MGA Forms


Company Specific Forms added 11/03/2006

Company Specific Forms

Macchia General Agency

  • Farmers and Ranchers Mobile
  • Farmers and Ranchers Homeowners
  • Southern County Mutual Travel Trailer Application
  • Republic Van Guard Mobile Home Application
  • Republic Van Guard Homeowners Application
  • Republic Van Guard HO-B Manufactured Home Application

National Group Insurance

  • Artisan Liability Application
  • Balance Sheet
  • Business Auto Application
  • Commercial Auto Application
  • Commercial Auto Garage Policy Change Request
  • Commercial General Liability Application
  • Commercial Insurance Application
  • Commercial Property Application
  • Crime Application
  • Debit-Credit Worksheet
  • Equipment Floater Section
  • Garage – Garagekeeper Legal Liability Application
  • Garage Supplement Application
  • Glass Sign Supplement Application
  • Habitational Questionnaire
  • Liquor Liability Application
  • Restaurant Supplemental Questionnaire
  • Self Audit Checklist
  • Service Station Application
  • Service Station Supplemental
  • Total Office Protection Program Application

 

Company Specific Forms added 8/3/2006

Company Specific Forms

American Reliable

Commercial Equine Liability Application
Farmers and Ranchers Commercial Excess Liability Application
Farm/Ranch Application

Canal

Commercial Motor Vehicle Liability and Physical Damage Application

Century

Contractors Questionnaire
Garage Application
Habitational Supplemental Questionnaire
Liquor Liability Application
Motorcycle Supplemental
Restaurant Supplemental Questionnaire
Recreational Vehicle Supplemental
Special Events Application

Great American

Pleasure Horse Individual Owners Liability
Camp Supplemental Application
Equine Care, Custody, and Control Application
Equine Farm & Ranch Application
Equine Liability
Race Horse Owners Liability – CA
Race Horse Owners Liability – Except CA
Woodburning Stove Questionnaire

Hartford

Animal Mortality Application
Aquaculture Stock Mortality Application
Confined Swine Application
Dairy Cattle Application
Exotic Animal Mortality Application
Feedlot Application
Livestock Market Application
Pasture Cattle Application

ISERA

General Recreation Audit Information Form
General Recreation Discovery Questionnaire
Inflatable Jump Audit Information Form
Inflatables Discovery Questionnaire
Monthly Events Schedule

Lloyds

Corporate Supplemental

Markel

Mortality & Theft Application
Private Horse Owner Application
Substantiation of Value
Standard All Risk Mortality & Theft Application

NAS

Supplemental Builders Risk Application
Supplemental Builders Risk Renovation Application

Performance

Avian Flu Business Interruption
Avian Flu Farm Schedule
Avian Flu Application
Farm Pollution Hazard Application
Poultry/Swine Supplemental Questionnaire
Property Program Application

St. Paul – Travelers

Agribusiness Insurance Application
Boat Application
Boat / Yacht Quote Sheet
Care, Custody, and Control Questionnaire
Commercial Equine Liability Application
Equine Liability Renewal Questionnaire
Farm/Ranch Application
Insured’s Statement of Health
Livestock Insurance Application
Older Building Checklist Supplemental Questionnaire
Pleasure Horse Owners Liability Application
Poultry Questionnaire
Winery Supplemental Questionnaire
Yacht Quote / Application

WOGA

Climbing Operations Supplemental Discovery Questionnaire
Equestrian Risk Supplemental Discovery Questionnaire
General Liability Discovery Questionnaire
Guided River Trips Supplemental Discovery Questionnaire
Monthly Events Schedule

MGA and Company Specific Forms added 7/18/2006

MGA Forms

GuideOne Insurance

Builders Risk Supplemental App
Cornerstone Plus Application
IRPM – Individual Risk Premium Modification

Brownyard Programs

Security Guard, Private Investigative and Alarm Agencies Excess Liability Application
Private Security Agency Umbrella Liability Application

Southern Cross Underwriters

Adult Daycare General Liability Application
Alarm Installation, Servicing, Monitoring or Repair General Liability Application
Amusement Program Supplemental Application

Sullivan Company California

American Modern Watercraft Application
Navigators Insurance Personal Liability Application
Navigators Insurance Personal Umbrella Application
American Modern Personal Watercraft Application

Americas 1st Financial

Jefferson-Pilot Annuity Application

Aberdeen Insurance Group

Habitational Application/Supplemental
Contractors Questionnaire
Contractors Classification Listing
Contractor Warranty
Credit Check Supplemental
Employment Practices Liability Premium Short Form
Janitorial Services Supplemental Questionnaire
Coverage Limits Warranty
Loss Warranty Letter
PA Commercial Auto Coverage Selection Form
Commercial Package Application

Insure Your Horse

Equestrian Day Camp Supplemental
Pony / Horse Drawn Vehicle Rides Supplemental

AFC Insurance

Social Service Agencies Application

Affinity Programs

Employment Practices Liability Premium Short Form
Professional Liability Insurance

American Collectors

American Bankers NJ Standard Antique Auto Selection Form – 5000 Miles
NJ Antique Motorcycle Application
American Bankers NJ Antique Motorcycle Selection Form
American Bankers NJ Standard Antique Auto Selection Form – 2500 Miles
NJ Standard Antique/Classic Car Application
NJ Standard Modified Vehicle Application
American Bankers NJ Standard Modified Vehicle Application – 5000 Miles
American Bankers NJ Standard Modified Vehicle Application – 2500 Miles

Anderson Murison

Law Enforcement Professional Liability Application

Apogee

Educators Legal Liability Application
House Inspectors Professional Liability Application
Professional Liability Application

Apollo General

Contractors Claims Made Application
Contractors Questionnaire
Contractors and Consultants Application
Courier Driver Schedule
Courier Program Questionnaire

Bond Brokers

Underwriting Kit

Brecht and Associates

Commercial Auto Application

Horizon Surplus

Gemini Contractors Questionnaire

K & B

James River Allied Healthcare General Application

MiniCo

MiniPak Gold Application

Ray Rochester

Church Profile

South and Western

American Modern Watercraft Application

The Combined Group

Employer’s First Report Of Injury
Employer’s Report for Reimbursement of Voluntary Payment
Employer’s Wage Statement

Underwriters Direct Access

General Liability
Homeowners

Vista

Climbing Wall Questionnaire

Company Specific Forms

American Modern

Watercraft Application
Personal Watercraft Application

Navigators Insurance

Personal Liability Application
Personal Umbrella Application

Jefferson-Pilot

Jefferson-Pilot Annuity Application
Annuity Application

Lexington

Social Service Agencies Application
Employment Practices Liability Application

American Bankers

American Bankers NJ Antique Motorcycle Selection Form
American Bankers NJ Standard Antique Auto Selection Form – 2500 Miles
American Bankers NJ Standard Modified Vehicle Application – 5000 Miles
American Bankers NJ Standard Modified Vehicle Application – 2500 Miles

Western World

Law Enforcement Professional Liability Application

Seneca Environmental

Contractors Claims Made Application
Contractors and Consultants Application

Gemini

Contractors Questionnaire

Indiana Lumberman’s Mutual

Indiana Worker’s Compensation First Report
Michigan Employer’s Basic Report of Injury
Minnesota First Report of Injury
Texas Employer’s First Report of Injury

James River

Allied Healthcare General Application

Medical Mutual Group

Entity Professional Liability Application
Medical Practitioners Professional Liability Application
Non-Physician Personnel Professional Liability Application

Scottsdale

Supplemental Claim Information
Public Entity Application
Adult Daycare General Liability Application
Amusement Program Supplemental Application
Bars/Restaurants/Taverns General Liability Application
Beauty/Barber Shop and Day Spa Liability Application
Motor Truck Cargo Application
Motor Truck Cargo Supplemental Application
Commercial Auto Application
Dwelling & Habitational Fire Application

Tapco

Dwelling Fire Application

Cap-Dat ACORD has listened to our users. As a result we will be adding 1000’s of MGA and company specific applications and forms to our site. We believe this will make the service even more useful.

We will be releasing new forms every week or 10 days for the next several months. If you have a specific MGA or company group of forms that you would like us to get to quickly, please email me with the name.

New Forms – June 29th, 2006 Cap-Dat ACORD has introduced the following:

Beauchamp McSpadden

Agribusiness and Farm Insurance Application
Business Agreement
Heating Supplemental
Older Building Supplemental


Florida Workers Comp JUA

Applicant Affidavit
Contractor Supplemental
Employer Affidavit
Acknowledgement by Employer of Terms and Conditions of an “If Any” Policy
Wage Information

Piedmont Mutual

Consent To Rate
Roof Exclusion
Special Liability Exclusion
Supplemental Application
Swimming Pool Exclusion

Prime Insurance Syndicate

ISERA General Recreation Audit
ISERA General Recreation Discovery
ISERA Inflatable Jump Audit
ISERA Inflatables Discovery
ISERA Monthly Events Schedule
UDA General Liability
UDA Commercial Liability
UDA Homeowners
WOGA Climbing Operations Supplemental
WOGA Equestrian Risk Supplemental
WOGA General Liability Discovery
WOGA Guided River Trips Supplemental
WOGA Monthly Events Schedule

South Carolina Medical Malpractice JUA

Hospital Professional Liability Application
Partnership Professional Liability Application
Supplemental Professional Liability Application
Dentists and Oral Surgeons Professional Liability Application
Nurse, Pharmacist, Physician Assistant, Anesthesia Assistant, and Surgical Technician Professional Liability Application
Physician Professional Liability Application
Locum Tenens Physician Underwriting Application
Locum Tenens Physician Coverage Request
Loss Notice

Tower Services

American Bankers Nonowned Horses Liability Application
American Reliable Farmers and Ranchers Commercial Excess Liability Application
American Reliable Farm Application
American Reliable Commercial Equine Liability Application
Performance Insurance Avian Flu Business Interruption Form
Performance Insurance Avian Flu Schedule of Farms
Performance Insurance Avian Flu Application
Beef Operations Questionnaire
St Paul Travelers Commercial Equine Liability Application
St Paul Travelers CCC Supplemental
St Paul Travelers Livestock Insurance Application
St Paul Travelers Mortality Application
Dairy Operations Questionnaire
St Paul Travelers Farm/Ranch Application
Farm Pollution Hazard Application
The Hartford Aquaculture Stock Mortality Application
The Hartford Confined Swine Application
The Hartford Dairy Cattle Application
The Hartford Exotic Animal Mortality Application
The Hartford Feedlot Application
The Hartford Livestock Market Application
The Hartford Animal Mortality Application
The Hartford Pasture Cattle Application
Hog Confinement Questionnaire
Lagoon Questionnaire
Lloyds Property Application
Poultry Operation Questionnaire
Poultry Supplemental
Performance Insurance Poultry/Swine Supplemental Application
Poultry/Swine Application
Canal Commercial Motor Vehicle Liability and Physical Damage Application
St Paul Travelers Pleasure Horse Owners Liability Application
St Paul Travelers Winery Supplemental
St Paul Travelers Boat Application
Tower Services Cover Page
Underground Tank Questionnaire

New Forms – June 22th, 2006 Cap-Dat ACORD has introduced the following:

Grocers Insurance Company – 5 Forms

Druggist Supplemental Electronic Application
Property supplemental Application
Retail Shopping Center Supplemental Application

Strip Mall Supplemental Application
Workers Compensation Assessment Form

Capitol Indemnity Corporation – 21 Forms

Swimming Pool Questionaire
Restaurant / Tavern Questionnaire
Resort / Campground Questionnaire
Fitness Club Questionnaire
Sports Club / Clay Target Questionnaire
Hunting Club Questionnaire
Bowling Center Questionnaire
Golf Course Questionnnaire
Contractors Questionnaire
Mobile Home Park Questionnaire
Fairground Application
Detective & Security Agency Application
Clubs – Veterans and Non-Profit Applications
Day Care Premises – Swimming Pool Questionnaire
Adult Day Care Questionnaire
Child Care Questionnaire
Artists & Crafters Program Questionnaire
3-B Program Questionnaire
Special Events and Sports Questionnaire
Alarm Installation or Monitoring Questionnaire
Martial Arts Questionnaire

Topa Insurance Company – 6 forms

Restaurants – Supplemental Application
California Residential Property Insurance Bill of Rights
California Residential Property Insurance Disclosure
C.O.C. Questionnaire
Dwelling Fire App
Homeowners Supplemental Application

Big Sky Underwriters – 21 Forms

Swimming Pool Questionnaire
Restaurant / Tavern Questionnaire
Resort / Campground Questionnaire
Fitness Club Questionnaire
Sports Club / Clay Target Questionnaire
Hunting Club Questionnaire
Bowling Center Questionnaire
Golf Course Questionnaire
Contractors Questionnaire
Mobile Home Park Questionnaire
Fairground Application
Detective & Security Agency Application
Clubs – Veterans and Non-Profit Applications
Day Care Premises – Swimming Pool Questionnaire
Adult Day Care Questionnaire
Child Care Questionnaire
Artists & Crafters Program Questionnaire
3-B Program Questionnaire
Special Events and Sports Questionnaire
Alarm Installation or Monitoring Questionnaire
Martial Arts Questionnaire

New ACORD related Commercial Vehicle Schedule Forms

We have added ten new versions of the ACORD 129 form. As you know, if you combine the same schedule form to list a larger group of vehicles than the 6 on an ACORD 129, the field names in the forms are the same, so you overwrite each added form.

This new list of forms is for specific groups of cars in a schedule. For instance, if you have a fleet of 15 cars you would combine the forms for units 1-6, 7-12 and 13-18. These forms have been setup with unique data filed names so they will not overwrite each other.

We will be doing the same for the driver and property schedules soon.

New Forms – June 12th, 2006 Cap-Dat ACORD has introduced the following:

ABCO

ABCO Named Driver Exclusion
ABCO Non-Business Use Statement
ABCO Statement of Diligent Effort
ABCO Statement of No Loss
Accounts Receivable Valuable Papers – combine with Commercial Insurance Application
Business Auto Section – combine with Commercial Insurance Application
Chubb Cancellation Request Loss Policy Release
Chubb Homeowners
Chubb Inland Marine
Chubb Personal Auto
Chubb Personal Policy Change Request Except Automobile
Chubb Personal Umbrella
Commercial Auto Driver Information Schedule
Commercial General Liability Section – combine with Commercial Insurance Application
Commercial Insurance Application
Commercial Policy Change Request
Crime Section – combine with Commercial Insurance Application
Crime Section 2000 – combine with Commercial Insurance Application
Florida Commercial Auto – combine with Commercial Insurance Application
Florida Garage and Dealers – combine with Garage and Dealers Section and Commercial Insurance Application
Florida Workers Compensation Monthly Change Sheet
Florida Workers Compensation Application
Garage and Dealers Section
GMAC Auto – Personal Insurance Application
GMAC Commercial Auto Application
Homeowner Application
Personal Inland Marine Application
Installation Builders Risk Section – combine with Commercial Insurance Application
LexElite Builders Risk Supplemental Application
LexElite Homeowners Application
LexElite Excess Flood Application
Lexington Personal Umbrella Excess Liability Policy Application
LexElite Personal Umbrella (A) Excess Liability (B) Information
Lloyds Cancellation Request Policy Release
Lloyds Homeowner Application
Lloyds Florida Personal Auto Application
Lloyds Personal Policy Change Request – Excluding Automobile
Lloyds Vacant Property Application
Motorcycle Quote Request
Personal Umbrella Application
Property Section – combine with Commercial Insurance Application
Umbrella Section
Vehicle Schedule
Watercraft Application
Workers Compensation Application

 

Abrams Interstate

Flood Application and Quote Sheet
Apartment Building Program
Homeowner Application
Evidence of Personal Property Insurance
Agent/Broker of Record Change
Supplemental and Alternate Heating Questionnaire
California Race and Gender Form
California Personal Auto Application
California Offer of Earthquake Coverage
Camp Supplement Application – Great American
Cancellation Request Policy Release
California Residential Property Insurance Disclosure
Equine Care, Custody and Control Application – Great American
Race, National Origin and Gender Community Service Statement – Topa Insurance
Commercial General Liability Section
Commercial Insurance Application
Commercial Policy Change Request
Property Section
Contractors Questionnaire – Century Insurance Group
Dwelling Fire Application
Earthquake Coverage Request
Equine Care, Custody and Control Application Supplemental
Equine Farm and Ranch Application – Great American
Equine Liability Application – Great American
Equine Farm and Ranch Insurance Application
Equipment Floater Section
Agricultural Insurance Company – Equine Division
Garage Application – Century Insurance Group
Equine Liability Application
Habitational Supplemental Questionnaire – Century Insurance Group
Mortality and Theft Application – Markel Insurance Group
Earthquake Coverage Request Form – ICAT
Pleasure and Show Horse – Individual Horse Owners Liability – Great American
Personal Inland Marine Application
LexElite Composite Application – California
LexElite Supplemental ACORD Application – California
LexElite Insurance Application
Liquor Liability Application – Century Surety Group
Lloyds of London Program – Supplemental Corp or LLC Questionnaire
Mobile Home Application
Motorcycle Supplement – Century Insurance Group
New Ventures Supplemental Questionnnaire
New Ground Up – Builders Risk Supplemental Application – North American Specialty Insurance Company
Non-Admitted – Surplus Lines Carrier Notice – California
Personal Auto Policy Change Request
Personal Policy Change Request Except Auto
Private Horseowner Application – Markel Insurance Co.
Prior Construction or Renovation Start Questionnaire – Builders Risk
Professional Liability Errors and Omissions Section
Property Loss Notice
Remodel – Renovation – Rehabilation Supplemental Builders Risk Application – North American Specialty Ins Co.
Restaurant – Bar – Tavern – Nightclub Supplemental Questionnaire – Century Surety Co.
Race Horse Owners Liability – All States Except California – Great American
Race Horse Owners Liability – California – Old Rates – Great American
Recreational Vehicle Supplement – Century Insurance Group
SL-2 – Diligent Search Report
Substantiation of Value – Showing – Markel Insurance Co.
Special Events Coverage – Century Surety Co.
Standard All Risk Theft and Mortality Application – Markel Insurance Co.
Supplemental Corporate or LLC Questionnaire
Supplemental Homeowners Application – Topa Insurance Co.
Agribusiness Insurance Application – St. Paul Travelers
Care, Custody and Control Questionnaire – St. Paul Travelers
Application for Commercial Equine Liability – St. Paul Travelers
Preferred Home and Dwelling Supplemental Questionnaire
California Residential Property Insurance Disclosure – Topa
Preferred Home and Dwelling Supplemental Questionnaire – Travelers
Boat Application – Travelers
Boat/Yacht Quote Sheet – Travelers
Quick Qualifier Application – Travelers
Yacht Application – Travelers
Umbrella / Excess Section
Personal Umbrella Application
Water Disclosure – Topa
Woodburning Stove Questionnaire – Great American
Supplemental Heating Questionnaire – Woodburning