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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, jmathiason@berkleyrisk.com 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.

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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
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