Producer Appt. Forms  

WC Submission Forms

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Producer Appointment Forms   
      Producer Appointment Application Form
  Producer Agreement
  IRS Form W-9 (Request For Taxpayer ID No. and Certificate)
   
Workers' Compensation Forms
  Broker of Record Letter - WC
  Broker of Record Letter - Release By Current Broker
  Confidential Request For Ownership Information - Form (ERM-14)
  Confidential Request For Ownership Information - Instructions
  Commercial Insurance Application (ACORD 125)
  Workers’ Compensation Application (ACORD 130)
  Supplemental Workers’ Compensation Application - Regular
  Supplemental Workers’ Compensation Application - Framers
  Supplemental Workers’ Compensation Application - Roofers
  Waiver of Subrogation Job Exposure Worksheet (AmTrust)
  Waiver of Subrogation Job Exposure Worksheet (Companion)
  Waiver of Subrogation Job Exposure Worksheet (Everest)
  Waiver of Subrogation Job Exposure Worksheet (ICW)
  Waiver of Subrogation Job Exposure Worksheet (Republic Indemnity)
  Waiver of Subrogation Job Exposure Worksheet (Republic Underwriters)
  Waiver of Subrogation Job Exposure Worksheet (Star)
   
Employee Benefits Forms
 

Check List - Information Needed to Request Employer Stop Loss Quotation
(Self-Funded Employee Benefits Plan)

   
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