Ambulance and hospital fleet
Additional coverage forms and supplements
- Management liability - For profit new business
- Management liability - Not for profit new business
- Management liability - For profit renewal business
- Management liability - Not for profit renewal business
In addition to the application, we need the following:
- 3-5 years of currently valued hard copy carrier loss runs
- Driver schedule to include full driver name, DL #, DL state, date of birth, and date of hire
- MVR's if available
- Vehicle schedule to include year, make, ambulance manufacturer, type (I, II, or III), original cost new, current value, and lienholder information (for example - 2003 Ford AEV type II OCN $72,000 / ACV $28,000 on lien)
- If new or newer venture (less than 3 years in business), please also include resumes of the firm principals, a copy of their business plan, and current financial statements
Return to the agent portal to upload the completed application.
Having a trouble with an application?
Adobe Acrobat Reader must be integrated with your web browser to enable you to complete our applications and forms online.
Should you have difficulty printing or opening fillable forms online, please save the form to your desktop (select "Save As" or "Save Link As" by right clicking on the hyperlink to the desired form) and then open and complete the form locally using Adobe Acrobat.Contact us should you have any issues and need a hard copy emailed, faxed or mailed to you.