- Most Recent State Facility Evaluation Report and any plan of correction resulting from Deficiency Citations.
- Copy of your Facility Current License
- Copy of Current Valued Loss History for all available years up to maximum of 5 years.
- Copy of your any Marketing Brochure
- Copy of your Current Policy Declaration Page from your professional liability insurance
Please feel free to call our office at 818-341-2107 with any questions you may have or if you simply needs assistance in completing the application we are here to help you.