Applications
Our Process
As a broker, you play a vital role in helping your clients find the right insurance partner. We’re here to help you navigate the quoting process, and help our mutual client find the best coverage and services.
As an insurance carrier, we work with any broker or agent of the customer’s choice. We do not offer insurance direct, without a broker.
Submissions
Please send all materials listed below to [email protected] to make a formal submission.
Package / Excess
ACORD 125 Applications
Loss Runs (5 Years)
Audited Financial Report
Statement of Values
New Business Questionnaire
12- and 15-Passenger Vans:
- Transportation Action Plan ⤓ (if you own or use vans)
Map of Camp(s) (for all organizations that operate camps)
Wildfire Self-Assessment ⤓ (if you have camp locations in AZ, CA, CO, ID, MT, NM, NV, OK, OR, TX, UT, WA or WY)
Workers’ Compensation
ACORD 130 Application
Loss Runs (5 Years)
Audited Financial Report
Premium History (5 Years)
Payroll History (5 Years)
Experience Mod Worksheet
Experience Mod History (4 Years)
Directors & Officers / EPLI
Audited Financial Report
Loss Runs (5 Years)
Current Declarations Page
Package / Excess Renewal
Audited Financial Report
Statement of Values
Renewal Questionnaire
12- and 15-Passenger Vans:
- Transportation Action Plan ⤓ (if you own or use vans)
