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• Completed Acord Applications, including expiring and target premiums
• Schedule of Maintenance Equipment & Golf Carts
  (Include Replacement Cost Value for each item)
• Four Years of Hard-Copy Loss Information for each coverage being requested
• Current Audited Financial Statement or Income and Expense Statement
• Completed and Signed Supplemental Applications
  • Copies of All Applicators' Licenses
  • Copy of Prior Pollution Declaration Page
    (Including retroactive date and Tank Schedule)
• Completed Fiduciary Questionnaire/Application and Completed Directors & Officers Liability Application - include all required attachments
  • Copy of Current 5500 Annual Return
  • Fiduciary Liability Questionnaire is needed only if ERISA Liability is desired
• Excess Crime (if limits exceed $250,000)
• Full Pollution Application
• Brokerage Agreement including W9 form

Liberty Mutual Group of Companies is the underwriter for the Program and offers financial stability, excellent claims service, and specialized loss control services.