Hear our sound bites Our Mission Savin Jones Insurance Agency provides our clients with an innovative insurance solution. By using the efficiencies of the Internet, and our home office, we have streamlined the Insurance process and are able to pass significant knowledge and savings on to our clients. Our licensed Agents have years of experience in the areas they serve, allowing you to save and gain coverage, without compromising on service. Mission Statement To create an enjoyable, convenient, and affordable experience by providing insurance products along with excellent service. Our Services Our neighborhood Agents have years of experience in the areas they serve and are active members of their local, state and national insurance associations. In addition, our website provides a step-by-step approach to guide our clients through buying insurance and providing information to our clients. Our History Saraf Insurance / Savin Jones Insurance Agency was founded on the belief that selling or buying insurance could be faster, easier and more efficient. On February 01, 1996, this belief was turned into a reality when Saraf Insurance / Savin Jones was established. Since then, the company has continued to expand its services, offering excellent service, savings, and convenience as well as knowledge to our clients. Personal Insurance  Personal Auto  Homeowners  Renters  Condominium Owners  Personal Items  Boats  Umbrella  Motorcycles  Motorhomes  Mobile Homes  Dwelling Fire  Watercraft  Gap Insurance  Flood  Antique Cars Business/Commercial Insurance  Commercial Auto  Workers Compensation  Commercial Liability  Commercial Property  Contractors  Manufacturers  Retail  Wholesale  Professional Liability  Restaurants  Garage & Repair  Hotel/Motel  Inland Marine  Bonds  Business Owners Policy  Commercial Umbrella  Commercial Trucks  Dump Trucks  Long Haul Trucks  Errors and Omissions Life Insurance  Term Life Insurance  Whole Life  Universal Life  Variable Life & Annuities Health Insurance  Traditional Health Insurance  Short Term Health  Medical Savings Accounts  Medicare Supplements  Long Term Care  Accident  Trip Insurance  Disability  Health Savings Accounts (HSA) Financial Planning   Retirement Plans  Traditional IRA  Roth IRA  Annuities  Long Term Care  Mutual Funds  Simple IRA  401k Group Insurance  Group Life  Group Health  Group Dental  Group Retirement Bonding  Court Judicial  Court Fiduciary  Public Official  License  Permit  Janitorial Services  Employee Dishonesty  Pension/Trust (ERISA)  Guarantees of Financial Performance Contract Bonds  Bid Bonds  Payment Bonds  Peformance Bonds  Maintenance Bonds  Supply Bonds Complimentary Review of Current Insurance Complimentary Insurance Quotes Complimentary Replacement Cost Analysis of Your Home Registry Service Notary Public Real Estate Services Complimentary Financial Review Complimentary Review of Your Liability Insurance vs. Assets Complimentary Life Insurance Needs Analysis James P Saraf, President Personal lines and Commercial Lines 617.474.9900 Jim founded the Saraf Insurance / Savin Jones Insurance Agency in 1996. He has extensive experience with all lines of insurance. Jim is an active member of many local civic groups. A.I.M. Mutual The A.I.M. Mutual Insurance Companies are one of the top providers of workers compensation in Massachusetts and are rated A (Excellent) by A.M. Best Company, the nationally recognized insurance rating organization, for their financial strength. Aflac Aflac has a range of policies for individuals and employers that can be used to help with the out-of-pocket expenses not covered by the existing primary insurance coverage of U.S. consumers. MPIUA The Massachusetts Property Insurance Underwriting Association (MPIUA) also known as the Massachusetts FAIR Plan (Fair Access to Insurance Requirements) provides basic property insurance on eligible property for applicants who have been unable to gain insurance through the voluntary market. MPIUA offers policies under the Homeowners, Dwelling Fire and Commercial Property programs as approved by the Massachusetts Division of Insurance. New England Guaranty Located in the Green Mountains of central Vermont and first established in 1874, the Union Mutual of Vermont Companies have been providing quality insurance products for over 130 years. Pilgrim Founded in 1987, Pilgrim is a licensed insurer based in Massachusetts. Pilgrim was the first company in Massachusetts to provide third-party management and operational services to both property and casualty insurers and financial institutions. Plymouth Rock Plymouth Rock Assurance Corporation remains the flagship of the Plymouth Rock Group of Companies with more than 125,000 individual policyholders and personal auto insurance premium exceeding $260 million in 2003. Plymouth Rock maintains a rating of “A-/Excellent” from A.M. Best, the insurance industry’s premier independent rating service. Union Mutual Located in the Green Mountains of central Vermont and first established in 1874, the Union Mutual of Vermont Companies have been providing quality insurance products for over 130 years. Massachusetts Registry of Motor Vehicles Massachusetts Motor Vehicle Sales/Use Tax Forms Automobile Insurers Bureau of Massachusetts Checkpoint Insurance Inspections Edmunds Car Buying Guide Kelly Blue Book Car Values Massachusetts Division of Insurance Massachusetts Division of Industrial Accidents (Workers Compensation) Insurance Information Institute (III) National Flood Insurance Program Massachusetts Police Association OUR AUTO INSURANCE PROGRAMS AND DISCOUNTS - SAVE $$$- AND MORE..     Individual discounts - for who you are and how you drive Group discounts - for your affiliations and memberships Individual Discount Applies to Discount range* Public Transit Public transit commuters for 11 months of the year 10% Low Mileage Cars driven fewer than 7,500 miles per year 5-10% Passive Restraint Cars with qualifying restraints, such as airbags 25% Anti-Theft Cars with qualifying anti-theft devices, such as car alarm 20-36% Multi-Car Policies with more than one car 5-15% Safe Driver Drivers without violations or losses 20-25% Advanced Driver Training Inexperienced drivers who complete a certified training course 5% Student Away at School Full-time students who are children of the primary policyholder(s) and live more than 100 miles from home 5-15% Good Student High school and college students with a B average or higher 10-15% Senior Citizen Drivers over 65 years old 25% Agency Loyalty Your Loyalty is a factor in how much you can save after 1, 2, or 3 or more years with agency. 5-15% * Discounts apply to specific types of coverage.  Group Discount Applies to Discount range WBUR membership Members of Massachusetts public radio station WBUR 7% SBLI policyholders Members of Savings Bank Life Insurance Health and Safety Group             9%             $$$Motor Club Discounts - AAA PLUS MANY MANY MORE - 5% DISCOUNT$$$     Motor Clubs must provide Members with roadside and towing assistance; and have access to Service Providers entities that contract with the motor club to provide roadside assistance to the drivers.  These include towing companies, lock-smiths, service stations, etc ) throughout the Continental United States.   Additional Motor Club AAA Merrimack Valley AAA Southern New England AARP AllAmerica Allstate Motor Club Auto Club of Pioneer Valley (AAA) Auto Knight Autoclub of America Better World Club BP Motor Club Chevron Safe Trek Cross Country (Costco) GE Motor Club GM Motor Club Massachusetts AAA Berkshire County On-Star Paragon Pinnacle Motor Club (AFSCME-Union) Sam's Club Signature Nationwide                 Massachusetts Standard Coverage Bodily Injury Liability Optional Bodily Injury Liability Property Damage Liability Personal Injury Protection (PIP) Medical Payments Uninsured Motorists Underinsured Motorists Comprehensive Collision Physical Damage Limited Collision Substitute Transportation Towing and Labor       Massachusetts Enhanced Coverage To give you more value for your auto insurance, We offer several enhanced coverage options in Massachusetts. Some options apply automatically to qualified drivers. Ask us how you can qualify for and purchase these options. Replacement Cost Coverage Original Equipment Manufacturer (OEM) Parts Replacement Accident Forgiveness Coverage Disappearing Deductible   Replacement Cost Coverage Provided at no additional cost and covers newly acquired current and subsequent model year vehicles that have been driven less than 15,000 miles. If you qualify, the carrier will pay the replacement cost of a vehicle that has been deemed a total loss. An optional Replacement Cost endorsement can be purchased that does not contain a mileage restriction. This enhancement applies to Collision, Limited Collision and Comprehensive (excluding theft, fire and vandalism losses) coverage for vehicles that meet the requirements. Original Equipment Manufacturer (OEM) Parts Coverage Provided at no additional charge and covers the cost to replace damaged parts with Original Equipment Manufacturer parts when the damaged parts cannot be repaired, as long as the damage occurs within the vehicle�s first 20,000 miles, the vehicle is no more than ten model years old and you meet certain other requirements. This enhancement applies to Collision, Limited Collision and Comprehensive coverage (excluding glass and mechanical parts) for vehicles that meet the requirements. Accident Forgiveness Coverage Provided at no additional charge for qualifying policies upon renewal. This coverage "forgives" the surcharge associated with a single at-fault accident. In order to qualify, your policy must have been in force with the carrier for at least forty-eight months, all drivers on the policy must qualify for the Excellent Driver Discount Plus under the Safe Driver Insurance Plan, and you must meet certain other requirements. New customers can purchase this coverage when they qualify for the Excellent Driver Discount Plus under the Safe Driver Insurance Plan. Disappearing Deductible Provides an automatic $100 credit per vehicle for every year that it remains claim free for all specifiedy policyholders. This can be applied against your Collision deductible � up to a maximum of $500 credit per vehicle. Existing policyholders can start off with between $50 and $150 "in the bank" for each vehicle if they have been claim free customers of specifiedy carrier for at least twelve months. ***only applies to specifiedy auto companies policyholders and specific named insurance companies. Gap Insurance Personal Umbrella Term Life Identity Theft Flood Gap Insurance If you have recently purchased or are planning to purchase a new or used vehicle you may want to consider purchasing Gap Insurance. What is Gap Insurance? When you drive your new or used car off the dealer�s lot your car has most likely lost 20% of its value and you need Gap Insurance. If you put less than a 20% down payment on your car you need Gap Insurance. How does Gap Insurance Work? If your car is stolen or declared a total, your insurance company will pay the actual cash value of the car. The actual cash value can be a lot different from what you still owe on your loan. Without Gap Insurance your lender will hold you responsible for paying the difference between the actual cash value and the amount left on the loan. Dealers charge between $500 and $600 for this coverage. We can offer it to you for $299 for the life of your loan up to 84 months. Leased vehicles are not eligible. Not everyone needs Gap Insurance but if you think you should have it and would like more information on how it works, please give us a call and we will be happy to discuss it with you. Why do I need a Personal Umbrella policy? Jury awards and out-of-court settlements routinely run into hundreds of thousands or even millions of dollars. Add to this the cost of legal fees, and the expense becomes staggering. An unexpected catastrophe could result in a large judgment against you. Without adequate protection, your current assets could be placed in serious jeopardy. A Personal Umbrella policy could protect you against excess liability judgments for loss, injury, or even death caused by negligent acts. It is designed to provide liability protection over and above the insurance policies you currently have. Consider the following example: One evening a 17-year old took his parent's car out for a drive. He crossed over a median and collided head-on with another vehicle. Two passengers in the other car were killed, and a third was seriously injured. The 17-year old driver was found negligent and ordered to pay $1.5 million to settle the injury claims. The parents had an auto policy with a $300,000 per claim liability limit. Fortunately the parents carried a Personal Umbrella policy. The auto policy paid $300,000, and the Personal Umbrella policy paid the remaining $1.2 million. With a Personal Umbrella policy, you are covered if the limits under your primary policy are used up. Your assets, as well as your future earnings, are protected. In today's society, lawsuits are occurring with alarming frequency. Moreover, the monetary awards can be staggering. Your current insurance will protect you against a minor misfortune - but it probably would not give you the needed protection against a catastrophic loss. What is Term Life? A Term Life insurance policy is a life insurance policy where the premium stays the same for the life of the policy. Depending upon your needs and your age, you can write this policy for 5, 10, 15, 20 or 30 years and your premiums will never go up during this term. Who needs Term Life? If something should happen to you, a Term Life policy could cover your mortgage or a child�s education and leave your family with financial security. How much does a Term Life policy cost? The cost of a Term Life policy will be determined by your age although it is very reasonable at any age. Identity Theft Because of the high incidence of Identity Theft you can now obtain coverage on your homeowner's policy to protect yourself from the high cost of restoring your name and credit. Each year millions of Americans fall victim to Identity Theft and may spend months - even years - and their hard-earned money restoring their good names and credit records. Your doors and windows may be carefully locked, but identity thieves know no bounds. For comprehensive tips on how to protect your good name and credit record, refer to the Federal Trade Commission's Web site by clicking on: http://www.ftc.gov/bcp/edu/microsites/idtheft/consumers/about-identity-theft.html What is a flood? Flooding is defined as a general and temporary condition of partial or complete inundation of two or more acres of normally dry land area or of two or more properties from the following: Overflow of inland or tidal waters Unusual and rapid accumulation or runoff of surface waters from any source Mudflows Collapse or subsidence of land along the shore of a lake or other body of water, as a result of erosion or undermining caused by waves or currents of water exceeding anticipated cyclical levels that result in a flood What does a Flood Policy cover? Residential Building Coverage Building coverage insures a house or dwelling, attached and detached garages, as well as certain permanently installed fixtures such as built-in dishwashers, permanent shelving and cabinetry, furnaces and radiators, hot-water heaters, plumbing fixtures, stoves, ovens and refrigerators. Residential Contents Coverage Contents coverage insures most of your personal property and belongings, including: Clothing Furniture, housewares, bedding Decorative items, lamps and lighting fixtures Books, home electronics Area rugs and draperies Clothes washers and dryers Air conditioners Food freezers and the food in them Portable microwave ovens Coverage in Basements Flood insurance covers structural elements, essential equipment and other basic items normally located in a basement, such as: Unfinished drywall for walls and ceilings, including nonflammable insulation Electrical junction and circuit breaker boxes, and required utility connections Central air-conditioning units Furnaces, hot-water heaters, fuel tanks and the fuel inside them, and heat pumps Light fixtures Foundation elements Cleanup However, flood insurance does not cover basement improvements such as finished walls, floors or ceilings or personal belongings that may be left in a basement such as furniture and other contents. Facts Everyone lives in a flood zone - floods are caused by storms, melting snow, hurricanes, and water backup due to inadequate or overloaded drainage systems, dam or levee failure, etc. Flooding can happen anywhere - about 25% of flood insurance claims come from low to moderate-risk areas Flood damage is not covered by homeowners policies Flood insurance is affordable - homeowners can insure contents only for as little as $39 per year; building and contents for as little as $112 per year Flood insurance is available to homeowners, renters, and business owners There is a 30-day waiting period unless you are purchasing at the same time you are writing a mortgage Federal disaster assistance is not insurance coverage - it is a loan that must be paid back Rates Dwelling/Contents Building Contents Premium $20,000 $8,000 $137.00 $30,000 $12,000 $163.00 $50,000 $20,000 $205.00 Contents Only (Located above ground level) Contents Premium $8,000 $39.00 $12,000 $53.00 $20,000 $81.00 These are preferred rates - please contact us to see if you qualify for the preferred rates and for higher coverages. Massachusetts Personal Auto Homeowners Dwelling Fire Term Life Insurance Massachusetts Commercial Auto Workers Compensation Contact Information Name * Address City, State, Zip Phone Fax Email * Best Contact Method Email Phone Fax USMail Best Time to Call Current Insurance Company Name Expiration Date Annual Premium Vehicle(s) Vehicle 1 Year Make Model VIN Garage Location Odometer Reading Annual Mileage Business Use Age 65 or Older Air Bags Automatic Seatbelts Anti-Theft Device (Alarm) Vehicle Recovery System (Lojack) Public Transit Pass (11 months) Accident Forgiveness Good Student Discount Student Away at School Vehicle 2 Driver(s)   List all licensed drivers in your household. Name on License Date of Birth License Number State Date Licensed Driver Training 1. Yes  No 2. Yes  No 3. Yes  No 4. Yes  No 5. Yes  No 6. Yes  No Coverages Part 1 - Bodily Injury To Others 20/40 Part 2 - Personal Injury Protection 0 100 250 500 1,000 2,000 4,000 8,000 Part 3 - Bodily Injury By Uninsured Motorist 20/40 20/50 25/50 25/60 30/60 30/70 35/80 50/50 50/100 100/100 100/150 100/200 100/300 100/500 200/200 200/300 200/400 200/500 250/500 300/300 300/500 100/300 500/500 500/1000 Part 4 - Property Damage 50,000 100,000 150,000 200,000 250,000 300,000 400,000 500,000 Part 5 - Optional Bodily Injury No Coverage 20/40 20/50 25/50 25/60 30/60 30/70 35/80 50/50 50/100 100/100 100/150 100/200 100/300 100/500 200/200 200/300 200/400 200/500 250/500 300/300 300/500 100/300 500/500 500/1000 Part 6 - Medical Payments No Coverage 5,000 10,000 15,000 20,000 25,000 50,000 100,000 Part 7 - Collision Deductible No Coverage 300 500 1,000 2,000 Part 8 - Limited Collision No Coverage 0 300 500 1,000 2,000 Part 9 - Comprehensive Deductible No Coverage 300 500 1,000 2,000 Part 10 - Substitute Transportation No Coverage 15/day to 450 max 30/day to 900 max 45/day to 1,350 max 100/day to 3,000 max Part 11 - Towing & Labor No Coverage 50/incident 100/incident Part 12 - Bodily Injury By Underinsured Motorist No Coverage 20/40 20/50 25/50 25/60 30/60 30/70 35/80 50/50 50/100 100/100 100/150 100/200 100/300 100/500 200/200 200/300 200/400 200/500 250/500 300/300 300/500 100/300 500/500 500/1000   * required   Disclaimer - We will provide an estimated quote based on the information you provide. Actual premiums may vary due to additional or updated data received during the final underwriting process. A quote does not provide or guaranty insurance coverage. Insurance coverage can only be bound by an authorized agent upon receipt of down payment and signed application.   Contact Information Name * Address City, State, Zip Phone Fax Email * Best Contact Method Email Phone Fax USMail Best Time to Call Property Location Address City, State, Zip County Current Insurance Company Name Expiration Date Annual Premium Dwelling Coverage Limit Deductible $100 $250 $500 $750 $1,000 $1,500 $2,000 $2,500 $3,500 $5,000 $7,500 $10,000 $25,000 $50,000 Personal Liability Limit $100,000 $200,000 $300,000 $400,000 $500,000 $1,000,000 $2,000,000 $3,000,000 $5,000,000 $10,000,000 Earthquake Coverage Dwelling Information Estimated Replacement Cost Square Footage Year Built Construction Type Brick or Stone Brick or Stone Veneer Frame Frame with Aluminum or Plastic Siding Superior Fire Resistance Smoke Detectors Central Station Fire Alarm Central Station Burglar Alarm Located within 5 miles of Fire Station Located within 1000 feet of a Fire Hydrant Swimming Pool Trampoline Dogs or Exotic Pets (Note Breed and Bite History) Personal Property (estimated values) Jewelry Furs Fine Art and Collectibles Cameras Musical Instruments Silverware Stamps Coins Golfers Equipment Personal Computers   * required   Disclaimer - We will provide an estimated quote based on the information you provide. Actual premiums may vary due to additional or updated data received during the final underwriting process. A quote does not provide or guaranty insurance coverage. Insurance coverage can only be bound by an authorized agent upon receipt of down payment and signed application.   Contact Information Name * Address City, State, Zip Phone Fax Email * Best Contact Method Email Phone Fax USMail Best Time to Call Property Location Address City, State, Zip County Current Insurance Company Name Expiration Date Annual Premium Dwelling Coverage Limit Deductible $100 $250 $500 $750 $1,000 $1,500 $2,000 $2,500 $3,500 $5,000 $7,500 $10,000 $25,000 $50,000 Personal Liability Limit $100,000 $200,000 $300,000 $400,000 $500,000 $1,000,000 $2,000,000 $3,000,000 $5,000,000 $10,000,000 Dwelling Information Estimated Replacement Cost Square Footage Year Built Number of Floors Number of Families Construction Type Brick or Stone Brick or Stone Veneer Frame Frame with Aluminum or Plastic Siding Superior Fire Resistance   * required   Disclaimer - We will provide an estimated quote based on the information you provide. Actual premiums may vary due to additional or updated data received during the final underwriting process. A quote does not provide or guaranty insurance coverage. Insurance coverage can only be bound by an authorized agent upon receipt of down payment and signed application.   Contact Information Name * Address City, State, Zip Phone Fax Email * Best Contact Method Email Phone Fax USMail Best Time to Call Personal Information Date of Birth Amount of Insurance   * required   Disclaimer - We will provide an estimated quote based on the information you provide. Actual premiums may vary due to additional or updated data received during the final underwriting process. A quote does not provide or guaranty insurance coverage. Insurance coverage can only be bound by an authorized agent upon receipt of down payment and signed application.   Contact Information Name * Company Name Address City, State, Zip Phone Fax Email * Best Contact Method Email Phone Fax USMail Best Time to Call Vehicle(s) Vehicle 1 Year Make Model VIN Cost New Gross Vehicle Weight Radius of Operation Garaging Type of Use Vehicle 2 Coverages Liability 20/40 50/100 100/300 500/500 1000/1000 Collision Deductible 300 500 1,000 Comprehensive Deductible 300 500 1,000   * required   Disclaimer - We will provide an estimated quote based on the information you provide. Actual premiums may vary due to additional or updated data received during the final underwriting process. A quote does not provide or guaranty insurance coverage. Insurance coverage can only be bound by an authorized agent upon receipt of down payment and signed application.   Contact Information Name * Company Name Address City, State, Zip Phone Fax Email * Best Contact Method Email Phone Fax USMail Best Time to Call Business Information Type of Business Annual Payroll   * required   Disclaimer - We will provide an estimated quote based on the information you provide. Actual premiums may vary due to additional or updated data received during the final underwriting process. A quote does not provide or guaranty insurance coverage. Insurance coverage can only be bound by an authorized agent upon receipt of down payment and signed application.   Inbound Guest Inbound Hospital Inbound Immigrant Inbound USA Liaison Continent Liaison International Liaison Majestic Liaison Student Liaison Traveler Liaison Worldwide Policy Selection Reside Reside Prime RoundTrip Travel Benefits Massachusetts Personal Auto Policy Change Homeowners Policy Change Contact Information Name * Address City, State, Zip Phone Fax Email * Best Contact Method Email Phone Fax USMail Best Time to Call Policy Information Policy Number Company Name Expiration Date Effective Date of Change Driver(s)   List all licensed drivers in your household. Name on License Date of Birth License Number State Driver Training   1. Yes  No Add Remove 2. Yes  No Add Remove 3. Yes  No Add Remove Coverages Part 3 - Bodily Injury By Uninsured Motorist 50/100 100/500 250/500 500/500 Part 4 - Property Damage 100,000 250,000 Part 5 - Optional Bodily Injury 50/100 100/500 250/500 500/500 Part 6 - Medical Payments 25,000 Part 7 - Collision Deductible No Coverage 300 500 1,000 Part 9 - Comprehensive Deductible No Coverage 300 500 1,000 Part 10 - Substitute Transportation No Coverage 15/day to 450 max 30/day to 900 max 45/day to 1,350 max Part 11 - Towing & Labor No Coverage 50/incident 100/incident Part 12 - Bodily Injury By Underinsured Motorist 50/100 100/500 250/500 500/500 If your assets are above the maximum limit of $250,000, you need a Personal Umbrella policy. A Personal Umbrella policy will cover your auto(s) and your home premises. An additional $1 million to $10 million + limits of liability are available with a Personal Umbrella policy. Premiums start at $100 annually per $1 million of coverage. Other Remove Secured Lender/Lienholder Principal Place of Garaging Change Mailing Address to Change Home Phone Number to Change Cell Phone Number to   * required   My insurance agency has made me aware of the fact that I may be underinsured or have no coverage at all in some circumstances of possible claims situations of both liability for bodily injury and/or property damage claim(s). I understand once my liability limits have been exhausted from a claim for bodily injury I am liable for my own defense costs and pre-judgment interest. Once the limits of liability have been exhausted from a claim, the insurance company's "Duty to Defend" ends. I request the above change(s) to my insurance policy. My request has been carefully reviewed and selected and I understand my changes with no questions whatsoever. Please be advised that no coverage can be bound nor any changes made to your policy until confirmed in writing by an employee during regular business hours. If you have not heard from us within 24 hrs (excluding weekends & holidays), please let us know as we may not have received your information.   Contact Information Name * Address City, State, Zip Phone Fax Email * Best Contact Method Email Phone Fax USMail Best Time to Call Property Location Address City, State, Zip County Policy Information Policy Number Company Name Expiration Date Effective Date of Change Requested Changes Increase Dwelling Coverage Limit Change Deductible $100 $250 $500 $750 $1,000 $1,500 $2,000 $2,500 $3,500 $5,000 $7,500 $10,000 $25,000 $50,000 Increase Personal Liability Limit $500,000 $1,000,000 Add Earthquake Coverage Add Identity Theft Coverage Add Sewer Back Up/Sump Overflow Coverage   * required   I request the above change(s) to my insurance policy. My request has been carefully reviewed and selected and I understand my changes with no questions whatsoever. Please be advised that no coverage can be bound nor any changes made to your policy until confirmed in writing by an employee during regular business hours. If you have not heard from us within 24 hrs (excluding weekends & holidays), please let us know as we may not have received your information.   Contact Information Name * Company Name Address City, State, Zip Phone Fax Email * Certficate Holder (Recipient) Information Name Attention Address City, State, Zip Phone Fax Instructions Certificate is Urgent Same Day Next Day Please Fax Certificate Please name Holder as Additional Insured Please name the following as Additional Insured Please reference the following job Additional Description (if any)   * required     If you know someone who may need our services we would appreciate the opportunity to offer them our products and quality service. Just fill out the easy form below. Leave an introduction if you wish and send it along to us. Referral Your Name * Your Email * Your Friends Name Your Friends Email Your Introduction   * required   We have a policy to always maintain appropriate confidentiality regarding personal information obtained in the course of doing business with you. We only collect personal information about you necessary to conduct the business of insurance. We use the following sources to collect that information: Personal information you share with us, such as the information on your application, requested policy change information, questionnaires or other forms you may complete. Personal information about you from your transactions with us over the time you have been a policy holder with us. Personal information about you from a consumer reporting agency, such as the Registry of Motor Vehicles. Personal information you provide or which is obtained during the process of handling a claim, including medical information, such as from an accident report. We do not disclose any personal information about current or former customers to anyone, except as permitted by law. Contact Us Name * Address City, State, Zip Phone Fax Email * Best Contact Method Email Phone Fax USMail Best Time to Call Questions/Comments   * required