Insuring the Behavioral Healthcare & Related Social Services Industry for Nearly 50 Years
103 Eisenhower Parkway, Suite 101
Roseland, NJ 07068


Phone: 973-830-8500
Fax: 973-830-8585
Toll Free: 800-845-1209




















 
Submitting New Business

Negley Associates 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


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


Cyber Liability

Data Breach and Privacy Liability, Data Breach Loss to Insured and Electronic Media Liability Insurance Policy.
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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)