Additional Insured / Loss Payee Request


Loss Run Information Request
Agency Name * = Required

Please allow up to 7 days to receive your loss runs.

Please note that you can only request loss runs if you are the agent of record. If you're not the Agent of record, please have your insured send a letter of authorization to release their loss runs to you. The letter can be faxed to 814-255-6010 or emailed to

If you have any questions, please contact us at 800-452-0297 or


Contact Name *

Phone # *
Your Email Address *

A copy of this request will be sent to the email address above.


Insured Name *

Policy # *

Comments: (If more than one policy number, list others below.)


Interstate Insurance Management
2307 Menoher Blvd., Johnstown, PA 15905
Call: 814-255-7878
Fax: 814-255-6010

Interstate Insurance Management is a series of RSG Underwriting Managers, LLC. RSG Underwriting Managers is a Delaware Series limited
liability company and a subsidiary of Ryan Specialty Group, LLC. In California: RSG Insurance Services, LLC License # 0E50879
Website Designed and Developed by Smartsite by Inspotlight