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Loss Runs

* required field
Insured's Name and DBA (If applicable): Policy Number:
Agency Name: Agency Contact Name:
Agency Contact Email: Agency Contact Fax:
Best Method of Loss Run Delivery:
Special Notes:

Shield Commercial Insurance Services, Inc.
43-725 Monterey Ave, Ste A. Palm Desert, CA 92260
Tel: 760-345-9029 Fax: 800-345-4851
CA License Number: 0E67754