Other Forms – Workers’ Comp

All quotes require Acord 130 application. Other Workers’ Comp forms that may be required:
BHHC Supplemental
BHHC Check by Fax
Everest Supplemental
New Venture Questionnaire

Workers’ Comp

Acord 130 Workers’ Comp
(SAMPLE) Acord 130

Form(s) or links for specialty CL programs

Travelers Apartment/Condo Supplemental Application
Travelers Garage Risks Supplemental Application
Travelers Restaurant Supplemental Application
The Hartford Technology E&O Supplemental Application
Fairs & Fairgrounds Supplemental Application
Festivals/Special Event Supplemental Application

Other Forms – Commercial Lines

WIAA BOP New Venture/No Prior Coverage Questionnaire
AmTrust Hotel Supplement
AmTrust BOP Apartment Supplement
Acord 24 Certificate of Property Insurance
Acord 25 Certificate of Liability Insurance
Acord 27 Evidence of Property Insurance

Commercial Lines

Acord 125 Commercial Insurance
Acord 126 General Liability
Acord 127 Business Auto Section
Acord 129 Vehicle Schedule
Acord 131 Umbrella Section
Acord 137 Calif. Commercial Auto
Acord 140 Property Section
Acord 146 Equipment Floater

EFT Forms by Carrier

Safeco EFT Bank Account Form (include copy of voided check or provide insured’s account and routing number below signature line)
Safeco Recurring Credit Card Form (provide insured’s full credit card number, security code and billing zip code)
Hartford EFT Bank Account Form
Travelers EFT Bank Account Form (include copy of voided check or insured’s account and routing number)
Nationwide EFT Bank Account Form
Kemper Preferred EFT Bank Account Form
Kemper Preferred Recurring Credit Card Form (provide insured’s full credit card number, security code and billing zip code)
Travelers Recurring Credit Card Form

 

Liberty Mutual CL Bank EFT Form
Hartford CL Bank EFT Form

Personal Lines

Acord 80 Homeowners (HO3) 
Acord 83 Personal Umbrella
Acord 84 Dwelling Fire
Acord 90 Calif. Personal Auto
Acord 90 Colorado Personal Auto
Acord 90 Texas Personal Auto
Acord 61 Calif. Auto Supplement (Uninsured/Underinsured Motorist)
Residential Replacement Cost Estimator (A MSB cost estimator is required for all homeowners, renters and fire submissions)
Acord 36 Agent/Broker of Record Change
Acord 50 CA ID Card
Foremost Mobile Home Application (Required for all mobile home submissions)
Travelers CA Accident Verification Form (Required for all Travelers submissions when there are prior at-fault losses)