

Management Safety Organization – Narrative

You need to “tell the story” of why this account justifies the Credit Or Debit you want for this particular Risk Characteristic. Accident investigation and analysis, record keeping, safety committee organization and effectiveness Physical condition, preventative maintenance, hazards controlled, housekeeping Degree of control exercised by owners, managers, etc. This includes cooperation with insurance company, adjusters, reporting firms, loss control and engineers