Submitting New Business

The Mental Health Risk Retention Group values the opportunity to review your new business submission.  Our experienced underwriting staff is here to evaluate your submission and design a comprehensive solution for your insured’s needs.

Below are items required for underwriting.


General & Professional Liability

  • Completed Negley GL/PL application or incumbent’s renewal application (including supplemental applications)
  • Most current audited financial statement, tax form, or Profit & Loss Statement (including Balance Sheet)
  • Brochure or website address
  • 5 years of currently valued loss runs
  • 5 years of premium and carrier history


Directors & Officers Liability

including Employment Practices

  • Completed Negley application or incumbent’s renewal application
  • Current list of the Board of Directors
  • Copy of By-Laws
  • 5 years of currently valued loss runs
  • 5 years of premium and carrier history



Other Coverages available through Negley Associates

Excess Liability and Umbrella

  • $4,000,000 additional limits of coverage is available separately


Property

  • Completed ACORD 140 application
  • 5 years of currently valued loss runs
  • 5 years of premium and carrier history


Automobile

  • Completed ACORD 137 application (Coverage/ Limits Section)
  • Completed ACORD 127 application (Driver and Vehicle Schedule)
  • Completed Auto Supplemental Application
  • 5 years of currently valued loss runs
  • 5 years of premium and carrier history


Workers Compensation

  • Completed ACORD 130 application
  • Current experience rating worksheet
  • 5 years of currently valued loss runs
  • 5 years of premium and carrier history



Submissions may be sent electronically via e-mail to submissions@jjnegley.com or via fax to 973-830-8585.Contact our Underwriting Department today with any questions! (973-830-8500)