Application Requirements

• Completed Acord 130 Workers’ Compensation Application
• Completed CompSource Supplemental Application
• The employer must have a minimum of three years in business or provide a written verification of management experience in similar business: i.e. résumé.
• Currently valued loss information (valued no earlier than 90 days prior to requested effective date)
  
  
  • Current year and immediate preceding three years.
    
    
  • Loss information must be from an insurance carrier and shall be verifiable.
  
  
• Any other information the underwriter may need to ensure the risk is properly classified and adequately rated.