Search
  • States RRG
    • Home
    • About
    • Agents & Brokers
    • Downloads & LinksCurrently selected
    • Members
  • Affiliations and Partnerships

 ​

Need States' Application Forms?

 

You can download States' Application forms by just "right clicking" your mouse on the blue title links below and choosing the menu instructions to download the chosen document to the file location you select on your computer. Simply download the appropriate application form(s), complete it based on the instructions on the form and submit it to Jay Mathiason, [email protected] or fax (612) 766-3398.

Application Forms are provided in Microsoft Word and PDF formats .  The MS Word format allows completion of the form information fields "electronically" using a computer with MS Word installed.  If you do not have MS Word available to you, you can download and print out the PDF format version and completing the form manually. Microsoft Word format documents ares indicated by  icons,  PDF format documents are indicated by  icons. Download time will vary depending upon file size, connection speed and your computer system's capabilities.

TypeUse SHIFT+ENTER to open the menu (new window).
  
NameUse SHIFT+ENTER to open the menu (new window).
  
Form Description
File SizeUse SHIFT+ENTER to open the menu (new window).
  
collapse Form Type : Primary Forms ‎(6)
collapse Title : States' Primary Application Form ‎(2)
1 States PRIMARY App.-01.2008 UPDATED edition.doc1 States PRIMARY App.-01.2008 UPDATED edition
(REQUIRED FOR ALL NEW BUSINESS AND EVERY THIRD YEAR ON DOWNLOADRENEWALS)

(A separate application is required for any public school operations that are part of the public entity applying for insurance from States. See that application listed below. Supplemental application information may also be required. Please check with States' Underwriting Dept. for assistance.)
483 KB
1 States PRIMARY App.-01.2008 UPDATED edition.pdf1 States PRIMARY App.-01.2008 UPDATED edition
(REQUIRED FOR ALL NEW BUSINESS AND EVERY THIRD YEAR ON DOWNLOADRENEWALS)

(A separate application is required for any public school operations that are part of the public entity applying for insurance from States. See that application listed below. Supplemental application information may also be required. Please check with States' Underwriting Dept. for assistance.)
167 KB
collapse Title : States' Public Schools Application Form ‎(2)
2 PUBLIC SCHOOLS App.- 11.2007 UPDATED edition.doc2 PUBLIC SCHOOLS App.- 11.2007 UPDATED edition
This appplication form is for use by Public Schools where no other municipal operations are involved ---- only the school operations. The form is designed to simplify the application process for public schools and minimize the need to complete application information that does not appply. If other public entity operations exist beyond those of the public school, the main application form should also be used (see States Primary Application Form above).
338 KB
2 PUBLIC SCHOOLS App.- 11.2007 UPDATED edition.pdf2 PUBLIC SCHOOLS App.- 11.2007 UPDATED edition
This appplication form is for use by Public Schools where no other municipal operations are involved ---- only the school operations. The form is designed to simplify the application process for public schools and minimize the need to complete application information that does not appply. If other public entity operations exist beyond those of the public school, the main application form should also be used (see States Primary Application Form above).
137 KB
collapse Title : States' RENEWAL Application Form ‎(2)
3 States RENEWAL App.-11.2007 UPDATED edition.doc3 States RENEWAL App.-11.2007 UPDATED edition
Intended for use in renewal periods between the new business application (first year) and the subsequent two renewal years. Every third renewal year, an original, "primary" application form should be complete, subject to underwriting requirements.
388 KB
3 States RENEWAL App.-11.2007 UPDATED edition.pdf3 States RENEWAL App.-11.2007 UPDATED edition
Intended for use in renewal periods between the new business application (first year) and the subsequent two renewal years. Every third renewal year, an original, "primary" application form should be complete, subject to underwriting requirements.
65 KB
collapse Form Type : Supplementary Forms ‎(6)
collapse Title : Application Supplement for 15 Passenger Van Operations ‎(2)
6 States Supp App.-15 PSGR VAN OPS-11.2006.doc6 States Supp App.-15 PSGR VAN OPS-11.2006
Application Supplement for 15 Passenger Van Operations
70 KB
6 States Supp App.-15 PSGR VAN OPS-11.2006.pdf6 States Supp App.-15 PSGR VAN OPS-11.2006
Application Supplement for 15 Passenger Van Operations
39 KB
collapse Title : Application Supplement for Day Care and/or Nursery Operations ‎(2)
5 States Supp App.-DAY CARE-NURSERY-11.2006.doc5 States Supp App.-DAY CARE-NURSERY-11.2006
Application Supplement for Day Care and/or Nursery Operations
73 KB
5 States Supp App.-DAY CARE-NURSERY-11.2006.pdf5 States Supp App.-DAY CARE-NURSERY-11.2006
Application Supplement for Day Care and/or Nursery Operations
30 KB
collapse Title : Application Supplement for Sexual & Physical Abuse Information ‎(2)
4 States Supp App.-SEXUAL-PHYS ABUSE INFO-11.2006.doc4 States Supp App.-SEXUAL-PHYS ABUSE INFO-11.2006
Application Supplement for Sexual & Physical Abuse Information
103 KB
4 States Supp App.-SEXUAL-PHYS ABUSE INFO-11.2006.pdf4 States Supp App.-SEXUAL-PHYS ABUSE INFO-11.2006
Application supplement for sexual & physical abuse information.
36 KB
Create Power View Report
/_layouts/15/images/ReportServer/16reportx_sp.gif
/downloads/_layouts/15/ReportServer/AdHocReportDesigner.aspx?list={ListId}&ID={ItemId}&ViewMode=Edit
0x0
0x1
FileType
bism
350
Create Power View Report
/_layouts/15/images/ReportServer/16reportx_sp.gif
/downloads/_layouts/15/ReportServer/AdHocReportDesigner.aspx?list={ListId}&ID={ItemId}&ViewMode=Edit
0x0
0x1
FileType
rsds
250
Edit in Power View
/_layouts/15/images/ReportServer/16reportx_sp.gif
/downloads/_layouts/15/ReportServer/AdHocReportDesigner.aspx?list={ListId}&ID={ItemId}&ViewMode=Edit
0x0
0x20
FileType
rdlx
250
Manage Data Sources
/downloads/_layouts/15/ReportServer/DataSourceList.aspx?list={ListId}&ID={ItemId}
0x0
0x20
FileType
rdlx
351
Manage Subscriptions
/_layouts/15/images/ReportServer/Manage_Subscription.gif
/downloads/_layouts/15/ReportServer/ManageSubscriptions.aspx?list={ListId}&ID={ItemId}
0x80
0x0
FileType
rdl
351
Manage Data Sources
/downloads/_layouts/15/ReportServer/DataSourceList.aspx?list={ListId}&ID={ItemId}
0x0
0x20
FileType
rdl
352
Manage Shared Datasets
/downloads/_layouts/15/ReportServer/DatasetList.aspx?list={ListId}&ID={ItemId}
0x0
0x20
FileType
rdl
353
Manage Parameters
/downloads/_layouts/15/ReportServer/ParameterList.aspx?list={ListId}&ID={ItemId}
0x0
0x4
FileType
rdl
354
Manage Processing Options
/downloads/_layouts/15/ReportServer/ReportExecution.aspx?list={ListId}&ID={ItemId}
0x0
0x4
FileType
rdl
355
Manage Cache Refresh Plans
/downloads/_layouts/15/ReportServer/CacheRefreshPlanList.aspx?list={ListId}&ID={ItemId}
0x0
0x4
FileType
rdl
356
View Report History
/downloads/_layouts/15/ReportServer/ReportHistory.aspx?list={ListId}&ID={ItemId}
0x0
0x44
FileType
rdl
357
View Dependent Items
/downloads/_layouts/15/ReportServer/DependentItems.aspx?list={ListId}&ID={ItemId}
0x0
0x4
FileType
rsds
350
Edit Data Source Definition
/downloads/_layouts/15/ReportServer/SharedDataSource.aspx?list={ListId}&ID={ItemId}
0x0
0x4
FileType
rsds
351
View Dependent Items
/downloads/_layouts/15/ReportServer/DependentItems.aspx?list={ListId}&ID={ItemId}
0x0
0x4
FileType
smdl
350
Manage Clickthrough Reports
/downloads/_layouts/15/ReportServer/ModelClickThrough.aspx?list={ListId}&ID={ItemId}
0x0
0x4
FileType
smdl
352
Manage Model Item Security
/downloads/_layouts/15/ReportServer/ModelItemSecurity.aspx?list={ListId}&ID={ItemId}
0x0
0x2000000
FileType
smdl
353
Regenerate Model
/downloads/_layouts/15/ReportServer/GenerateModel.aspx?list={ListId}&ID={ItemId}
0x0
0x4
FileType
smdl
354
Manage Data Sources
/downloads/_layouts/15/ReportServer/DataSourceList.aspx?list={ListId}&ID={ItemId}
0x0
0x20
FileType
smdl
351
Load in Report Builder
/downloads/_layouts/15/ReportServer/RSAction.aspx?RSAction=ReportBuilderModelContext&list={ListId}&ID={ItemId}
0x0
0x2
FileType
smdl
250
Edit in Report Builder
/_layouts/15/images/ReportServer/EditReport.gif
/downloads/_layouts/15/ReportServer/RSAction.aspx?RSAction=ReportBuilderReportContext&list={ListId}&ID={ItemId}
0x0
0x4
FileType
rdl
250
Manage Data Alerts
/_layouts/15/images/ReportServer/alert_manage_16.png
/downloads/_layouts/15/ReportServer/MyDataAlerts.aspx?list={ListId}&ID={ItemId}
0x0
0x20
FileType
rdl
350
Edit in Report Builder
/downloads/_layouts/15/ReportServer/RSAction.aspx?RSAction=ReportBuilderDatasetContext&list={ListId}&ID={ItemId}
0x0
0x4
FileType
rsd
250
Manage Caching Options
/downloads/_layouts/15/ReportServer/DatasetCachingOptions.aspx?list={ListId}&ID={ItemId}
0x0
0x4
FileType
rsd
350
Manage Cache Refresh Plans
/downloads/_layouts/15/ReportServer/CacheRefreshPlanList.aspx?list={ListId}&ID={ItemId}&IsDataset=true
0x0
0x4
FileType
rsd
351
Manage Data Sources
/downloads/_layouts/15/ReportServer/DataSourceList.aspx?list={ListId}&ID={ItemId}
0x0
0x20
FileType
rsd
352
View Dependent Items
/downloads/_layouts/15/ReportServer/DependentItems.aspx?list={ListId}&ID={ItemId}
0x0
0x4
FileType
rsd
353
Compliance Details
javascript:commonShowModalDialog('{SiteUrl}'+ '/_layouts/15/itemexpiration.aspx' +'?ID={ItemId}&List={ListId}', 'center:1;dialogHeight:500px;dialogWidth:500px;resizable:yes;status:no;location:no;menubar:no;help:no', function GotoPageAfterClose(pageid){if(pageid == 'hold') {STSNavigate(unescape(decodeURI('{SiteUrl}'))+ '/_layouts/15/hold.aspx' +'?ID={ItemId}&List={ListId}'); return false;} if(pageid == 'audit') {STSNavigate(unescape(decodeURI('{SiteUrl}'))+ '/_layouts/15/Reporting.aspx' +'?Category=Auditing&backtype=item&ID={ItemId}&List={ListId}'); return false;} if(pageid == 'config') {STSNavigate(unescape(decodeURI('{SiteUrl}'))+ '/_layouts/15/expirationconfig.aspx' +'?ID={ItemId}&List={ListId}'); return false;}}, null);
0x0
0x1
ContentType
0x01
898
Edit in Browser
/_layouts/15/images/icxddoc.gif?rev=23
/downloads/_layouts/15/formserver.aspx?XsnLocation={ItemUrl}&OpenIn=Browser&Source={Source}
0x0
0x1
FileType
xsn
255
Edit in Browser
/_layouts/15/images/icxddoc.gif?rev=23
/downloads/_layouts/15/formserver.aspx?XmlLocation={ItemUrl}&OpenIn=Browser&Source={Source}
0x0
0x1
ProgId
InfoPath.Document
255
Edit in Browser
/_layouts/15/images/icxddoc.gif?rev=23
/downloads/_layouts/15/formserver.aspx?XmlLocation={ItemUrl}&OpenIn=Browser&Source={Source}
0x0
0x1
ProgId
InfoPath.Document.2
255
Edit in Browser
/_layouts/15/images/icxddoc.gif?rev=23
/downloads/_layouts/15/formserver.aspx?XmlLocation={ItemUrl}&OpenIn=Browser&Source={Source}
0x0
0x1
ProgId
InfoPath.Document.3
255
Edit in Browser
/_layouts/15/images/icxddoc.gif?rev=23
/downloads/_layouts/15/formserver.aspx?XmlLocation={ItemUrl}&OpenIn=Browser&Source={Source}
0x0
0x1
ProgId
InfoPath.Document.4
255
Document Set Version History
/_layouts/15/images/versions.gif?rev=23
javascript:SP.UI.ModalDialog.ShowPopupDialog('{SiteUrl}'+ '/_layouts/15/DocSetVersions.aspx' + '?List={ListId}&ID={ItemId}')
0x0
0x0
ContentType
0x0120D520
330
Send To other location
/_layouts/15/images/sendOtherLoc.gif?rev=23
javascript:GoToPage('{SiteUrl}' + '/_layouts/15/docsetsend.aspx' + '?List={ListId}&ID={ItemId}')
0x0
0x0
ContentType
0x0120D520
350
View in Browser
{SiteUrl}/_layouts/15/WopiFrame.aspx?sourcedoc={ItemUrl}&action=view&source={Source}
0x0
0x1
FileType
ODS
255
View in Browser
{SiteUrl}/_layouts/15/WopiFrame.aspx?sourcedoc={ItemUrl}&action=view&source={Source}
0x0
0x1
FileType
XLS
255
View in Browser
{SiteUrl}/_layouts/15/WopiFrame.aspx?sourcedoc={ItemUrl}&action=view&source={Source}
0x0
0x1
FileType
XLSB
255
View in Browser
{SiteUrl}/_layouts/15/WopiFrame.aspx?sourcedoc={ItemUrl}&action=view&source={Source}
0x0
0x1
FileType
XLSM
255
View in Browser
{SiteUrl}/_layouts/15/WopiFrame.aspx?sourcedoc={ItemUrl}&action=view&source={Source}
0x0
0x1
FileType
XLSX
255
View in Browser
{SiteUrl}/_layouts/15/WopiFrame.aspx?sourcedoc={ItemUrl}&action=view&source={Source}
0x0
0x1
ProgId
OneNote.Notebook
255
View in Browser
{SiteUrl}/_layouts/15/WopiFrame.aspx?sourcedoc={ItemUrl}&action=view&source={Source}
0x0
0x1
FileType
ONE
255
View in Browser
{SiteUrl}/_layouts/15/WopiFrame.aspx?sourcedoc={ItemUrl}&action=view&source={Source}
0x0
0x1
FileType
ONETOC2
255
View in Browser
{SiteUrl}/_layouts/15/WopiFrame.aspx?sourcedoc={ItemUrl}&action=view&source={Source}
0x0
0x1
FileType
ODP
255
View in Browser
{SiteUrl}/_layouts/15/WopiFrame.aspx?sourcedoc={ItemUrl}&action=view&source={Source}
0x0
0x1
FileType
POT
255
View in Browser
{SiteUrl}/_layouts/15/WopiFrame.aspx?sourcedoc={ItemUrl}&action=view&source={Source}
0x0
0x1
FileType
POTM
255
View in Browser
{SiteUrl}/_layouts/15/WopiFrame.aspx?sourcedoc={ItemUrl}&action=view&source={Source}
0x0
0x1
FileType
POTX
255
View in Browser
{SiteUrl}/_layouts/15/WopiFrame.aspx?sourcedoc={ItemUrl}&action=view&source={Source}
0x0
0x1
FileType
PPS
255
View in Browser
{SiteUrl}/_layouts/15/WopiFrame.aspx?sourcedoc={ItemUrl}&action=view&source={Source}
0x0
0x1
FileType
PPSM
255
View in Browser
{SiteUrl}/_layouts/15/WopiFrame.aspx?sourcedoc={ItemUrl}&action=view&source={Source}
0x0
0x1
FileType
PPSX
255
View in Browser
{SiteUrl}/_layouts/15/WopiFrame.aspx?sourcedoc={ItemUrl}&action=view&source={Source}
0x0
0x1
FileType
PPT
255
View in Browser
{SiteUrl}/_layouts/15/WopiFrame.aspx?sourcedoc={ItemUrl}&action=view&source={Source}
0x0
0x1
FileType
PPTM
255
View in Browser
{SiteUrl}/_layouts/15/WopiFrame.aspx?sourcedoc={ItemUrl}&action=view&source={Source}
0x0
0x1
FileType
PPTX
255
View in Browser
{SiteUrl}/_layouts/15/WopiFrame.aspx?sourcedoc={ItemUrl}&action=view&source={Source}
0x0
0x1
FileType
DOC
255
View in Browser
{SiteUrl}/_layouts/15/WopiFrame.aspx?sourcedoc={ItemUrl}&action=view&source={Source}
0x0
0x1
FileType
DOCM
255
View in Browser
{SiteUrl}/_layouts/15/WopiFrame.aspx?sourcedoc={ItemUrl}&action=view&source={Source}
0x0
0x1
FileType
DOCX
255
View in Browser
{SiteUrl}/_layouts/15/WopiFrame.aspx?sourcedoc={ItemUrl}&action=view&source={Source}
0x0
0x1
FileType
DOT
255
View in Browser
{SiteUrl}/_layouts/15/WopiFrame.aspx?sourcedoc={ItemUrl}&action=view&source={Source}
0x0
0x1
FileType
DOTM
255
View in Browser
{SiteUrl}/_layouts/15/WopiFrame.aspx?sourcedoc={ItemUrl}&action=view&source={Source}
0x0
0x1
FileType
DOTX
255
View in Browser
{SiteUrl}/_layouts/15/WopiFrame.aspx?sourcedoc={ItemUrl}&action=view&source={Source}
0x0
0x1
FileType
ODT
255
View in Browser
{SiteUrl}/_layouts/15/WopiFrame.aspx?sourcedoc={ItemUrl}&action=view&source={Source}
0x0
0x1
FileType
PDF
255