| Question # |
Print Sequence |
Required |
Question |
Response |
|
1
|
1.0
|
Yes
|
Have you attached a copy of your Knox County Business License, if applicable?
|
|
|
2
|
2.0
|
Yes
|
Experience Modification Factor
|
|
|
3
|
3.0
|
Yes
|
Pool Adjustment Factor
|
|
|
4
|
4.0
|
Yes
|
Insurance Carrier:
|
|
|
5
|
5.0
|
Yes
|
Insurance Rating of carrier:
|
|
|
6
|
6.0
|
Yes
|
Financial Rating of carrier:
|
|
|
7
|
7.0
|
Yes
|
Do you process your claims in house?
|
|
|
8
|
8.0
|
Yes
|
If you do not process your claims in house, please state who through:
|
|
|
9
|
9.0
|
Yes
|
Did you include a copy of your State of Tennessee Insurance License?
|
|
|
10
|
10.0
|
Yes
|
Did you include the list of administrative services per Section 3.4?
|
|
|
11
|
11.0
|
Yes
|
Did you include a specimen policy per Section 3.28?
|
|
|
12
|
12.0
|
Yes
|
Will you accept payment via credit card as per Section 1.16?
|
|
|
13
|
13.0
|
Yes
|
Did you include any exceptions from the specifications?
|
|
|
14
|
14.0
|
Yes
|
If yes, please note exceptions.
|
|
|
15
|
15.0
|
Yes
|
Did you include Attachment A Insurance Checklist?
|
|
|
16
|
16.0
|
Yes
|
Did you include Attachment B Iran Divestment Act/No Boycott of Israel/Tennessee Procurement Protections Act?
|
|