Surplus Lines Forms for Download

		D-1 Disclosure Statement.pdf
		SL2 Diligent Search Report

Supplemental Applications

		Auto Service
		Arson Supplement
		Bar/Tavern
		Bed-N-Breakfast
		Lessors Risk
		Mobile Home Park
		Motel
		Metalworker
		Restaurant
		Retail and / Office
		Apartments
		Specialty Contractor
		Beauty Salons
		Daycare
		Health Club Studios
		Special Events
		Tanning
		Welders

Commercial Auto Program

Argonaut Midwest Insurance Company

		CenCal Comm Auto Application CA 6-1-2008 Argonaut Midwest Insurance Company application. Addmitted "A" Rated by A.M. Best Co.
		CenCal CA Uninsured Motorist Coverage 6-1-2008 California Uninsured (Including Underinsured) Motorists Coverage Selection/Rejection, Waiver of Collision Deductible.
		CenCal Terrorism Risk 6-1-2008 Disclosure of Important Information Relating to Terrorism Risk Insurance Act.
		CenCal Hired Auto Coverage Supplemental 6-1-2008 Complete if hired auto coverage is desired. (This coverage not available unless written with primary auto liability including non-owned coverage)
		CenCal Non-Owned Auto Supplemental 6-1-2008 Complete if non-owned coverage is desired. (This coverage not available unless written with primary auto liability including hired auto coverage)
		QuickQuote Auto Application Please fax completed form to: 925-275-0281 or email for processing.

Empire Fire and Marine Insurance Company

		Commercial Automobile Application EM 20 07 (01-93)
		Insurance for Non-Trucking Use EM 20 22 (10-98)
		Non-Owned Auto Coverage Supplement EM 22 13 (01-98)
		Hired Auto Coverage Supplement EM 22 14 (01-98)
		Empire California Uninsured (Incuding Underinsured) Motorists Coverage Selection/Rejection EM 10 45 (01-04)
		Motor Truck Cargo Application EM 20 02 (10-98)
		Application for Commercial General Liability EM 20 05 (10-98)
		Automobile Inspection Report EM 22 01 (03-89)
		autoapplicationquickquote.pdf Quick Quote Application

Commercial Trucking Programs

		Delos Trucking Application Delos Trucking Application - California local intermediate only
		CenCal Comm Auto Application CA 6-1-2008 Argonaut Midwest Insurance Company application. Addmitted "A" Rated by A.M. Best Co.
		CenCal CA Uninsured Motorist Coverage 6-1-2008 California Uninsured (Including Underinsured) Motorists Coverage Selection/Rejection, Waiver of Collision Deductible.
		CenCal Terrorism Risk 6-1-2008 Disclosure of Important Information Relating to Terrorism Risk Insurance Act.
		CenCal Hired Auto Coverage Supplemental 6-1-2008 Complete if hired auto coverage is desired. (This coverage not available unless written with primary auto liability including non-owned coverage)
		CenCal Non-Owned Auto Supplemental 6-1-2008 Complete if non-owned coverage is desired. (This coverage not available unless written with primary auto liability including hired auto coverage)
		QuickQuote Auto Application Please fax completed form to: 925-275-0281 or email for processing.