2. If you have any difficulties completing the form below, please contact Michele Keplinger at MicheleK@lgit.org for assistance.

4. FOR LGIT MEMBERS ONLY

   To request an additional Member Portal user, please complete the form below.
6. Are you a Main Contact, Main CC, or Administrator?

   1. Yes
   2. No

   In order to add a portal user, this form must be completed by a main contact or administrator.

8. Contact Name*
9. Contact Email*
11. Contact Job Title*
12. Contact Department
14. Phone Number*
15. Local Government*
17. New User Information:
19. First Name*
20. Last Name*
22. Job Title*
23. Department
25. Phone Number*
26. Email*
28. 1) Policy Change Request Management

    1. Users are given rights to do service requests (must also have rights to view policies)
30. 2) Policy Document Read

    1. Users have access to read documents
32. 3) Policy Document Upload

    1. Users can upload documents
34. 4) Policy View Access

    1. Users can view policies
36. 5) Renewal Edition Write

    1. Users are given rights to the renewal wizard (must also have rights to view policies)
38. 6) Claims

    Only the main contact or departmental contact designated by the main contact has the right to file an incident report or view incident or claim information because incident information is confidential.

    1. A) Claims Read Access User can view all claims filed against an incident and the claim summary detail
    2. B) Occurrence Document Read User can view documents that are uploaded by the user
    3. C) Occurrence Document Upload User can upload documents to the incident
    4. D) Occurrence File Supplemental Information User can file supplemental information for a previously filed incident
    5. E) Occurrence Finance Read User can view financial information related to incidents.
    6. F) Occurrence Read Access User can view all previously filed incidents and the incident summary detail
    7. G) Occurrence Write Access User can file a first report for an incident
    8. H) All of the above
40. 7) Dashboard

    Users are given rights to the Analysis tab.

    1. A) Dashboard Access Users are given access to the Overview, Premium Drivers, and Loss Run tabs
    2. B) Dashboard Extended Access Users are given access to additional tabs for Natures of Loss, Causes of Loss, Cause and Effect, and Sources of Loss
    3. C) All of the above
Leave This Blank:


42. 1. Receive an email copy of this form.
43. Email address

    This field is not part of the form submission.

44. Submit

* indicates a required field