Forms

Submiting forms:

1. Type the required information in the gray boxes on the form, print the completed form, and fax to 888-329-8842.

2. Print the form first, handwrite in the necessary information, and fax it to 888-329-8842.


Personal Insurance Forms:

Auto Claim

General Liability Claim

Property Claim

Request Change of Broker Record
Please type in your information in the gray boxes provided, print and mail to your current insurance carrier

Business Forms:
Auto Claim

General Liability Claim

MVR Release

If you are a business owner please have your employee(s) type in their information in the gray boxes provided. Once completed the form can be printed for the employee(s) signature and date of completion. The form can be returned via fax 559-440-9752 or mail to PO Box 27020, Fresno, CA 93729-7020

Property Claim Form

Request Change of Broker of Record
Please type in your information in the gray boxes provided, print and mail to your current insurance carrier

Request of Loss Runs

Please type in your information in the gray boxes provided, print and mail to your current insurance carrier

Cal-OSHA Document Request Form