LONGSHORE LITE RISK QUALIFICATIONS

Named Insured *

Agent Email Address *

Effective Date * +

Does this risk meet or exceed $10,000 in minimum premium? *

Yes

Thank you for your inquiry. However, we will be unable to assist you as this risk will not meet our minimum premium.

Please think of LIG for your next WC/Longshore or Commercial Marine Risk.

Thanks

LIG Longshore

Longshore Lite is designed for smaller simple submissions. Can you please check ALL the boxes below that might apply to this account: *

Estimated Premium over $125,000

Business is a Labor Provider

Business is a Diving Contractor

Business is in California AND has <10% Marine or Longshore payroll

Business is Oil & Gas AND over $100,000 premium

None of the above

Save & Return Account (optional)

New Users / Returning Users CLICK HERE to setup or return to your account for this form. Creating an account enables you to return to this form and your submitted results. An account will also enable you to partially complete this form and return later to finish. The account you establish is only for this form.