Mid-Atlantic

Online Applications


Allied Medical & Social Services


*MHCF New Business Application
*MHCF Renewal Application
*Specified Medical Professions Application
Acupuncturists Application
Adoption/Foster Placement Agency
Adult Day Care
Allied Medical General Application
Ambulance Services - to be completed with New or Renewal App
Ambulatory Surgery Centers - to be completed with New or Renewal App
Ambulatory Surgical Centers
Assisted Living Facility
Blood Donor Banks - to be completed with New or Renewal App
Chiroprators Professional Application
Claim Information Supplement
Clinical Trials
Clinics (Medical, Public Health, Dental) Application
Counselors and Counseling Facilities
Day Care Centers and Nurseries
Dental Professional
Durable Medical Equipment
Emergency Care Services Professional
Exercise and Health Studios
Group Home Non-Elderly Residents
Home Health & Hospice Care - to be completed with New or Renewal App
Home Health Care-Medical Staffing Agency
Laboratory & Imaging - to be completed with New or Renewal App
Locum Tenens Contract Staffing Application
Managed Care Organizations
Medical Laboratories, Medical Imaging Center and Blood PlasmaPheresis Centers
Medical Spas - to be completed with New or Renewal App
Medical Students
Mental Health/Retardation Facilities Application
No-Known Claims Statement
Paramedics, EMT
Physical-Occupational Therapy Center
Social Service Organization
Supplement for Airambulance Operators( *to be submitted with Spec Med App)
Supplement for Blood Banks ( *to be submitted with Spec Med App)
Supplement for Home Health/Medical Staffing ( *to be submitted with Spec Med App)
Supplement for Nurse Anesthetists -CRNA ( *to be submitted with Spec Med App)
Supplement for Testing Laboratories ( *to be submitted with Spec Med App)
Supplemental Claim Information


Business Auto / Trucking


.Argonaut Transportation App
Argonaut Dump Truck Supplement
Argonaut Hire Auto Supplement
Argonaut Non-Owned Auto Supplement
Canal Commercial Combination Ins. Application - Kentucky
Canal Commercial Combination Ins. Application - Maryland
Canal Commercial Combination Ins. Application - Pennsylvania
Canal Commercial Combination Ins. Application - West Virginia
Canal Commercial Combination Ins. Application with Supp- West Virginia
Canal Supplemental Application - Maryland
Canal Truck Renewal/Anniversary Update Form
Canal Truck Renewal/Anniversary Update Form
Canal Truck Renewal/Anniversary Update Form
Essex Commercial Physical Damage Application
Essex Motor Truck Cargo Application
National Casualty Commercial Auto Application
National Casualty Hired & Non-Owned Application
National Casualty Motor Truck Cargo Supplement
NICO Cargo Application (stand alone)
NICO Cargo Supplement to be attached to Trucking application
NICO DE Business Auto / Trucking Application
NICO DE Contingent / Non-Trucking Use Application
NICO Hired & Non-Owned Auto Supplement
NICO KY Non-Trucking Use Application
NICO KY Truck Application
NICO MD Business / Trucking Application
NICO MD Contingent / Non-Trucking Use Application
NICO Mobile Home Transporters Supplement
NICO NC Truck application
NICO Ohio Business / Trucking Application
NICO Ohio Non-trucking Use Application
NICO PA Business Auto/Trucking Application
NICO PA Contingent / Non-Trucking Use Application
NICO Renewal Application
NICO Reposessors Supplemental
NICO SC Contingent / Non-Trucking Use Application
NICO SC Trucking Application
NICO Tow Truck Supplement
NICO TRIA Notice
NICO VA Business Auto / Trucking Application
NICO VA Non-Trucking Use Application
NICO WV Business Auto / Trucking Application
NICO WV Non-Trucking Use Application
Stratford PA Truck Application
Tow Truck Supplement
WV Split Limits Form


Directors & Officers / Employment Practices


Fiduciary E&O Application
Claim Warranty Letter
Click Here for the Answer!
Community Association Product Application
Corporate D&O and EPLI Application
D&O - Condo Association Application
D&O - Non Profit Application
Employment Practices Liability Application
EPLI - New Jersey Addendum
EPLI - Pennsylvania Addendum
EPLI - Virginia Addendum
EPLI application
Supplement - EPLI Third Party Discrimination
Management Liability Coverages

Environmental


Contractors & Consultants Pollution Application
Contractors & Consultants Application
Contractors Pollution Application (for Non-Pollution Contractors
Environmental Impairment (Petroleum Storage Tanks)
Environmental Impairment (Site Specific Pollution)
Environmental Service Providers (Engineers, Consultants, Contractors)
Mold Consultants Application
Mold Coverage for Non-Environmental Contractors
Mold Remediation Contractors
Site Specific Pollution Liability Application
Underground Storage Tank Application


Garage


Colony - Garage Service App
Essex Dealers Open Lot / Garage Keepers Legal
Heavy Vehicle Service Questionnaire
National Casualty Garage Application
NICO (All States) Automobile Services Operations (Garage)
NICO (All States) Motorcycle and Recreational Vehicle Dealers Garage Application
NICO DE Selelction Forms
NICO DE Used Auto Dealer Application
NICO Garage TRIA Notice
NICO MD Selection Forms
NICO MD Used Auto Dealer Application
NICO PA Selection Forms
NICO PA Used Auto Dealer Application
NICO SC Used Auto Dealer Application
NICO Tow Truck Supplement
NICO VA Selection Forms
NICO VA Used Auto Dealer Application
NICO WV & OH Used Auto Dealers Application
NICO WV Selection Forms


General Liability


Amusement Centers and Devices Supplemental Application
Beauty Salons, Barber Shops and Spas (GL/Prof)
Burlington Restaurant Bar and Tavern Supplement
Caterers & Halls Application
Club Liability
Condominium & Homeowners Association GL Application
Day Care Application
Hull and Company Restaurant Bar and Tavern
Farms and Ranches General Liability
Habitational Questionnaire
Health & Exercise Studios (GL/Prof)
Home Health Care & Nurse Registries Application
Leased Employees Provided to Others Application
Marinas
Nutraceuticals & Dietary Supplements Questionnaire (Complete with Products App)
Pest Control Services (GL/Prof)
Products Completed Operations
Recreational Facilities
Recycling Center Supplemental Application
Schools (GL/Prof)
Security Guards and Detective Agencies (GL/Prof)
Sexual Molestation Coverage
Social Services Application (GL/Prof.)
Special Events / Spectators Liability
Special Events Liability (USLI)
Swimming Pools, Beaches
Truckers Supplemental GL Application
USLI Restaurant Bar and Tavern
Vacant Building Application


General Liability - Contractors Applications


Artisan Contractors Supplement
Blasting Questionnaire
Contractors Equipment Rental - GL Application
Contractors Supplemental Application
Contractors Supplemental Application for NY/NJ Offices
Crane Operators Supplemental Application
Demolition Application
General Contractors Application
OCP /Builders Risk Supplement (to be completed with an Acord App)
Owners & Contractors Protective Liability Application
Penn America TRIA Notice
Roofers Questionnaire
Snow Removal Questionnaire
Tree Surgeons and Landscapers (GL/Prof)
Welding Supplement
Western World TRIA Notice


Liquor Liability and R/B/T


Burlington Restaurant Bar and Tavern Supplement
Hull and Company Restaurant Bar and Tavern
Hall Rental / Caterers Liquor Supplement
Liquor Liability Application
Liquor Liability Application
Liquor Liability Application
Liquor Liability Renewal Application
Multi - Location Liquor Supplement
Off-Premises Liquor Supplement
Special Event Liquor Liability
Special Events Liability
USLI Restaurant Bar and Tavern


Media


* Media Application to be completed with Supplement
.Advertising Application
Advertising Agency Application
Author Supplement
Book Publisher Supplement
Broadcasters - Radio, Television & Cable Supplement
Cable Television Operator Supplement
Commercial Printing Supplement
Film & Program Distributor Supplement
Film, Program & Theatrical Producer Supplement
Magazine Publisher Supplement
Multimedia Supplement
Music Publisher Supplement
Newpaper Application
Online Content & Professional Services Supplement
Personal Appearance & Media Contributor Supplement


Medical Malpractice


Application
Application - Bariatric Surgery Supplement
Application - Renewal
Application - Substance Impairment Supplement
Application - Urgent Care Supplement
Claim Information Supplement
Click Here for some Examples of what Hull and Company Can Do!
Statement of No Known Claims
Waiver of Insured's Consent to Settle


Products Liability


Products Liability Application
Questionnaire for Nutraceuticals & Dietary Supplements (Complete with Products App)


Professional / E&O


* Consultants & Specified Professions App
* Misc. Professional Application - complete with one of the following supplemental apps
* Specified Professions/STP E&O Application
Adult Day Care Centers(GL/Prof)
Advertising Agency/Public Relations Supplemental App
Architects & Engineers E&O
Beauty Salons, Barber Shops and Spas (GL/Prof)
Collection Agencies Supplement
Commercial Property Managers App
Computer/ Electronic Data Processing Supplemental App
Day Care Centers and Nurseries
Employee Leasing Service Supplemental App
Employment Agency / Executive Search Supplemental App
Executive Recruiting Consutants Supplment
Individual Travel AgentsSupplement (*complete w/ Consultants app)
Information Technology Professionals E&O App
Insurance Agents & brokers Professional Liability App
International Trade Related Services Supplement
Law Enforcement
Leased Employees Provided to Others
Mortgage Bankers Supplemental App
Mortgage Brokers Supplement (* complete w/ Consultants app)
Multimedia Supplement
Pest Control Services (GL/Prof)
Premium Finance Supplement
Printers Supplemental App
Real Estate E & O Application
Real estate Services Supplement
Residential Property Managers Professional Liab App
Schools (GL/Prof)
Security Guards and Detective Agencies (GL/Prof)
Technology Professional Liability Application
Travel Agents Supplement (* complete with Specified Professions app)
Travel Agents/ Tour Operations Supplemental App
Tree Surgeons and Landscapers (GL/Prof)
Volunteer Firefighters E&O


Property / Marine


Builders Risk Application
Burlington Restaurant Bar and Tavern Supplement
Contractors Equipment Floater Application
Contractors Equipment Floater Application (USLI)
Dealers Open Lot/GKLL
Hull and Company Restaurant Bar and Tavern
Excess Flood - Commercial Lines
Excess Flood - Personal Lines Lines
Fine Arts Supplemental Application
Habitational (Apartments/Dwellings/boarding homes)
Jewelers Block
Marine Comprehensive Liability
Motor Truck Cargo (Canal)
Motor Truck Cargo (Essex)
Open Cargo
Terrorism Application (Property)
USLI Restaurant Bar and Tavern
Vacant Building Application
Warehouseman's Legal Liability
Wind Application (Eastern Seaboard)


Public Auto and Special Types


Argonaut Passenger Carrier App
Argonaut Passenger Carrier Supplement
Essex High Value Physical Damage Application
Essex Taxi Application for Auto Liability (Not for PA or NJ)
National Casualty Public Auto - All Other Supplement
National Casualty Public Auto - Charter/Sightseeing/Intercity Buses
National Casualty Public Auto - Social Service & Ambulance
NICO DE Public Auto Application
NICO DE Special Types Application
NICO Hired & Non-Owned Auto Supplement
NICO KY Public Auto Application
NICO KY Special Types Application
NICO MD Public Auto Application
NICO MD Special Types Application
NICO OH Public Auto Application
NICO OH Special Types Application
NICO PA Public Auto Application
NICO PA Special Types Application
NICO Renewal Questionnaire
NICO SC Public Auto Application
NICO SC Special Types Application
NICO Short Term Rental - Autos and Trucks
NICO TRIA Notice
NICO VA Public Auto Application
NICO VA Special Types Application
NICO WV Public Auto Application
NICO WV Special Types Application
Stratford PA Public Auto Application


Quik Quote Questionnaires


Auto Dealers Operations Fast Trac
Hatboro Quik Quote Questionnaire -Truckers/Auto 1-4 units
NICO Automobile Service Operations Fast Trac Questionnaire
Pittsburgh Quik Quote Questionnaire for Local & Intermediate Trucking
West Virginia Quik Quote Questionnaire


Selection Forms


Colony/Argonaut WV Selection Form
National Casualty PA Selection Forms
NICO (all States) Hired and Non/Owned
NICO DE Selection Form
NICO MD Selection Form
NICO PA Selection Forms
NICO VA Selection Form
NICO WV Selection Form
Stratford Selection Forms


end faq

 

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West Virginia
3768 Teays Valley Road
Suite 200
Hurricane, WV 25526
800.982.3882

 

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One Forestwood Drive
Suite 203
Pittsburgh, PA 15237
800.892.5938

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