Letter of authorization loss run request

below is an example of a letter of authorization for a loss run request:

Freds Bumper and Jumpers

1111 main

Anytown, USA 112233

 12/11/2017

To:

 State Fund of California
10105 Pacific Heights Blvd
San Diego, CA 92121
Phone: 877-405-4545
Attention: Loss Runs Department
Fax: 707-455-9240

Re: Loss Run Request

Policy type: Workers Compensation

Policy # 11111aaaa1111

To whom it may concern:

With regard to the above captioned policy, this letter authorizes and requests your company to release the complete detailed loss runs showing all experience (open and closed) for the periods directly to:

Best Insurance agency EVER:

attention: Best Insurance agent EVER

email: bestinsurance@bestinsuranceagency eve . com

Fax: 614-741-5555

This authorization should remain in force for the period of 90 days starting from 12/11/2014.

I appreciate your cooperation and assistance in this matter.

Sincerely,

Fred bup

Owner

Freds bumpers  and jumpers

547-555-5555

Fredbup@fredsbupandjup . com