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Loss Runs

* required field
Name of Insured and DBA (If applicable):*
Agency Name:*
Agency Contact Email:*
Best Method of Loss Run Delivery:*
Policy Number:*
Agency Contact Name:*
Agency Contact Phone:*
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