ACORD application Loss runs (min 4 full years, 5 years preferred) Experience mod sheet Two years financial statements No. of years in business Historical payroll and premium by state (min 3 full years) Projected payroll by code by class, by state (should not be submitted within the ACORD application) Details on losses over $25,000 To obtain a pre-audit premium and collateral quotation forward a full submission to: Robert McWeeney Innovative Risk Services Inc. Two Pierce Place Itasca, IL 60143 U.S.A. Tel: (630) 285-3863 Fax: (630) 285-3648 Email: bob_mcweeney@ajg.com