Web Quoting Systems Scheduled Maintenance Friday, May 28 - Tuesday, June 1, 2010. Read more >>
We will be performing scheduled maintenance on our quoting systems over Memorial Day weekend from Friday, May 28, 2010 at 9:00 p.m. Eastern Time until Tuesday, June 1, 2010 at 12:00 a.m. Eastern Time. During that time our Customer and Retail Web Quoting Systems will be unavailable. You will be able to email or fax submissions during that time and our home office underwriters will handle them Tuesday morning, June 1, 2010. We apologize for any inconvenience this may cause.
Multi-Line Quoting - Excess Personal Umbrella
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Applicant Information
Applicant Name
Excess Liability
Entity Type
Association
Civil Union
Commercial Trust
Condominium Association
Corporate Partnership
Corporation
Estate
Family Partnership
Governmental Agency
Homeowner Association
Husband And Wife
Individual
Leasing Company
Limited Liability Company
Limited Partnership
Non-Profit Corporation
Partnership
Railroad
Real Estate Trust
Trust
Has the applicant or any resident of the applicant's household had a liability loss greater than $50,000 in the past 5 years or is there an open liability claim or lawsuit pending against them?
No
Yes
Unknown
Is a United States Liability Insurance Group company the expiring carrier? (United States Liability Insurance Co., Mt. Vernon Fire Insurance Co., U.S. Underwriters Co. or Mt. Vernon Specialty Insurance Co.)
No
Yes
Is any member of the household a Federal or State Political Figure, Professional Athlete or Coach, Music or Television Entertainer, or CEO of a Fortune 500 Company?
Yes
No
Unknown
Email Address of Applicant or Applicant primary contact
Primary Location Address
Street Address
Zip
State
AL - Alabama
AK - Alaska
AZ - Arizona
AR - Arkansas
CA - California
CO - Colorado
CT - Connecticut
DE - Delaware
DC - District of Columbia
FL - Florida
GA - Georgia
HI - Hawaii
ID - Idaho
IL - Illinois
IN - Indiana
IA - Iowa
KS - Kansas
KY - Kentucky
ME - Maine
MD - Maryland
MA - Massachusetts
MI - Michigan
MN - Minnesota
MS - Mississippi
MO - Missouri
MT - Montana
NE - Nebraska
NV - Nevada
NH - New Hampshire
NJ - New Jersey
NM - New Mexico
NY - New York
NC - North Carolina
ND - North Dakota
OH - Ohio
OK - Oklahoma
OR - Oregon
PA - Pennsylvania
RI - Rhode Island
SC - South Carolina
SD - South Dakota
TN - Tennessee
TX - Texas
UT - Utah
VT - Vermont
VA - Virginia
WA - Washington
WI - Wisconsin
WY - Wyoming
City
TerritoryCode
CountryID
Underlying Liability
What is the limit of the primary (or underlying) umbrella policy
$1,000,000
$2,000,000
$3,000,000
$4,000,000
$5,000,000
$6,000,000
$7,000,000
$8,000,000
$9,000,000
$10,000,000
$11,000,000
$12,000,000
$13,000,000
$14,000,000
$15,000,000
$16,000,000
$17,000,000
$18,000,000
$19,000,000
$20,000,000
$21,000,000
$22,000,000
$23,000,000
$24,000,000
$25,000,000
$26,000,000
$27,000,000
$28,000,000
$29,000,000
$30,000,000
$31,000,000
$32,000,000
$33,000,000
$34,000,000
$35,000,000
$36,000,000
$37,000,000
$38,000,000
$39,000,000
$40,000,000
$41,000,000
$42,000,000
$43,000,000
$44,000,000
$45,000,000
$46,000,000
$47,000,000
$48,000,000
$49,000,000
$50,000,000
Personal Umbrella Exposures
Excess Personal Liability
Are any Locations used as rooming houses, student housing, assisted living facilities or group home facilities?
No
Yes
Unknown
Are the minimum underlying limits for automobiles covered completely by a business auto policy?
No
Yes
Unknown
Is any of the Required Underlying Insurance, other than Auto or Farm owners Coverage, provided by a commercial general liability policy or coverage form?
No
Yes
Unknown
Is there an additional insured endorsement required for this risk?
No
It's an Individual, Husband/Wife, Civil Union.
It's a Trust
It's a Limited Liability Company, Limited Partnership, Estate, or Family Partnership.
It's an Association, Corporation, Non-Profit Corporation, Real Estate, Trust, Commercial Trust or Corporate Partnership
Within the past five (5) years, has the trust engaged in any form of business or owned any real estate for business purposes whether or not identified on the application?
No
Yes
Unknown
Within the past five (5) years, has the trust been the subject of litigation of any kind?
No
Yes
Unknown
Does the trust have any employees?
No
Yes
Unknown
Does the trust own any real estate, personal property or assets not listed on the application?
No
Yes
Unknown
Is there any Business Exposure operation covered by the Primary Homeowners or Comprehensive Personal Liability Policy?
No
Yes
Unknown
Does the applicant have any owner occupied secondary residences?
Total number of additional residential units owned and occupied (do not include Primary Residence; a duplex=2 units)
Does the applicant have any 1-4 family residential units rented to others?
Total number of residential units rented to others (count each unit; a duplex=2)
Does the applicant have any automobiles or motor homes licensed for road use in your household?
Total number of Automobiles and Motor Homes owned or regularly used
Does the applicant have any motorcycles, scooters or other vehicles with less than four wheels and licensed for road use in your household?
Total number of Motorcycles, Scooters or Other Vehicles with less than 4 wheels owned or regularly used
Does the applicant have any recreational vehicles (vehicles not licensed for road use)?
Total number of Recreational Vehicles (vehicles not licensed for road use) owned or regularly used
Watercraft Information
Name
Edit
Delete
Add Watercraft
Driver Information (Include all household members age 14 and over)
Name
Edit
Delete
Number of drivers to add?
Add Driver