Carolina Casualty Insurance Corporation
Applications
State Applications for 15 and under Power Units
Effective
2
-200
8
Non-Fleet Application 1-15 Units
(CTP5037 03-10)
(Please include appropriate State Supplemental)
Non-Fleet Application Extension
IL Supplemental Application 1-15 Units
IN Supplemental Application 1-15 Units
KY Supplemental Application 1-15 Units
MI Supplemental Application 1-15 Units
OH Supplemental Application 1-15 Units
Fleet Application
(CTP5036 03-10)
Fleet Application
Word Fill (CTP5036 03-10)
Non Trucking Application
(CTP5446 02-00)
Non Trucking Application
Word Fill (CTP5446 02-00)
Missouri Commercial Auto Fleet
(CTP5036MO 03-10)
Missouri Commercial Auto Non Fleet
(CTP5037MO 03-10)
Cargo Application
(CTP5377 02-00)
Cargo Application
Word Fill (CTP5377 02-00)
Drive Away and Toter Application
(CTP5802 01-11)
Drive Away and Toter Application
Word Fill (CTP5802 01-11)
G/L Liability Supplemental
(CTP5038 07-99)
G/L Liability Supplemental
Word Fill (CTP5038 07-99)
Racing Program
(CTP5525 02-00)
Hired Non Owned Supplemental
(CTP5599 07-99)
Hired Non Owned Supplemental
Word Fill (CTP5599 07-99)
Truckers Supplement to Acord
(CTP 5599 07-99)
Truckers Supplement to Acord
Word Fill
(CTP 5599 07-99)
Uninsured & Underinsured Motorist, PIP Forms
UM/UIM Selection Form - Alabama
(ILU041 1208)
UM/UIM Selection Form - Alabama
Word Fill (ILU041 1208)
UM/UIM Selection Form - Arizona
(CTP5353 10-03)
UM/UIM Selection Form - Arizona
Word Fill (IL U 030 12-04)
UM/UIM Selection Form - Arkansas
(CTP5442 10-99)
UM/UIM Selection Form - Colorado
(CTP5275 12-06)
UM/UIM Selection Form - Colorado
Word Fill (CTP5275 12-06)
UM/UIM Selection Form - Florida
(IL U 002 12-03)
UM/UIM Selection Form - Florida
Word Fill (IL U 002 12-03)
Waiver of PIP Coverage - Florida
(CTP 5316 10-03)
Waiver of PIP Coverage - Florida
Word Fill (CTP 5316 10-03)
UM/UIM Selection Form - Illinois
(ILU003 09-03)
UM/UIM Selection Form - Indiana
(CTP 5320 03-10)
UM Selection Rejection Form - Kansas
(IL U 047 03-06)
UM/UIM Selection Form - Kentucky
(CTP5321_01-08)
UM/UIM Selection Form - Kentucky
Word Fill (CTP5321_01-08)
UM/UIM Selection Form - Maryland
(CTP5325 01-03)
UM/UIM Selection Form - Maryland
Word Fill (CTP5325 01-03)
Waiver of PIP Coverage - Maryland
(CTP5324 12-93)
Waiver of PIP Coverage - Maryland
Word Fill (CTP5324 12-93)
UM/UIM Selection Form - Michigan
Word Fill (CTP5362 03-10)
UM/UIM Selection Form – Minnesota
Word Fill (IL U 055 06-08)
UM/UIM Selection Form – Minnesota
(IL U 055 06-08)
PIP Stacking Options - Minnesota
(CTP5327 12-93)
PIP Stacking Options - Minnesota
- Word Fill (CTP5327 12-93)
UM/UIM Selection Form - Missouri
(CTP5403 03-09)
UM/UIM Selection Form - Missouri
Word Fill (CTP5403 03-09)
UM/UIM Selection Form - Nebraska
(CTP5329 01-96)
UM/UIM Selection Form - Nebraska
Word Fill (CTP5329 01-96)
UM/UIM Selection Form - New Jersey
(CTP5528 08-98)
UM/UIM Selection Form - New Jersey
Word Fill (CTP5528 08-98)
UM/UIM Selection Form - North Carolina
(CTP5331 12-93)
UM/UIM Selection Form - North Carolina
- Word Fill (CTP5331 12-93)
UM/UIM Selection Form - Oklahoma
(IL U 023 04 05)
UM/UIM Selection Form - Oklahoma
Word Fill (IL U 023 04 05)
UM/UIM Selection Form - Ohio
(CTP5332 03-10)
UM/UIM Selection Form - South Carolina
(ILU_007_01-07)
UM/UIM Selection Form - South Carolina
Word Fill (ILU_007_01-07)
UM/UIM Selection Form - Tennessee
(ILU050 01-09)
UM/UIM Selection Form - Tennessee
Word Fill (ILU050 01-09
)
UM/UIM Selection Form - Texas
Word Fill (CAU005 04-08)
PIP Rejection Form - Texas
Word Fill (520)
UM Selection Form - Virginia
(CTP5064_04-04)
UM Selection Form - Virginia
Word Fill (CTP5064 04-04)
UM Selection Form - Washington
(CA2134 03-06)
UM Selection Form - Washington
- Word Fill (CA2134 03-06)
UNDERINSURED Selection Form - Washington
(ILU008 04-06)
UNDERINSURED Selection Form - Washington
-
Word Fill (ILU008 04-06)
PIP Selection Form - Washington
- (CTP 5448 06-94)
PIP Selection Form - Washington
- Word Fill (CTP 5448 06-04)
UM Selection Form - West Virginia
(ILU011 09-03)
UM Selection Form - West Virginia
Word Fill
(ILU011 09-03)
UM/UIM Selection Form - Wisconsin
(CAU007 01-08)
UM/UIM Selection Form - Wisconsin
Word Fill (CAU007 01-08)
Supplements and other forms
Estimated Annual Rates for Ohio UM/UIM
Physical Damage Monthly Report of Values
(509 06-98)
Physical Damage Monthly Report of Values
Word Fill (509_06-98)
Monthly Report of Gross Receipts or Mileage
(583 11-07)
Monthly Report of Gross Receipts or Mileage
Word Fill (583 11-07)
Letter of Credit
(Sample)
Security Agreement - Deductible Liability Agreement
(Sample)
Passengers and For-Hire Truckers
Loss Reporting Procedures
Driver Guidelines
Lost Policy Release
(ILT001 05-05)
Supplemental Application - Municipal and County Taxes -
AL, AR, DE, FL, KY, LA, MD, NV, SC
(578 12-08)
Supplemental Application - Municipal and County Taxes -
AL, AR, DE, FL, KY, LA, MD, NV, SC
Word Fill (578 12-08)
Minnesota Supplemental Application
(CTP5360 08-94)
Minnesota Supplemental Application
Word Fill (CTP5360 08-94)
Oklahoma Sexual Abuse Exclusion Endorsement
(CTP 5408 03-09)
Drive-A-Way Toter Supplemental Questionnaire
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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