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-A CW 1209) Business Auto Questionnaire word fill (U-GU-785-A CW 1209) Cargo Questionnaire(U-GU-777-A CW 1209) Cargo Questionnaireword fill (U-GU-777-A CW 1209) Commercial Auto Questionnaire (U-GU-833-B CW 1209) Commercial Auto Questionnaire word fill (U-GU-833-B CW 1209) Dump Questionnaire (U-GU-784-A CW 1209) Dump Questionnaire word fill (U-GU-784-A CW 1209) Environmental Transport Questionnaire (U-GU-778-A CW 0508) Environmental Transport Questionnaire word fill (U-GU-778-A CW 0508) Hired & Non-Owned Questionnaire (U-GU-776-A CW 1209) Hired & Non-Owned Questionnaire word fill (U-GU-776-A CW 1209) 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-B CW 1209) Public Auto Questionnaire word fill (U-GU-786-B CW 1209)

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 and Fliers

Driver Guidelines Helping to Protect your Business Zurich Dumping Operations Flyer Zurich Garbage and Waste Operations Flyer Zurich Miscellaneous Business Auto Flyer Zurich Petroleum Operations Flyer Zurich Public Auto Operations Flyer Zurich Trucking Operations Flyer New Federal DOT regulations for small passenger-carrying motor carriers

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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 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 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 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)

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Maxum Casualty

Applications

Truck Application A002-10-09 Truck Application A002-10-09 Word Fill Truckers GL Application GL APP 01 2006 Truckers GL Application GL APP 01 2006 Word Fill

Supplements and other forms

Supplemental Application Supplemental Application Word Fill New Venture Supplement UM/UIM Selection Form Indiana A020-11-06 UM/UIM Selection Form Indiana A020-11-06 Word Fill UM/UIM Selection Form Michigan A050-04-07 Letter of Credit Letter of Credit Word Fill Renewal Questionnaire Renewal Questionnaire Word Fill

Miscellaneous Flyers about Maxum

Maxum Key Facts Transportation - Coverage and Service Reasons to do Business Claims Service Claims Handling

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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

Supplements and other forms

Freight Forwarders Liability and Contingent Cargo Transportation Brokers Liability and Contingent Cargo

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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     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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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

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E-mail Submission to: Autoquotes@CreativeUnderwriters.com

Transportation Fax: (317) 848-7869