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Excess / Umbrella Quote — Fusco Insurance

An umbrella sits on top of your other policies and picks up where their limits stop. To quote one, we need the picture underneath it: what policies you have, with whom, and at what limits. Tell us once — your answers go into the standard application (ACORD 125 + the umbrella section, ACORD 131) — and we come back with real numbers. No obligation, and no coverage is bound by this form. The declarations pages of your current policies answer most of this in one shot — the Day 0 email will tell you how to send them securely.

Applicant

Contact name

Contact email

Contact phone

Is this for a business or for you personally?

Insured name (business legal name or your full name)

DBA, if any

Entity type (business)

State of the business or your residence

Mailing address

For a business: describe what it does (personal applicants: write "personal")

Requested effective date for the umbrella

The umbrella wanted

Excess limit wanted

Umbrella or true excess? (Umbrella can broaden; excess only follows the underlying form)

Do you have an umbrella or excess policy now?

A
B

If yes: carrier

If yes: current limit

If yes: expiration date

Underlying schedule

Type of underlying policy

Carrier

Policy number (last 4 digits are enough for the quote stage)

Limits (liability per occurrence / aggregate; for auto: bodily injury per person/per accident; for homeowners: personal liability)

Policy effective date

Policy expiration date

Type of underlying policy

Carrier

Policy number (last 4 digits are enough)

Limits

Policy effective date

Policy expiration date

Additional underlying policies (3rd, 4th, 5th, 6th): for each, list type, carrier, last 4 digits of policy number, limits, and effective-expiration dates

Any underlying policy with limits below these minimums? (GL below $1M/$2M, auto below $250k/$500k, homeowners liability below $300k) - not sure is a fine answer; we'll read it off the dec pages

A
B
C

Any claims on any underlying policy in the last 5 years?

A
B

For each claim: year, what happened, amount

Exposures the umbrella carrier will ask about

Business only: do you have employees, company vehicles, or watercraft/aircraft exposures?

Please describe

Personal only: youthful drivers in the household, rental properties, boats, pools, or dogs?

Please describe