Public Sector Insurance Services - Applications
Please print and complete the following applications and have your agent/broker submit it to the underwriting contact in your territory.
Information on agent/broker member programs is available at the ACORD website.
Municipalities:
Public Sector Services Insurance Application
Public Sector Services Insurance Multi-Use (All states EXCEPT MT and NC)
Public Sector Services Utility
Dams, Levees, Dikes, Canals, Flood Walls
Workers Compensation (N/A in Wisconsin)
Cyber
Public Sector Services CyberRisk Applications:
- Admitted Application (All States EXCEPT CA, FL, MD, NY, TX, VT and WA)
- New York Free Trade Zone or Excess & Surplus Application (NY and VT Only)
- Renewal Applications
- Admitted (All States EXCEPT CA, FL, MD, NY, TX, VT and WA)
- NYFTZ or Excess/Surplus (NY and VT Only)
- Employed Lawyers Supplements
- Admitted (All States EXCEPT CA, FL, MD, NY, TX, VT and WA)
- NYFTZ or Excess/Surplus (NY and VT Only)
- Payment Card Supplements
- Admitted (All States EXCEPT CA, FL, MD, NY, TX, VT and WA)
- NYFTZ or Excess/Surplus (NY and VT Only)
- Social Engineering Fraud Supplements
- Admitted (All States EXCEPT CA, FL, MD, NY, TX, VT and WA)
- NYFTZ or Excess/Surplus (NY and VT Only)
CyberFirst Liability Application (CA, FL, MD, TX and WA Only)