Online Raters/Forms
Online Raters/Forms

Applications and Forms

Please fax and mail the appropriate original forms listed below.

All of these applications are in Adobe Acrobat format, you must have Adobe Acrobat, which is free.

Online Raters
  1. Aegis Security Mobile/Manufactured Home
  2. Direct Insured Billing System (D.I.B.S.) for the Aegis Security Mobile/Manufactured Home Program
  3. American Reliable Dwelling Fire and Homeowner Online Rating and Underwriting System
  4. American Reliable California and Washington Mobile/Manufactured Home Online Rating and Underwriting System
  5. Lloyd's of London Assisted Living Facility Online Application & Submission
  6. Scottsdale Insurance Company Programs
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Union General
  1. New Agent
  2. Producer Information Form
  3. Producer's Agreement
  4. Request for Taxpayer Identification (IRS W-9)
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New Commercial Producer
  1. Prospective Commercial Producer Questionnaire
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New Trucking Producer
  1. Prospective Truck Producer "Welcome Letter"
  2. Prospective Trucking Producer Questionnaire
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ACORD
  1. ACORD Commercial Insurance 125
  2. ACORD Property 140
  3. ACORD General Commercial Liability 126-S
  4. ACORD Umbrella 131-S
  5. ACORD Dwelling Fire - 84
  6. ACORD Flood
  7. ACORD Homeowner 80
  8. ACORD Property Loss Notice 1
  9. ACORD General Liability Claim 3
  10. ACORD Certificate of Liability Insurance 25
  11. ACORD Cancellation Request/Release 35
  12. ACORD Equipment Floater 146
  13. ACORD Commercial Policy Change Request 175
 ACORD
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American Reliable + American Bankers
  1. American Bankers Equine Farm and Ranch Application
  2. American Reliable Bed and Breakfast
  3. American Reliable Bed and Breakfast Terrorism Form
  4. American Reliable Dwelling Fire
  5. American Reliable Farm and Ranch Application
  6. American Reliable California Mobile Home
  7. American Reliable HO-4 Tenants (Personal Property) Package
  8. American Reliable Homeowner
  9. American Reliable Condominium Homeowner (HO6)
  10. American Reliable Mobile Home
  11. American Reliable Personal Watercraft
  12. American Reliable Traveler
  13. American Reliable Woodburning Stove Inspection
  14. American Reliable Watercraft
 American Reliable
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Aegis
  1. Aegis Mobile Home
  2. Aegis Mobile Home Property Disclosure Form
  3. Aegis Travel Trailer
 Aegis
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Burlington
  1. Burlington Restaurant/Bar/Tavern Supplemental
  2. Burlington Contractor Supplement (BG-C-07)
  3. Burlington Farm Liability Supplemental
  4. Burlington - Liquor Supplement
  5. Burlington Special Event
Burlington Insurance Group
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Capitol Indemnity Corporation
  1. Capitol Apartment Supplement
  2. Capitol Beauty, Barber, & Body Program Supplement
  3. Capitol Childcare Supplement
  4. Capitol Liquor Liability Supplement
  5. Capitol Restaurant & Tavern Supplement
  6. Capitol Hotel/Motel Supplement
 Capitol Indemnity Corporation
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CBIC
  1. CBIC Contractor's License and Miscellaneous Bond Application
  2. CBIC Janitorial Bond Application
  3. CBIC Contrac Pac - California Class Descriptions
  4. CBIC Contrac Pac - Application
  5. CBIC GC New Home Builders or Remodelers - Application
  6. CBIC Contractor Optional Coverages - Application
  7. CBIC Contrac Pac - Renewal Application
  8. CBIC Contrac Pac - California Ineligible Operations/Classes
  9. CBIC Contrac Pac - California Eligibility Requirements
 CBIC
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Chubb
  1. Chubb Homeowner's Supplemental
  2. Chubb Homeowner's Coverage Comparison
  3. Chubb Homeowner Flyer
 Chubb
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First Financial
  1. First Financial - Liquor Supplement
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International Catastrophe Insurance Managers
  1. ICAT - Commercial Earthquake Application
 ICAT
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Lexington Insurance Company
  1. Lexington Homeowner Supplemental Application in Conjunction with the ACORD 80
  2. Lexington Homeowner Application
  3. Lexington Older Home Questionnaire (home older than 25 years)
  4. Lexington Questionnaire for Named Applicants that are "Estate of"
  5. Lexington Questionnaire for Pets
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Lloyd's of London
  1. Lloyd's of London - Assisted Living Facility Application
  2. Lloyd's of London - Nursing Home Application
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Maxum Indemnity
  1. Maxum Bed & Breakfast Supplement
  2. Maxum Contractors Supplement
  3. Maxum Day Care Center Supplement
  4. Maxum Exercise & Health Club Supplement
  5. Maxum Health Care Facility Application
  6. Maxum Hotels & Motels Supplement
  7. Maxum Logging and Lumbering Supplement
  8. Maxum Mobile Home Parks Supplement
  9. Maxum Restaurant, Bar, & Tavern Supplement
  10. Maxum Special Event Application
  11. Maxum Swimming Pool Supplement
  12. Maxum Vacant Building Supplement
  13. Maxum Vacant Land Supplement
  14. Maxum Welders Supplement
Maxum Indemnity
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Northland
  1. Northfield Health Care Facility
  2. Northland Builder's Risk
  3. Northland Residential Property Application Supplement
  4. Northland Public Auto
  5. Northland California Public Transportation GL Supplement
  6. Northland Public Auto- Hired Auto Liability Supplement
  7. Northland Public Auto- Hired Auto Physical Damage Supplement
  8. Northland Public Auto- Non-Owned Auto Supplement
  9. Northland California Rejection or Selection of Uninsured Motorists
  10. Northland Annual Automobile Safety Inspection Report
  11. Northland Commercial Driver Employment History
  12. Northland Insurance Application for Commercial Auto Genenral Liability Supplement
 Northland
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Scottsdale
  1. Scottsdale Adult Day Care
  2. Scottsdale Alarm, Fire Extinguisher & Fire Protection Systems Installation, Servicing or Repair GL
  3. Scottsdale Amusement Program
  4. Scottsdale Bar and Restaurant
  5. Scottsdale Barber Shop and Beauty Salon
  6. Scottsdale Condominium or Homeowners Association GL
  7. Scottsdale Dwelling Fire
  8. Scottsdale Dwelling Liability
  9. Scottsdale Event/Party Planners & Coordinators
  10. Scottsdale Exercise and Health Studio
  11. Scottsdale Exterminator
  12. Scottsdale Habitational
  13. Scottsdale Halfway House GL & Professional Liability
  14. Scottsdale Homeowners
  15. Scottsdale Janitorial
  16. Scottsdale Liquor Liability
  17. Scottsdale Martial Arts
  18. Scottsdale Medical Statement
  19. Scottsdale Mobile Home Park
  20. Scottsdale Motel
  21. Scottsdale Nursery and Preschool
  22. Scottsdale Security Guards & Related Operations
  23. Scottsdale Swimming Pool Maintenance and Management
  24. Scottsdale Tanning Salon
  25. Scottsdale Truckers-Warehouse Program Supplemental
  26. Scottsdale Personal Umbrella
  27. Scottsdale Personal Umbrella Rates for Indication Purposes Only
  28. Scottsdale Personal Umbrella Renewal Application
  29. Scottsdale Welding, Brazing, & Cutting
  30. Scottsdale Insurance Commercial Auto
  31. Scottsdale Insurance Monoline Cargo
  32. Scottsdale Insurance & Indemnity Cargo Supplemental
  33. Scottsdale Indemnity Commercial Auto
  34. Scottsdale Indemnity Monoline Cargo
 Scottsdale
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Topa
  1. Topa C.O.C. Questionaire
  2. Topa Commercial Auto
  3. Topa Comprehensive Personal Liability
  4. Topa Fire Dwelling
  5. Topa Garage Package Underwriting Guidelines
  6. Topa Garage Supplemental
  7. Topa Homeowners
  8. Topa Dwelling Fire/Homeowner Supplement in Conjunction with the Acord 84/80 Application
  9. Topa Limited Water Damage Acc/Reject. Form
  10. Topa Home Business Supplement
  11. Topa Personal Umbrella
 Topa
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Travelers
  1. Homeowner Acord 80 Application
  2. Travelers Replacement Cost Supplement (mandatory for every submission)
  3. Acord CA Residential Disclosure Form
  4. Acord Earthquake Form
  5. Travelers Supplemental Heating Device Form
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Travelers Auto Forms - Auto Must Be Written In Conjunction With Homeowners
  1. Personal Auto Acord Application
  2. CA Auto Acord Supplement (mandatory for every submission)
  3. Named Driver Exclusion Form
  4. Travelers CA Accident and Loss Detail Form (required if any accidents and/or loss history)
  5. Good Student/Driver Training Acord Form
 Travelers
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Voyager
  1. Voyager Indemnity Bed and Breakfast
  2. Voyager Indemnity Bed and Breakfast Terrorism Form
 Voyager
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Generic
  1. SL-2 Diligent Search
  2. D-1 Insurer Not In California
  3. Generic Supplemental Building
  4. Generic Wood Stove
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