Producer Appt. Forms  

WC Submission Forms

 

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    Downloads
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
  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 (Everest)
  Waiver of Subrogation Job Exposure Worksheet (ICW)
  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)