Laserfiche WebLink
DocuSign Envelope ID: 2FEC7950-846A-4427-8D35-5C28M6B81A1 WAWA CYNTHIA INSURANCE AGENCY <br />(626) 810-5556 <br />Nationwide <br />360 Clinic <br />Commercial Insurance Application <br />Quote Number: ACP 3009934033 Effective: 01/18/2021 to 01/18/2022 <br />For Internal Use Only <br />Account Summary <br />First Quoted 10/13/2020 05:52 PM EDT Current Policy Number <br />Account Origin New Business First in Conflict No <br />Serviced By Agency <br />ACORD No <br />Pricing Modifications Summary <br />Line of Business (Prefix) Pricing Modification <br />Business Auto (BA) None <br />Underwriting Instructions <br />Account: Accelerated <br />Practice Area <br />Assigned: No Practice Area <br />Lines of Business: Underwriting: <br />Business Auto (BA) Accelerated <br />Credit <br />Debit <br />Final Premium <br />None <br />None <br />$ 3,750.76 <br />Total: <br />$ 3,750.76 <br />1100 Locust St., Dept. 1100 Page 10 Des Moines, IA 50391-1100 <br />