Zurich

Questionnaires and Applications Each questionnaire should be completed and returned in conjunction with the required Accord application(s) as stated at the top of the form.

Business Auto Questionnaire (U-GU-785-E CW 1011) Business Auto Questionnaire word fill (U-GU-785-E CW 1011) Cargo Application (All States Except Ohio) Cargo Application (All States Except Ohio) word fill Cargo Questionnaire (Ohio only) (U-GU-777-C CW 1209) Cargo Questionnaire (Ohio only) word fill (U-GU-777-C CW 1209) Renewal Application for all Zurich Commerical Auto Accounts (U-GU-833-C CW 1011) Renewal Application for all Zurich Commerical Auto Accounts word fill (U-GU-833-C CW 1011) Dump Questionnaire (U-GU-784-D CW 1011) Dump Questionnaire word fill (U-GU-784-D CW 1011) Motor Carrier Questionnaire (U-GU-776-E CW 0212) Motor Carrier Questionnaire word fill (U-GU-776-E CW 0212) Non Truck Application (U-GU-799-A CW 0209) Non Truck Application word fill (U-GU-799-A CW 0209) Public Auto Questionnaire (U-GU-786-F CW 1011) Public Auto Questionnaire word fill (U-GU-786-F CW 1011) Public Auto Renewal Questionnaire (U-GU-834-C CW 1011) Public Auto Renewal Questionnaire word fill (U-GU-834-C CW 1011)

Uninsured & Underinsured Motorist Forms

Illinois UM/UIM Selection/Rejection Form (U CA 248D IL) Illinois UM/UIM Selection/Rejection Form word fill (U CA 248D IL) Indiana UM/UIM Selection/Rejection Form (UA 179b) Indiana UM/UIM Selection/Rejection Form word fill (UA 179b) Ohio UM/UIM Selection/Rejection Form (EM1020)

Other forms, Fliers and useful Links

Driver Guidelines Helping to Protect your Business Zurich Auto Accident Report Guide Zurich Claim Service Proposal Zurich Claims Fact Sheet Zurich Claims Reporting Guide Zurich Dumping Operations Flyer Zurich Garbage and Waste Operations Flyer Zurich Miscellaneous Business Auto Flyer Zurich Motor Vehicle Enhancements Flyer Zurich Non-Trucking Flyer Zurich Petroleum Operations Flyer Zurich Public Auto Operations Flyer Zurich Trucking Operations Flyer New Federal DOT regulations for small passenger-carrying motor carriers Zurich Risk engineering and loss prevention tools

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National Casualty / Scottsdale Insurance

Applications

Commercial Auto Application (CA-APP-1) Commercial Auto Application (CA-APP-1) word fill Commercial Auto Application Renewal (CA-APP-REN-1) Commercial Auto Application Renewal (CA-APP-REN-1) word fill Commercial Auto/Truckers Supp App (CA-APP-27) (Use with Accord) Commercial Auto/Truckers Supp App (CA-APP-27) (Use with Accord) Word Fill Motor Truck Cargo Application (CTS-APP-2) Motor Truck Cargo Application (CTS-APP-2) word fill Motor Truck Cargo Supplemental (CTS-APP-1) General Liability Supplemental Application National Casualty For Hire Application (CA-APP-25 07-11) National Casualty For Hire Application (CA-APP-25 07-11) word fill National Casualty GL For Hire Supp (GL-APP-86g 07-11) National Casualty GL For Hire Supp (GL-APP-86g 07-11) word fill Extension – Schedule of Driver Info (CA-APP-28) Extension – Schedule of Driver Info CA-APP-28) word fill Non-Trucking Application (CAS-APP-8) SIC Garage Insurance Application Truck Driving School Application Truck Driving School Application word fill

Uninsured & Underinsured Motorist Forms

UM/UIM Selection Form Arkansas UM/UIM Selection Form Illinois UM/UIM Selection Form Indiana UM/UIM Selection Form Kentucky UM/UIM Selection Form Missouri Estimated Annual Rates for Ohio UM/UIM UM/UIM Selection Form Ohio UM/UIM Selection Form Ohio word fill UM/UIM Selection Form Oklahoma

Supplements and other forms

Kentucky No Fault / PIP (NF1a 1 P&C) Audit Report - Commercial Auto (CA-STMT-2) Broker of Record Letter (UTS-217) Drive-A-Way/Toter Supplemental (CA-APP-18) Drive-A-Way/Toter Supplemental (CA-APP-18) word fill Hazardous Material Supplemental (CA- APP-19) Hazardous Material Supplemental (CA- APP-19) word fill Hired & Non-Owned Auto Supplement (CA-APP-12) Hired & Non-Owned Auto Supplement (CAS-APP-12) SIC Michigan PIP Selection/Rejection (NOTX0399MI) Public Auto - Ambulance (CAS-APP-3) Public Auto - Ambulance (CAS-APP-3) word fill Public Auto - Charter / Sightseeing / Intercity Buses (CA-APP-2) Public Auto – Charter / Sightseeing / Intercity Buses (CAS-APP-2) word fill Public Auto - Limousine and Airport Shuttle (CA-APP-4) Public Auto – Limousine and Airport Shuttle (CAS-APP-4) word fill Public Auto - Non-Emergency Transport (CA-APP-20) Public Auto - Non-Emergency Transport (CA-APP-20) Public Auto - All Other Risks (CA-APP-5) Public Auto - All Other Risks (CA-APP-5) word fill Tow Trucks / Wreckers Supplemental (CA-APP-16) Driver Guidelines Claim Reporting Information Monthly Reporter for Liability Monthly Reporter for Liability (word fill) Monthly Reporter for Physical Damage Monthly Reporter for Physical Damage (word fill) For Hire Trucking E-Flyer Long Haul Flyer Letter of Credit Sample

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Lloyds of London

Applications

Auto Physical Damage (NMA1561) Motor Truck Cargo Proposal / Application Ocean Marine Cargo Application New Venture Profile Logging Equipment Proposal / Application Trash & Safeguard Warranty Disclosure Notice of Terrorism

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Great American Insurance Company

Applications

Cargo Application Motor Truck Cargo Coverage Form   Possible endorsements that may apply   Restricted Theft Coverage Endorsement   Tarpaulin Warranty and Ginning Warranty for Baled Cotton   Brokers Liability and Contingent Cargo Liability

Supplements and other forms

Freight Forwarders Liability and Contingent Cargo Transportation Brokers Liability and Contingent Cargo Great American Claim Reporting Procedures

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Hartford

Applications

Hartford Motor Truck Cargo Application Hartford Motor Truck Cargo Application Word Fill Confirmation of Rejection of Coverage – Terrorism Risk Insurance Act Inland Marine (IH 09 54 02 06) Confirmation of Rejection of Coverage – Terrorism Risk Insurance Act Inland Marine Word Fill (IH 09 54 02 06) Hartford General Liability Application Cargo Supplemental Questionnaire Warehouse Legal Logistics Application Warehouse Legal Logistics Program Highlights     Hartford - Carrier For Hire Marketing Information Hartford - Cargo Coverage Analyzer     Cargo Coverage Form Sample Form Cargo Extra Expense Sample Form Mechanical Breakdown of Refrigeration Sample Form Carrier For Hire Reporting Endorsement Sample Form   Hartford - Worldwide Transportation Policy Marketing Material Ocean Cargo Application Hartford - Ocean Cargo Coverage Analyzer

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General Star

Applications

Excess Contract Coverage Excess Auto Quick Quote App

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ACE

Applications

Environmental Claims Services Hazardous Transporters Commercial Auto

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OneBeacon

Non-Trucking Liability and Vehicle Physical Damage

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Miscellaneous Forms

Drive-A-Way & Toter Questionnaire Drive-A-Way & Toter Questionnaire Word Fill Truck Driving School Questionnaire Terminal Questionnaire Supplemental Trucking for use with Accord Application Truckers Supplemental Questionnaire Non-Trucking Monthly Reporter Hired Auto Supplemental Questionnaire Non-Owned Auto Supplemental Questionnaire Miscellaneous Public Auto Miscellaneous Public Auto Renewal CAB's Resume 2000 Auto Mechanical Inspection Report Lost Policy Release Monthly Report Power Units Monthly Report Power Units Word fill Ohio Fraud Warning Commercial Auto Diamond State Flyer New Venture Questionnaire New Venture Questionnaire word fill Quick Quote Trucking Application

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E-mail Submission to: Autoquotes@CreativeUnderwriters.com

Transportation Fax: (317) 848-7869