Portal Access Request Form

Use this form to request access to our portal if you:

File Claims for your entity

Need to view Claims Metrics

Need to download or read Loss Control Guidelines and Resources

Date of Request: *

Name *

Title *

Organization *

Email *

Phone *

I need access for the following: *

Claims Metrics

Online Claims Filing

Risk Resource Library

I need access to the following lines of coverage: *

Liability

Property

Workers' Comp

Sign me up for Public Entity Partner's online portal. PLEASE ONLY CLICK THE SUBMIT BUTTON ONCE.