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Date:______/______/______
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Ins. Co:___________________________________
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RE: Request for Insurance Policy
Loss Runs
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Policy #___________________________________
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Dear Sir/Madam:
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My business currently or has
been insured by your company. Pursuant to the provisions of the California
Insurance Code, I hereby request and authorize you to prepare a complete
summary of the loss history pertaining to our policy (or, if there were
no losses a notice stating that there were none).
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The requested loss history should
reflect a minimum of three (3) years of previous claims (if applicable).
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As time is of the essence to
meet various requirements, please forward this information to the following
person by the quickest means possible including fax transmission. Do not
send them directly to our business as this would delay the process and
our intent.
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Send information to:
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Executive Commercial Insurance
Services
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6354 Tupelo Drive
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Citrus Heights, CA 95621
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(916) 721-5577 FAX
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This authorization will remain
in effect for one year following the date of the letter. Your prompt
attention to this request is greatly appreciated.
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Best regards,
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X___________________________________
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Authorized Representative/Owner