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:
Choicepoint Credit Dispute Center
PO Box 105289
Atlanta, GA 30348
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.
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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