|
Form
|
State
|
Description
|
|
1
|
|
Property Loss Notice
|
|
2
|
|
Automobile Loss Notice
|
|
3
|
|
General Liability Notice of Occurrence / Claim
|
|
4
|
WI
|
Wisconsin Employer's First Report of Injury or Disease
|
|
4
|
|
Workers Compensation - First Report of Injury or Illness
|
|
11
|
|
Auto Accident Information Form
|
|
12
|
|
Exchange of Information Form
|
|
13
|
|
Witness Card
|
|
18
|
|
Jewelry Appraisal and Claim Evaluation
|
|
22
|
|
Intermodal Interchange Certificate of Insurance
|
|
23
|
|
Leased Auto Certificate of Insurance
|
|
24
|
|
Certificate of Property Insurance
|
|
25
|
|
Certificate of Liability Insurance
|
|
26
|
|
Policy Certification Log
|
|
27
|
|
Evidence of Personal Property Insurance
|
|
28
|
|
Evidence of Commercial Property Insurance
|
|
35
|
|
Cancellation Request/Policy Release
|
|
36
|
|
Agent/Broker of Record Change
|
|
37
|
|
Statement of No Loss
|
|
38
|
|
Notice of Information Practices (Privacy)
|
|
38
|
AZ
|
Arizona Notice of Information Practices (Privacy)
|
|
38
|
CA
|
Notice of Information Practices (Privacy)
|
|
38
|
CT
|
Notice of Information Practices (Privacy)
|
|
38
|
DE
|
Notice of Information Practices (Privacy)
|
|
38
|
GA
|
Notice of Information Practices (Privacy)
|
|
38
|
IL
|
Notice of Information Practices (Privacy)
|
|
38
|
KS
|
Kansas Personal Insurance Supplement - Notice of Insurance Information Practices
|
|
38
|
MN
|
Minnesota Authorization
|
|
38
|
ND
|
North Dakota Personal Insurance Supplement - Notice of Information Practices
|
|
38
|
NJ
|
Notice of Information Practices (Privacy)
|
|
38
|
NV
|
Notice of Information Practices (Privacy)
|
|
38
|
NY
|
New York Personal Insurance Supplement - Notice of Insurance Information Practices
|
|
38
|
OR
|
Oregon Notice of Information Practices (Privacy)
|
|
38
|
RI
|
Notice of Information Practices (Privacy)
|
|
38
|
VA
|
Notice of Information Practices (Privacy)
|
|
38
|
WA
|
Notice of Information Practices (Privacy)
|
|
38
|
WV
|
West Virginia Personal Insurance Supplement - Notice of Insurance Information Practices
|
|
39
|
MD
|
Maryland Application Supplement
|
|
42
|
|
Residential Property Replacement Cost Information Supplement
|
|
45
|
|
Additional Interest
|
|
50
|
|
Insurance Identification Card
|
|
50
|
AL
|
Alabama Insurance Identification Card
|
|
50
|
AR
|
Arkansas Proof of Insurance Card
|
|
50
|
AZ
|
Arizona Insurance Identification Card
|
|
50
|
CA
|
California Insurance Identification Card
|
|
50
|
CO
|
Colorado Insurance Identification Card
|
|
50
|
CT
|
Connecticut Insurance Identification Card
|
|
50 WM
|
DE
|
Insurance Identification Card (with Watermark)
|
|
50
|
FL
|
Florida Auto Insurance ID Card
|
|
50
|
GA
|
Georgia Insurance Policy Information Card
|
|
50
|
HI
|
Hawaii Motor Vehicle Insurance Identification Card
|
|
50
|
IA
|
Iowa Financial Liability Card
|
|
50
|
ID
|
State of Idaho Liability Insurance Identification Card
|
|
50
|
IL
|
Illinois Insurance Identification Card
|
|
50
|
KY
|
Commonwealth of Kentucky Proof of Insurance
|
|
50
|
LA
|
Louisiana Auto Insurance ID Card
|
|
50
|
MI
|
Michigan Certificate of No-Fault Insurance
|
|
50
|
MO
|
Missouri Auto Insurance Identification Card
|
|
50
|
MS
|
Mississippi Insurance Identification Card
|
|
50 WM
|
NJ
|
Insurance Identification Card (with Watermark)
|
|
50 WM SET
|
|
Insurance Identification Card
|
|
50 WM
|
NJ
|
TEMPORARY State of New Jersey Insurance Identification Card
|
|
50
|
NV
|
Nevada Insurance Identification Card
|
|
50
|
OK
|
Oklahoma Owners Security Verification Form
|
|
50
|
PA
|
Pennsylvania Financial Responsibility Identification Card
|
|
50
|
RI
|
Rhode Island Insurance Identification Card
|
|
50
|
TX
|
Texas Liability Insurance Card
|
|
50
|
WV
|
West Virginia Certificate of Insurance
|
|
50 WM
|
|
Insurance Identification Card (With Watermark)
|
|
50 WM SET
|
|
Insurance Identification Card
|
|
51
|
CA
|
California Evidence of Liability Insurance
|
|
51
|
GA
|
Georgia Fleet Policy Information Card
|
|
51
|
OK
|
Oklahoma Operators Security Verification Form
|
|
54
|
|
Financial Responsibility Form
|
|
57
|
|
Financial Responsibility Form (Notice of Cancellation or Termination)
|
|
60
|
|
Flood Insurance Notice/Rejection
|
|
60
|
HI
|
Hawaii Auto Supplement Uninsured/Underinsured Motorists Coverage Selection Stacked
or Non- Stacked UM and UIM Coverage
|
|
60
|
LA
|
Louisiana Dwelling Supplement - Loss Settlement (DWG 1)
|
|
60
|
MA
|
Massachusetts Property Insurance Underwriting Association - Application for Homeowners
Insurance Inspection and Placement
|
|
60
|
MN
|
Minnesota FAIR Plan Homeowners Application - HO 6 Condo Unit Owners Coverage
|
|
60
|
MT
|
Montana Application Supplement - Refusal to Renew
|
|
60
|
NJ
|
New Jersey Personal Property Insurance Supplement - Flood Exclusion
|
|
60
|
NM
|
New Mexico Confidential Abuse Information Disclosure Notice
|
|
60
|
NY
|
New York Homeowners Supplement
|
|
60
|
OK
|
Oklahoma Auto Supplement, Oklahoma Uninsured Motorists Coverage Law
|
|
60
|
PA
|
Pennsylvania Auto Supplement UM Coverage Selection/Rejection
|
|
60
|
TX
|
Texas Auto Supplement Consumer Bill of Rights for Personal Automobile Insurance
|
|
60
|
US
|
Insurance Supplement, Notice of Terrorism Coverage/Disclosure of Premium
|
|
60
|
VA
|
Virginia Auto Supplement Rental Reimbursement Coverage
|
|
60
|
WV
|
West Virginia Auto Supplement UM/UIM Vehicle Coverages
|
|
61
|
AK
|
Alaska Auto Supplement, Uninsured/Underinsured Motorists Coverage Selection Form
|
|
61
|
AR
|
Arkansas Auto Supplement, Uninsured/Underinsured Motorists Coverage Selection; Personal
Injury Protection Selection
|
|
61
|
AZ
|
Arizona Auto Supplement
|
|
61
|
CA
|
California Auto Supplement Mandatory Uninsured Motorists Bodily Injury Coverage
Offer
|
|
61
|
CO
|
Colorado Auto Supplement Summary of Coverages
|
|
61
|
CT
|
Connecticut Auto Supplement UM Coverage
|
|
61
|
DE
|
Delaware Auto Supplement Delaware Motorist's Protection Act - Required Statement
to Policyholders
|
|
61
|
FL
|
Florida Auto Supplement Rejection/Election of UM Coverage/Personal Injury Protection
Disclosures
|
|
61
|
GA
|
Georgia Auto Supplement
|
|
61
|
IA
|
Iowa Auto Supplement, UM and UIM Coverage Offer/Rejection Form
|
|
61
|
IL
|
Illinois Auto Supplement Uninsured/Underinsured Motorists Coverage
|
|
61
|
LA
|
Louisiana Homeowners Supplement - Loss Settlement (HO4)
|
|
61
|
MA
|
Massachusetts Property Insurance Underwriting Association - Inspection Notice, Credit
Reporting Notice and Instructions for Completing Homeowners Application ACORD 60
MA
|
|
61
|
MS
|
Mississippi Auto Supplement: Mississippi Non-Stacking Uninsured Motorist Insurance
|
|
61
|
NC
|
North Carolina Auto Supplement Selection/Rejection Form Uninsured Motorists Coverage
Combined Uninsured/Underinsured Motorists Coverage
|
|
61
|
NJ
|
New Jersey Auto Supplement - Auto Insurance Buyer's Guide
|
|
61
|
NM
|
New Mexico Auto Supplement - UM Coverage Selection and Rejection Of Stacked UM Coverage
|
|
61
|
NV
|
Nevada Auto Supplement
|
|
61
|
NY
|
New York Auto Supplement Optional Basic Economic Loss (OBEL) Coverage
|
|
61
|
OK
|
Oklahoma Auto Supplement Election of Non-Stacked Coverage
|
|
61
|
OR
|
Oregon Auto Supplement Uninsured Motorists Coverage Selection Form
|
|
61
|
PA
|
Pennsylvania Auto Supplement Summary of Coverages
|
|
61
|
RI
|
Rhode Island Auto Supplement Uninsured/Underinsured Motorists Bodily Injury Coverage
Rejection Notice and Warning
|
|
61
|
SC
|
South Carolina Auto Supplement Offer of Additional Uninsured Motorists and Optional
Underinsured Motorists Coverage;
|
|
61
|
UT
|
Utah Auto Supplement
|
|
61
|
WI
|
Wisconsin Auto Supplement Underinsured Motorists Coverage Selection Form
|
|
61
|
WV
|
West Virginia Uninsured/Underinsured Motorist Coverage - Offer of Split Limits Liability
|
|
62
|
AK
|
Alaska Auto Supplement
|
|
62
|
AL
|
Alabama Insurance Application Supplement
|
|
62
|
AZ
|
Arizona Auto Supplement (Spanish Version) Uninsured/Underinsured Coverage Selection
Form
|
|
62
|
CO
|
Colorado Personal Property Supplement
|
|
62
|
DE
|
Delaware Auto Supplement - Personal Injury Protection Deductible Options
|
|
62
|
IA
|
Iowa Auto Supplement, Notice Regarding UM/UIM Coverage
|
|
62
|
IL
|
Illinois Property Supplement - Notice of Availability of Earthquake Insurance
|
|
62
|
LA
|
Louisiana Commercial Property Supplement Loss Settlement
|
|
62
|
MD
|
Maryland Commercial Auto Supplement
|
|
62
|
MI
|
Michigan Collision Insurance Options Notice
|
|
62
|
MN
|
Minnesota Auto Supplement
|
|
62
|
MO
|
Missouri Property Supplement - Notice of Availability of Earthquake Insurance
|
|
62
|
NC
|
North Carolina Joint Underwriting Association - North Carolina Insurance Underwriting
Association FAIR and Beach Plan Coverage Instructions
|
|
62
|
NJ
|
New Jersey Auto Supplement Basic Policy Coverage Selection Form
|
|
62
|
NV
|
Nevada Umbrella Supplement
|
|
62
|
NY
|
Application for Dwelling Insurance NYPIUA
|
|
62
|
OK
|
Oklahoma Property Supplement - Notice to Property Owners in Rural Fire Protection
Districts
|
|
62
|
OR
|
Oregon Personal Lines Supplement - Notice of Use of Loss History Report - Home Insurance
|
|
62
|
PA
|
Pennsylvania Auto Supplement UIM Coverage Selection/Rejection
|
|
62
|
RI
|
Rhode Island Property Supplement - Notice of Flood Coverage Exclusion
|
|
62
|
TX
|
Texas Auto Supplement Consumer Bill of Rights for Personal Automobile Insurance
(Spanish Language Text)
|
|
62
|
US
|
Insurance Supplement - Standard Fire Policy Only, Notice of Terrorism Coverage/Disclosure
of Premium
|
|
62
|
VA
|
Virginia Property Supplement
|
|
62
|
WA
|
Washington Auto Supplement Mandatory Offer of PIP Coverage
|
|
62
|
WV
|
West Virginia Uninsured/Underinsured Motorist Coverage - Offer of Single Limit Liability
|
|
63
|
|
General Fraud Statement
|
|
63
|
CO
|
Colorado Application Supplement Fraud Warning
|
|
63
|
HI
|
Hawaii Application Supplement
|
|
63
|
OH
|
Ohio Fraud Statement
|
|
63
|
OK
|
Oklahoma Fraud Statement
|
|
63
|
UT
|
Utah Fraud Statement
|
|
64
|
CA
|
California Insurance Supplement - Agency Language Form
|
|
64
|
DC
|
Application to District of Columbia Property Insurance Facility for Basic Property
Inspection and Insurance Program
|
|
64
|
DE
|
Insurance Placement Facility of Delaware
|
|
64
|
IA
|
Iowa Auto Supplement, UM/UIM Coverage Stacking Coverage Option Notice
|
|
64
|
LA
|
Louisiana Homeowners Supplement - Loss Settlement (HO 2 & 3)
|
|
64
|
MA
|
Mass. Residential Property Liability Supplement
|
|
64
|
MD
|
Maryland Property Insurance Availability Program Essential Property Insurance Inspection
and Placement
|
|
64
|
MI
|
Michigan Basic Property Insurance Association - Insurance Application
|
|
64
|
MN
|
Minnesota FAIR Plan Homeowners Application - HO 4 Renters Coverage
|
|
64
|
NC
|
North Carolina Property Supplement - Flood Insurance Notice
|
|
64
|
NJ
|
New Jersey Auto Supplement Standard Coverage Selection Form
|
|
64
|
NY
|
New York Auto Supplement - Supplementary UM/UIM Insurance Coverage
|
|
64
|
PA
|
Insurance Placement Facility of Pennsylvania - Basic Property Insurance Application
|
|
64
|
RI
|
Rhode Island Joint Reinsurance Association - Application for Homeowners Insurance
Inspection and Placement
|
|
64
|
SC
|
South Carolina Personal Property Supplement - Cancellation Rules Disclosure
|
|
64
|
TX
|
Texas Windstorm Insurance Association - Application for Windstorm and Hail Insurance
|
|
64
|
VA
|
Virginia Property Supplement - Notice of Flood Insurance Coverage Exclusion
|
|
64
|
WV
|
West Virginia Essential Property Insurance Association - Basic Property Insurance
Application
|
|
65
|
PA/DE/WV
|
Fair Plan Supplementary Questionnaire
|
|
65
|
CA
|
California Insurance Supplement - Race, National Origin and Gender Form
|
|
65
|
IA
|
Iowa Auto Supplement - Notice - Payment for Aftermarket Crash Parts
|
|
65
|
LA
|
Louisiana Homeowners Supplement - Loss Settlement (HO6)
|
|
65
|
MA
|
Massachusetts Property Insurance Underwriting Association - Application for Dwelling
Fire Insurance Inspection and Placement
|
|
65
|
MD
|
Maryland Property Insurance Availability Program Essential Homeowners Insurance
Inspection and Placement
|
|
65
|
MN
|
Minnesota Guaranty Association Notice
|
|
65
|
NJ
|
New Jersey Property Insurance Supplement
|
|
65
|
NY
|
New York Auto Supplement, Supplemental Spousal Liability Coverage, Mandatory Offer
of Insurance
|
|
65
|
RI
|
Rhode Island Joint Reinsurance Association - Inspection Notice, Credit Reporting
Notice and Instructions for Completing Homeowners Application ACORD 64 RI
|
|
65
|
WV
|
West Virginia Personal and Commercial Umbrella Liability Supplement Uninsured/Underinsured
Motor Vehicle Coverage Important Notice
|
|
66
|
CA
|
California Offer of Earthquake Coverage
|
|
66
|
CT
|
Connecticut FAIR Plan Application for Basic Property & Liability Insurance
|
|
66
|
DC
|
District of Columbia Property Insurance Facility - Essential Homeowners Insurance
Inspection and Placement Application p. 1
|
|
66
|
FL
|
Florida Insurance Supplement Credit Report Disclosure Information
|
|
66
|
IA
|
Iowa Personal Insurance Supplement - Disclosure Use of Claims History
|
|
66
|
LA
|
Lousiana Dwelling Supplement - Loss Settlement (DWG 2 & 3)
|
|
66
|
MA
|
Massachusetts Property Insurance Underwriting Association - Inspection Notice, Credit
Reporting Notice and Instructions for Completing Homeowners Application ACORD 65
MA
|
|
66
|
MD
|
Maryland Property Insurance Availability Program Essential Homeowners Insurance
Inspection and Placement
|
|
66
|
MN
|
Minnesota Fair Plan Homeowners Application
|
|
66
|
NC
|
North Carolina Insurance Supplement
|
|
66
|
RI
|
Rhode Island Joint Reinsurance Association - Application for Dwelling Fire Insurance
Inspection and Placement
|
|
66
|
UT
|
Utah Arbitration Provisions
|
|
66
|
VT
|
Vermont Insurance Supplement Fair Credit Reporting Act
|
|
66
|
WV
|
West Virginia Personal and Commercial Umbrella Liability Supplement Uninsured/Underinsured
Motor Vehicle Coverage Offer of Split Limits Liability
|
|
67
|
|
IL / IN / KY / WV Mine Subsidence Property Insurance Supplement
|
|
67
|
AR
|
Arkansas Property Supplement - Declination of Residential Earthquake Coverage
|
|
67
|
CA
|
California Residential Property Disclosure
|
|
67
|
DC
|
District of Columbia Property Insurance Facility - Essential Homeowners Insurance
Inspection and Placement Application p. 2
|
|
67
|
FL
|
Florida Homeowners Supplement
|
|
67
|
IL
|
Mine Subsidence Property Insurance Supplement, Illinois, Indiana, Kentucky, West
Virginia
|
|
67
|
IN
|
Mine Subsidence Property Insurance Supplement, Illinois, Indiana, Kentucky, West
Virginia
|
|
67
|
KY
|
Mine Subsidence Property Insurance Supplement, Illinois, Indiana, Kentucky, West
Virginia
|
|
67
|
LA
|
Louisiana Certification of Mobile Home Tie Downs
|
|
67
|
MA
|
Massachusetts Property Insurance Underwriting Association - Application for Commercial
Fire Insurance Inspection and Placement
|
|
67
|
MD
|
Maryland Personal Auto Supplement - PIP Coverage/Waiver
|
|
67
|
MN
|
Minnesota Fair Plan Dwelling Fire Application
|
|
67
|
MO
|
Missouri FAIR Plan Insurance Application
|
|
67
|
NJ
|
New Jersey Insurance Underwriting Insurance Association Dwelling Fire Application
|
|
67
|
NY
|
Instructions for Completion of Application for Dwelling Insurance NYPIUA
|
|
67
|
OH
|
Ohio Mine Subsidence Homeowners and Dwelling Supplement
|
|
67
|
RI
|
Rhode Island Joint Reinsurance Association - Inspection Notice, Credit Reporting
Notice and Instructions for Completing Dwelling Fire Application ACORD 66 RI
|
|
67
|
TX
|
Texas Homeowners and Personal Property Supplement
|
|
67
|
UT
|
Utah Auto Insurance Supplement Personal Injury Protection Coverage Waiver of Loss
of Income Benefits
|
|
67
|
VA
|
Virginia Property Insurance Association Application For Insurance
|
|
67
|
WV
|
Mine Subsidence Property Insurance Supplement, Illinois, Indiana, Kentucky, West
Virginia
|
|
68
|
CA
|
California Scheduled Personal Property - Loss Computation Disclosure
|
|
68
|
FL
|
Citizens Property Insurance Corporation, Residential - Dwelling Wind Only
|
|
68
|
IL
|
Illinois FAIR Plan Association (Part 2 of 2 Parts) Supplemental Application for
(1-4 Family) Homeowners & Dwelling Property Insurance
|
|
68
|
LA
|
Louisiana Plan Services Application for Insurance
|
|
68
|
MA
|
Massachusetts Property Insurance Underwriting Association - Inspection Notice, Credit
Reporting Notice and Instructions for Completing Commercial Fire Application ACORD
67 MA
|
|
68
|
MD
|
Maryland Personal Property Supplement - Statement Regarding Flood Insurance
|
|
68
|
MN
|
Minnesota Fair Plan Commercial Fire Application
|
|
68
|
ND
|
North Dakota Supplement to Property Insurance Applications
|
|
68
|
NJ
|
New Jersey Insurance Underwriting Association - Commercial Fire Application
|
|
68
|
NY
|
New York Liability Supplement - Claims-Made Policy Important Information
|
|
68
|
OH
|
Ohio Offer of Mine Subsidence Ins. HO & Dwelling Supplement
|
|
68
|
RI
|
Rhode Island Joint Reinsurance Association - Application for Commercial Fire Insurance
Inspection and Placement
|
|
68
|
TX
|
Texas Homeowners and Personal Property Supplement (Spanish Language Text)
|
|
68
|
WV
|
West Virginia Personal and Commercial Umbrella Liability Supplement Uninsured/Underinsured
Motor Vehicle Coverage Offer of Single Limit Liability
|
|
69
|
FL
|
Citizens Property Insurance Corporation, Wind Only Supplemental Residential Application
Schedule
|
|
69
|
IL
|
Illinois FAIR Plan Association (Part 1 of 2 Parts) Application for (1-4 Family)
Homeowners & Dwelling Property Insurance
|
|
69
|
LA
|
Louisiana Auto Supplement - UM/UIM BI Coverage - UM Property Damage Coverage
|
|
69
|
MD
|
Maryland Insurance Supplement - Notice of Underwriting Period
|
|
69
|
MN
|
Minnesota FAIR Plan - Farm Fire Application
|
|
69
|
RI
|
Rhode Island Joint Reinsurance Association - Inspection Notice, Credit Reporting
Notice and Instructions for Completing Commercial Fire Application ACORD 68 RI
|
|
69
|
TX
|
Texas Special Mobile Home Windstorm & Hail Application - Texas Windstorm Insurance
Association
|
|
70
|
|
Personal Policy Change Request (Except Auto)
|
|
70
|
NY
|
Instructions for Completing Application for Commercial Insurance - NYPIUA
|
|
71
|
|
Personal Auto Policy Change Request
|
|
71
|
SC
|
Associated Auto Insurers Plan of South Carolina – Private Passenger Policy
Change Request
|
|
72
|
|
Certification of Mobile Home Tie Downs - Supplement to Mobile Home Application
|
|
73
|
|
Solid Fuel Questionnaire Personal Property Supplement
|
|
74
|
|
Residence Based Business Supplement to Personal Property Applications
|
|
75
|
|
Insurance Binder
|
|
76
|
|
Binder Log
|
|
78
|
|
Jewelry Insurance Appraisal-Single Item
|
|
79
|
|
Jewelry Insurance Appraisal
|
|
80
|
|
Homeowner Application
|
|
81
|
|
Personal Inland Marine Application
|
|
82
|
|
Watercraft Application
|
|
83
|
|
Personal Umbrella Application
|
|
84
|
|
Dwelling Fire Application
|
|
85
|
|
Mobile Home Application
|
|
86
|
|
Personal Lines Package Application
|
|
87
|
|
Personal Lines Package Application Watercraft/Inland Marine Supplement
|
|
90
|
AK
|
Alaska Personal Auto Application
|
|
90
|
AL
|
Alabama Personal Auto Application
|
|
90
|
AR
|
Arkansas Personal Auto Application
|
|
90
|
AZ
|
Arizona Personal Auto Application
|
|
90
|
CA
|
California Personal Auto Application
|
|
90
|
CO
|
Colorado Personal Auto Application
|
|
90
|
CT
|
Connecticut Personal Auto Application
|
|
90
|
DC
|
District of Columbia Personal Auto Application
|
|
90
|
DE
|
Delaware Personal Auto Application
|
|
90
|
FL
|
Florida Personal Auto Application
|
|
90
|
GA
|
Georgia Personal Auto Application
|
|
90
|
HI
|
Hawaii Personal Auto Application
|
|
90
|
IA
|
Iowa Personal Auto Application
|
|
90
|
ID
|
Idaho Personal Auto Application
|
|
90
|
IL
|
Illinois Personal Auto Application
|
|
90
|
IN
|
Indiana Personal Auto Application
|
|
90
|
KS
|
Kansas Personal Auto Application
|
|
90
|
KY
|
Kentucky Personal Auto Application
|
|
90
|
LA
|
Louisiana Personal Auto Application
|
|
90
|
MA
|
Application for Massachusetts Motor Vehicle Ins.
|
|
90
|
MD
|
Maryland Personal Auto Application
|
|
90
|
ME
|
Maine Personal Auto Application
|
|
90
|
MI
|
Michigan Personal Auto Application
|
|
90
|
MN
|
Minnesota Personal Auto Application
|
|
90
|
MO
|
Missouri Personal Auto Application
|
|
90
|
MS
|
Mississippi Personal Auto Application
|
|
90
|
MT
|
Montana Personal Auto Application
|
|
90
|
NC
|
North Carolina Personal Auto Application
|
|
90
|
ND
|
North Dakota Personal Auto Application
|
|
90
|
NE
|
Nebraska Personal Auto Application
|
|
90
|
NH
|
New Hampshire Personal Auto Application
|
|
90
|
NJ
|
New Jersey Personal Auto Application
|
|
90
|
NM
|
New Mexico Personal Auto Application
|
|
90
|
NV
|
Nevada Personal Auto Application
|
|
90
|
NY
|
New York Personal Auto Application
|
|
90
|
OH
|
Ohio Personal Auto Application
|
|
90
|
OK
|
Oklahoma Personal Auto Application
|
|
90
|
OR
|
Oregon Personal Auto Application
|
|
90
|
PA
|
Pennsylvania Personal Auto Application
|
|
90
|
PR
|
Puerto Rico Personal Auto Application
|
|
90
|
RI
|
Rhode Island Personal Auto Application
|
|
90
|
SC
|
South Carolina Personal Auto Application
|
|
90
|
SD
|
South Dakota Personal Auto Application
|
|
90
|
TN
|
Tennessee Personal Auto Application
|
|
90
|
TX
|
Texas Personal Auto Application
|
|
90
|
UT
|
Utah Personal Auto Application
|
|
90
|
VA
|
Virginia Personal Auto Application
|
|
90
|
VI
|
Virgin Islands Personal Auto Application
|
|
90
|
VT
|
Vermont Personal Auto Application
|
|
90
|
WA
|
Washington Personal Auto Application
|
|
90
|
WV
|
West Virginia Personal Auto Application
|
|
90
|
WI
|
Wisconsin Personal Auto Application
|
|
90
|
WY
|
Wyoming Personal Auto Application
|
|
91
|
|
Good Student/Driver Training
|
|
92
|
|
Medical Statement
|
|
93
|
|
Young Driver Questionnaire
|
|
94
|
HI
|
Hawaii Vehicle Inspection Report Supplement
|
|
94
|
NJ
|
Insurance Inspection Report
|
|
95
|
MA
|
Massachusetts Renewal Application (Statement of Facts)
|
|
97
|
SC
|
Associated Auto Insurers Plan of South Carolina – Private Passenger Application
|
|
97
|
WI
|
Wisconsin Automobile Plan - Private Passenger Auto Application
|
|
125
|
|
Commercial Insurance Application - Applicant Information Section
|
|
126
|
|
Commercial General Liability Section
|
|
127
|
|
Business Auto Section
|
|
128
|
|
Garage and Dealers Section
|
|
129
|
SC
|
Associated Auto Insurers Plan of South Carolina – Supplemental Vehicle Schedule
|
|
129
|
|
Vehicle Schedule
|
|
130
|
FL
|
Florida Workers Compensation Application
|
|
130
|
|
Workers Compensation Application
|
|
131
|
|
Umbrella/Excess Section
|
|
132
|
NJ
|
New Jersey Workers Compensation Insurance Plan Instructions and Rules
|
|
132
|
|
Truckers/Motor Carriers Section
|
|
133
|
|
Workers Compensation Insurance Plan Assigned Risk Section
|
|
133
|
FL
|
Florida Workers Compensation Joint Underwriting Association Inc. Addendum to 130
FL
|
|
133
|
MI
|
Michigan Application for Workers' Compensation Insurance
|
|
133
|
MT
|
Montana State Compensation Insurance Fund
|
|
133
|
NJ
|
New Jersey Workers Compensation Insurance Plan Application
|
|
133
|
TN
|
Tennessee Workers Compensation Insurance Plan Assigned Risk Supplement
|
|
133
|
WI
|
Wisconsin Workers Compensation Insurance Pool
|
|
134
|
|
Workers Compensation Application Supplement - Multi State Rating Worksheet
|
|
134
|
FL
|
Florida Workers Compensation Joint Underwriting Association Inc. Instructions for
Completing ACORD 130 FL & ACORD 133 FL
|
|
134
|
NJ
|
New Jersey Workers Comp. Insurance Plan Notice of Election - Proprietors and Partners
|
|
134
|
WI
|
Wisconsin Supplementary Non-Election Form
|
|
135
|
NJ
|
New Jersey Workers Compensation Insurance Plan - Supplemental Employee Leasing Application
|
|
135
|
WI
|
Wisconsin Supplementary Election of Coverage Form
|
|
136
|
NC
|
North Carolina Workers Compensation Insurance Plan - Instructions for Completing
ACORD 135 NC Application
|
|
136
|
NJ
|
New Jersey Workers Compensation Insurance Plan - Truckers Supplemental Application
|
|
136
|
WI
|
Wisconsin Supplementary Limited Other States Coverage Request
|
|
137
|
AK
|
Alaska Commercial Auto
|
|
137
|
AL
|
Alabama Commercial Auto
|
|
137
|
AR
|
Arkansas Commercial Auto
|
|
137
|
AZ
|
Arizona Commercial Auto
|
|
137
|
CA
|
California Commercial Auto
|
|
137
|
CO
|
Colorado Commercial Auto
|
|
137
|
CT
|
Connecticut Commercial Auto
|
|
137
|
DC
|
District of Columbia Commercial Auto
|
|
137
|
DE
|
Delaware Commercial Auto
|
|
137
|
FL
|
Florida Commercial Auto
|
|
137
|
GA
|
Georgia Commercial Auto
|
|
137
|
HI
|
Hawaii Commercial Auto
|
|
137
|
IA
|
Iowa Commercial Auto
|
|
137
|
ID
|
Idaho Commercial Auto
|
|
137
|
IL
|
Illinois Commercial Auto
|
|
137
|
IN
|
Indiana Commercial Auto
|
|
137
|
KS
|
Kansas Commercial Auto
|
|
137
|
KY
|
Kentucky Commercial Auto
|
|
137
|
LA
|
Louisiana Commercial Auto
|
|
137
|
MA
|
Massachusetts Commercial Auto
|
|
137
|
MD
|
Maryland Commercial Auto
|
|
137
|
ME
|
Maine Commercial Auto
|
|
137
|
MI
|
Michigan Commercial Auto
|
|
137
|
MN
|
Minnesota Commercial Auto
|
|
137
|
MO
|
Missouri Commercial Auto
|
|
137
|
MS
|
Mississippi Commercial Auto
|
|
137
|
MT
|
Montana Commercial Auto
|
|
137
|
NC
|
North Carolina Commercial Auto
|
|
137
|
ND
|
North Dakota Commercial Auto
|
|
137
|
NE
|
Nebraska Commercial Auto
|
|
137
|
NH
|
New Hampshire Commercial Auto
|
|
137
|
NJ
|
New Jersey Commercial Auto
|
|
137
|
NM
|
New Mexico Commercial Auto
|
|
137
|
NV
|
Nevada Commercial Auto
|
|
137
|
NY
|
New York Commercial Auto
|
|
137
|
OH
|
Ohio Commercial Auto
|
|
137
|
OK
|
Oklahoma Commercial Auto
|
|
137
|
OR
|
Oregon Commercial Auto
|
|
137
|
PA
|
Pennsylvania Commercial Auto
|
|
137
|
RI
|
Rhode Island Commercial Auto
|
|
137
|
SC
|
South Carolina Commercial Auto
|
|
137
|
SD
|
South Dakota Commercial Auto
|
|
137
|
TN
|
Tennessee Commercial Auto
|
|
137
|
TX
|
Texas Commercial Auto
|
|
137
|
UT
|
Utah Commercial Auto
|
|
137
|
VA
|
Virginia Commercial Auto
|
|
137
|
VT
|
Vermont Commercial Auto
|
|
137
|
WA
|
Washington Commercial Auto Coverages/Limits Section
|
|
137
|
WI
|
Wisconsin Commercial Auto
|
|
137
|
WV
|
West Virginia Commercial Auto
|
|
137
|
WY
|
Wyoming Commercial Auto - Coverages Limits Section
|
|
138
|
AK
|
Alaska Garage and Dealers
|
|
138
|
AL
|
Alabama Garage and Dealers
|
|
138
|
AR
|
Arkansas Garage and Dealers
|
|
138
|
AZ
|
Arizona Garage and Dealers
|
|
138
|
CA
|
California Garage and Dealers
|
|
138
|
CO
|
Colorado Garage and Dealers
|
|
138
|
CT
|
Connecticut Garage and Dealers
|
|
138
|
DC
|
District of Columbia Garage and Dealers
|
|
138
|
DE
|
Delaware Garage and Dealers
|
|
138
|
FL
|
Florida Garage and Dealers
|
|
138
|
GA
|
Georgia Garage and Dealers
|
|
138
|
HI
|
Hawaii Garage and Dealers
|
|
138
|
IA
|
Iowa Garage and Dealers
|
|
138
|
ID
|
Idaho Garage and Dealers
|
|
138
|
IL
|
Illinois Garage and Dealers
|
|
138
|
IN
|
Indiana Garage and Dealers
|
|
138
|
KS
|
Kansas Garage and Dealers
|
|
138
|
KY
|
Kentucky Garage and Dealers
|
|
138
|
LA
|
Louisiana Garage and Dealers
|
|
138
|
MA
|
Massachusetts Garage and Dealers
|
|
138
|
MD
|
Maryland Garage and Dealers
|
|
138
|
ME
|
Maine Garage and Dealers
|
|
138
|
MI
|
Michigan Garage and Dealers
|
|
138
|
MN
|
Minnesota Garage and Dealers
|
|
138
|
MO
|
Missouri Garage and Dealers
|
|
138
|
MS
|
Mississippi Garage and Dealers
|
|
138
|
MT
|
Montana Garage and Dealers
|
|
138
|
NC
|
North Carolina Garage and Dealers
|
|
138
|
ND
|
North Dakota Garage and Dealers
|
|
138
|
NE
|
Nebraska Garage and Dealers
|
|
138
|
NH
|
New Hampshire Garage and Dealers
|
|
138
|
NJ
|
New Jersey Garage and Dealers
|
|
138
|
NM
|
New Mexico Garage and Dealers
|
|
138
|
NV
|
Nevada Garage and Dealers
|
|
138
|
NY
|
New York Garage and Dealers
|
|
138
|
OH
|
Ohio Garage and Dealers
|
|
138
|
OK
|
Oklahoma Garage and Dealers
|
|
138
|
OR
|
Oregon Garage and Dealers
|
|
138
|
PA
|
Pennsylvania Garage and Dealers
|
|
138
|
RI
|
Rhode Island Garage and Dealers
|
|
138
|
SC
|
South Carolina Garage and Dealers
|
|
138
|
SD
|
South Dakota Garage and Dealers
|
|
138
|
TN
|
Tennessee Garage and Dealers Coverages/Limits Section
|
|
138
|
TX
|
Texas Garage and Dealers
|
|
138
|
UT
|
Utah Garage and Dealers
|
|
138
|
VA
|
Virginia Garage and Dealers
|
|
138
|
VT
|
Vermont Garage and Dealers
|
|
138
|
WA
|
Washington Garage and Dealers
|
|
138
|
WI
|
Wisconsin Garage and Dealers
|
|
138
|
WV
|
West Virginia Garage and Dealers
|
|
138
|
WY
|
Wyoming Garage and Dealers - Coverages/Limits Section
|
|
139
|
|
Statement of Values
|
|
139
|
MI
|
Michigan Automobile Insurance Placement Facility Supplement to ACORD Application.
Application for Commercial, Public Automobiles and Corporately Owned Vehicles
|
|
139
|
MS
|
Mississippi Statement/Schedule Of Values
|
|
140
|
|
Property Section
|
|
141
|
|
Crime Section
|
|
141 C
|
|
Crime Section 2000
|
|
143
|
|
Transportation Section
|
|
144
|
|
Glass and Sign Supplement
|
|
145
|
|
Accounts Receivable/Valuable Papers
|
|
146
|
|
Equipment Floater Section
|
|
147
|
|
Installation/Builders Risk Section
|
|
148
|
|
Electronic Data Processing Section
|
|
149
|
|
Dealer Section
|
|
151
|
|
Miscellaneous Crime Coverage Section
|
|
154
|
|
Jewelers Inventory Record
|
|
155 BM
|
|
Boiler & Machinery Section 2002
|
|
159
|
|
Schedule of Property Limits
|
|
160
|
|
Business Owners Application
|
|
163
|
|
Commercial Auto Driver Information Schedule
|
|
170
|
OH
|
Ohio FAIR Plan Underwriting Association - Instructions for Completion of Insurance
Applications
|
|
171
|
AK
|
Alaska Petition for Executive Officer Waiver
|
|
171
|
CO
|
Colorado Rejection of Coverage by Corporate Officers
|
|
171
|
CT
|
Workers' Compensation Commission of Connecticut
|
|
171
|
DE
|
Delaware Workers Compensation Election
|
|
171
|
FL
|
Florida Notice of Election of Coverage
|
|
171
|
GA
|
Georgia State Board of Workers Compensation Notice of Election or Rejection of Workers'
Compensation Coverage
|
|
171
|
IL
|
Illinois FAIR Plan Application for Commercial Property Insurance
|
|
171
|
KS
|
Kansas Election of Individual Partner or Self-Employed Individual
|
|
171
|
MI
|
Michigan Notice of Election
|
|
171
|
NJ
|
New Jersey Workers Compensation Plan - New Jersey Workers Compensation and Employers
Liability Manual, Part 3, Section 14
|
|
171
|
NM
|
New Mexico Executive Employee Affirmative Election Form
|
|
171
|
NY
|
New York Notice of Election of a Corporation
|
|
171
|
OH
|
Ohio FAIR Plan Underwriting Association - Application for Insurance - Basic Property
Application
|
|
171
|
PA
|
Pennsylvania Application for Executive Officer Exception From the Provisions of
the Pennsylvania Workers' Compensation Act: Section 104
|
|
171
|
VA
|
Virginia Rejection of Coverage Under The Virginia Workers' Compensation Act
|
|
172
|
CT
|
Workers' Compensation Commission of Connecticut
|
|
172
|
FL
|
Florida Revocation of Election to be Exempt
|
|
172
|
KS
|
Kansas Cancellation of Election of Individual
|
|
172
|
MI
|
Michigan Application for Exclusion of Partner(s)
|
|
172
|
NM
|
New Mexico Election to Accept
|
|
172
|
NY
|
New York Notice of Election of a Partnership or Sole Proprietorship to Bring Partners
or Self-Employed Persons Under the Coverage of the New York Workers Compensation
Law
|
|
172
|
OH
|
Ohio FAIR Plan Underwriting Association - Homeowners Supplement
|
|
172
|
PA
|
Pennsylvania Executive Officers Declaration
|
|
172
|
VA
|
Virginia Notice Terminating Prior Rejection of Coverage
|
|
173
|
CT
|
Workers' Compensation Commission of Connecticut
|
|
173
|
FL
|
Florida Notice of Election to be Exempt
|
|
173
|
KS
|
Kansas Cancellation of Election Not to Accept Coverage
|
|
173
|
MI
|
Michigan Workers Compensation Placement Facility Specific Person Exclusion Form
|
|
173
|
NM
|
New Mexico Revocation
|
|
173
|
NY
|
New York Notice of Election of an Incorporated Religious
|
|
173
|
OH
|
Ohio FAIR Plan Underwriting Association - Dwelling Fire Supplement
|
|
174
|
FL
|
Florida Revocation of Election of Coverage
|
|
174
|
KS
|
Kansas Election Not to Accept Coverage
|
|
174
|
NM
|
New Mexico Limited Liability Company Member Affirmative Election Form
|
|
174
|
NY
|
New York Revocation of an Incorporated Religious
|
|
174
|
OH
|
Ohio FAIR Plan Underwriting Association - Commercial Supplement
|
|
175
|
|
Commercial Policy Change Request
|
|
175
|
FL
|
Florida Workers Compensation Monthly Change Sheet
|
|
175
|
OH
|
Ohio FAIR Plan Underwriting Association - Farm Supplement
|
|
175
|
SC
|
Associated Auto Insurers Plan of South Carolina; Commercial Auto Policy Change Request
|
|
176
|
KS
|
Kansas Election of Employer to Cover Employees
|
|
176
|
OH
|
Ohio FAIR Plan Underwriting Association - Rehabilitation Supplement
|
|
177
|
CA
|
California Auto Supplement - Auto Body Repair Consumer Bill of Rights
|
|
177
|
KS
|
Kansas Election of Coverage for Volunteer Workers
|
|
177
|
OH
|
Ohio FAIR Plan Underwriting Association - Bowling Alley Supplement
|
|
177
|
SC
|
Associated Auto Insurers Plan of South Carolina; Commercial Application
|
|
177
|
WI
|
Wisconsin Automobile Insurance Plan - Business Auto Application
|
|
178
|
KS
|
Kansas Cancellation of Election of Employer To Cover Employees
|
|
178
|
WI
|
Wisconsin Automobile Insurance Plan - Truckers Application
|
|
179
|
KS
|
Kansas Cancellation of Election of Coverage for Volunteer Workers
|
|
179
|
SC
|
Associated Auto Insurers Plan of South Carolina; Garage Application
|
|
180
|
|
Errors and Omissions Section
|
|
180
|
KS
|
Kansas Election of Coverage for Persons Performing Public Service
|
|
181
|
KS
|
Kansas Cancellation of Election of Coverage for Persons Performing Public Service
|
|
181
|
SC
|
Associated Auto Insurers Plan of South Carolina; Company Performance Complaint Form
|
|
182
|
SC
|
Associated Auto Insurers Plan of South Carolina; Producer Performance Complaint
Form
|
|
182
|
KS
|
Kansas Election of a Noncompensated Volunteer To Be Covered
|
|
183
|
SC
|
Associated Auto Insurers Plan of South Carolina; Automobile Loss Notice
|
|
183
|
KS
|
Kansas Cancellation of Election of a Noncompensated Volunteer To Be Covered
|
|
184
|
SC
|
Associated Auto Insurers Plan of South Carolina; Garage Supplemental Form
|
|
185
|
SC
|
Associated Auto Insurers Plan of South Carolina; Uninsured & Underinsured Auto
Insurance Coverages Form for Private Passenger Risks
|
|
185
|
|
Restaurant/Tavern Supplement
|
|
186
|
SC
|
Associated Auto Insurers Plan of South Carolina; Uninsured & Underinsured Auto
Insurance Coverages Form for Commercial Risks
|
|
186
|
|
Contractors Supplement
|
|
187
|
SC
|
Associated Auto Insurers Plan of South Carolina; Name and/or Ownership Change
|
|
187
|
|
Professional Liability Supplement
|
|
188
|
SC
|
Associated Auto Insurers Plan of South Carolina; Endorsement Voiding Automobile
Insurance while Named Person is Operating Car
|
|
188
|
|
Employment Related Practices Liability Section
|
|
190
|
|
Supplemental Property Application
|
|
192
|
|
Equine Application
|
|
193
|
|
Open Cargo Section
|
|
194
|
|
Truckers/Motor Carrier Supplement, Request for State/Federal Filing Action
|
|
195
|
|
Design Professional's Individual Property Survey
|
|
196
|
|
Medical Professional Liability Insurance
|
|
199
|
|
Application Supplement - Undertaking
|
|
200
|
|
Producer Account
|
|
201
|
|
Producer Account Discrepancy Notice
|
|
210
|
|
Yacht Section
|
|
220
|
FL
|
Citizens Property Insurance Corporation, Commercial and Commercial - Residential
Wind Only Application
|
|
221
|
FL
|
Citizens Property Insurance Corporation, Wind Only Supplemental Commercial and Commercial
- Residential Application Schedule
|
|
225
|
|
Policyholder's Report
|
|
226
|
|
Statement of Premium Adjustment
|
|
301
|
|
Flood Insurance Application
|
|
302
|
|
Flood Insurance General Change Endorsement
|
|
303
|
|
Flood Insurance Preferred Risk Policy Application
|
|
304
|
|
Flood Insurance Cancellation/Nullification Form
|
|
401
|
|
Agriculture Application
|
|
402
|
|
Agriculture Property Section
|
|
403
|
|
Agriculture Property Section
|
|
404
|
|
Agriculture Liability Section
|
|
405
|
|
Agriculture Premises Diagram
|
|
410
|
|
Small Farm/Ranch Application
|
|
501
|
|
Surety Report of Execution
|
|
610
|
|
Premium Payment Supplement
|
|
752
|
|
Illustration Certification and Acknowledgement
|
|
758
|
|
Producer Appointment Data Sheet
|
|
764
|
|
Fair Credit Reporting Act Disclosure
|
|
765
|
|
Agent's Report
|
|
801
|
|
Railroad Protective Liability Supplement
|
|
802
|
|
Hotel/Motel Supplement
|
|
805
|
|
Jewelry Sales Receipt for Insurance Purposes
|
|
851
|
SC
|
Associated Auto Insurers Plan of South Carolina; Electronic Application Submission
Interface Retraction Request Form
|
|
851
|
TX
|
Texas Personal LInes Supplement - Use of Credit Information Disclosure
|
|
852
|
TX
|
Texas Personal Lines Supplement (Spanish Version) - Use of Credit Information Disclosure
|
|
855
|
CA
|
California FAIR Plan Property Insurance - Application for Property Insurance
|
|
856
|
CA
|
California FAIR Plan Property Insurance - Business Owners Application
|
|
857
|
CA
|
California Earthquake Authority - Application for Earthquake Insurance
|
|
810
|
|
Business Income / Extra Expense / Rental Value Supplement to Property Section
|
|
811
|
|
Value Reporting Information Supplement to Property Section
|
|
812
|
|
Agency Questionnaire
|
|
813
|
|
Request for Proof of Property Insurance
|
|
815
|
|
International Liability Exposure Supplement
|
|
816
|
|
International Property Exposure Supplement
|
|
823
|
|
Commercial Insurance Application Supplement - Additional Premises Information Section
|
|
860
|
CA
|
California Auto Supplement - Driver Self Certification
|
|
861
|
CA
|
California Residential Property Insurance Bill of Rights
|
|
861
|
LA
|
Louisiana Auto Supplement - Active Military Personnel Affidavit
|
|
862
|
WV
|
West Virginia Property Supplement - Notice of Flood Coverage Exclusion
|