[Insured legal name]
[Street address]
[City, State ZIP]
October 4, 2026
To
Liberty Mutual - Loss Runs Department
Email: LossRunRequest@ironshore.com (unconfirmed for your policy)
[CONFIRM THIS ADDRESS APPLIES TO YOUR POLICY: Published for Ironshore (Liberty Mutual specialty) policies only. For other Liberty Mutual business policies no loss-run channel is published; ask your agent.]
Re: Loss run request - [Insured legal name] - USDOT [USDOT #]
To whom it may concern,
- Named insured
- [Insured legal name]
- USDOT number
- [USDOT #]
- MC/MX docket
- N/A
- Policy number(s)
- All policies issued to the named insured
- Period requested
- Last 5 years (or full history with your company, if shorter)
Please provide currently valued loss runs for the named insured below, covering the last 5 years of coverage with your company, for auto liability, motor truck cargo, physical damage and general liability (all that apply).
Please include all open and closed claims with dates of loss, paid, reserved and total incurred amounts, along with the policy periods. If there were no claims, please confirm "no losses" in writing.
Please send the loss runs to: [Your name], Owner - [Email].
I am an authorized representative of the named insured and authorize Liberty Mutual to release these loss runs to the contact above.
Sincerely,
Print name: [Your name]
Title: Owner
Date: October 4, 2026