Public Sector Insurance Services - Applications
Please print and complete the following applications and ask your agent or broker to submit to the underwriting contact in your territory.
Information on agent/broker member programs is available at the ACORD website.
Municipalities
Public sector services insurance application
Public sector services insurance multi-use (All states EXCEPT MT and NC)
Public sector services utility
Dams, levees, dikes, canals, flood walls
Workers compensation (N/A in Wisconsin)
Public Sector Services CyberRisk Applications:
- Admitted Application (All States EXCEPT AK, NY and VT)
- NY Free Trade Zone (NYFTZ) or Excess & Surplus (E&S) (NY and VT Only)
- Renewal Applications
- Admitted (All States EXCEPT AK, NY and VT)
- NY Free Trade Zone (NYFTZ) or Excess & Surplus (E&S) (NY and VT Only)
- Employed Lawyers Supplements
- Admitted (All States EXCEPT AK, NY and VT)
- NY Free Trade Zone (NYFTZ) or Excess & Surplus (E&S) (NY and VT Only)
- Payment Card Supplements
- Admitted (All States EXCEPT AK, NY and VT)
- NY Free Trade Zone (NYFTZ) or Excess & Surplus (E&S) (NY and VT Only)
- Social Engineering Fraud Supplements
- Admitted (All States EXCEPT AK, NY and VT)
- NY Free Trade Zone (NYFTZ) or Excess & Surplus (E&S) (NY and VT Only)
