Important Notice - Please Read Carefully
While CBIZ is licensed in most
states in the USA, the personal lines department brings
the most advantage to our customers in areas near where
we have offices, DC, MD, PA, VA, & WV.
In order to determine what coverage is available to
you, and at what price, and to help the insurance
company evaluate your personal risk, we will be asking
you some questions concerning claim history, driving
record, and credit history. Insurance companies offer
better pricing for prospective clients with excellent
driving records and loss free claim history. In
addition, some companies, in some states, offer a
better price for persons with acceptable Insurance
Scores, which measure the likelihood of an insurance
loss based on financial behavior, according to credit
report information. By completing this quote request
form, you are acknowledging and giving your permission
for any or all of the following information or reports
to be obtained:
MVR (Motor Vehicle Record): State driving records
which may include driver's license information
including violations, convictions, revocations and
suspension information, as well as personal
information such as address and date of birth.
ADDITIONAL DRIVER DISCOVERY (ADD): is a database of
all licensed drivers in the household. This report
helps determine that all drivers in the household have
been disclosed on the quote request or application so
that appropriate evaluations and premium charges for
all drivers can be made by the insurance company.
CLUE (Comprehensive Loss Underwriting Exchange): is a
database of information containing claims history by
individual, by driver, by policy, by vehicle, and by
location address.
INSURANCE SCORE: This evaluates many aspects of your
credit management history, including, but not limited
to: number of open accounts, payment history,
frequency of recent inquiries into the credit report,
etc. In particular the model considers the presence
of any major financial blemishes such as bankruptcy,
liens, foreclosures, etc. Neither our agency, nor the
insurance company actually receives a copy of your
credit history or report. We simply receive an
Insurance Score of "Acceptable" or "Not Acceptable."
If a consumer has been denied insurance in the past
sixty days based on information contained in a credit
report, the Federal Fair Credit Reporting Act requires
the credit bureaus to provide a copy of the credit
report to you free of charge. You also have the
opportunity to check for any inaccuracies or erroneous
information. Customers who wish to receive a copy of
their credit reports should contact Equifax by calling
1-800-456-6004, or by writing:
Equifax Insurance Consumer Center
P.O. Box 105108
Atlanta, GA 30348-5108
NOTICE OF INFORMATON PRACTICES (PRIVACY)
Privacy Notification: Any information which we have
or may obtain about you or other individuals listed as
policyholders on your policy will be treated
confidentially. However, this information, as well as
other personal privileged information subsequently
collected, may, under certain circumstances, be
disclosed without prior authorization to third parties
such as to our affiliated companies for claims
handling, servicing, underwriting, and insurance
marketing. Personal information also may be disclosed
to affiliated and non-affiliated companies for non-
insurance marketing purposes, unless you write to us
at the address provided with your policy and direct us
not to make such disclosure.
You have the right to see personal information
collected about you, and you have the right to correct
any information which may be wrong.
If you are interested in obtaining a description of
our information practices and your rights regarding
information we collect, please write us.
FRAUD STATEMENT
Any person who knowingly and with intent to defraud
any insurance company or other person files an
application for insurance or statement of claim
containing any materially false information or
conceals for the purpose of misleading, information
concerning any fact material thereto commits a
fraudulent insurance act, which is a crime and
subjects the person to criminal and civil penalties.
Information submitted subject to verification. By
proceding with the quote request I am acknowledging
that I have read and understand the above information,
and give my express permission to obtain such
information to evaluate my personal insurance.
Quotation may vary from coverage requested.
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