Workers' Comp Supplemental Applications

Additional questionnaires for specific industries

Occasionally an underwriter needs more information to properly evaluate a particular type of business. We don't always ask for supplemental applications, but if you're working with one of the industries listed below, we may. By providing us with a complete submission including a supplemental application, we can send you a competitive quote as quickly as possible.

General Liability Builders Risk

Contractor - Download supplemental application
We write Artisan Contractors, and a few other construction businesses,
but not all of the them. Fill out the supplemental so we know exactly
what your client scope of work includes.

General Liability Distributor - Wholesaler

Freight Forwarders - Download supplemental application
We are the number 1 carrier for Freight Forwarders in Florida! This supplemental is required if there is more than a warehouse exposure.

Claim Medical

Home Health - Download supplemental application
Home health care, assisted living facilities, nursing homes and doctor's offices are some of the health-related businesses we insure. There are some specific questions we have regarding the various industries. By completing this supplemental, we'll know if your client is eligible for coverage with us.


Janitorial - Download supplemental application
Commercial cleaning is another business we write frequently. Complete
this supplemental to make sure they're doing the jobs we can insure.

General Liability Vacant Buildings & Vacant Lands

Lawn Maintenance/Landscaping - Download supplemental application
Companies that do landscaping vary from mow and blow, to snow
blowing. Every state has different exposures, that's why we may ask
for the supplemental for landscapers.

Security Guards

Security Guards - Download supplemental application
We write a select group of security guards including unarmed operations. Complete this supplemental so we can see if we can insure your client.

Workers' Comp Supplemental
Submit an Application

If you already submitted the Acord, you can email the supplemental
to or directly to your underwriter.

Get in Touch

Call: 866-688-6442


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