May 6th, 2025

AMIS Specific Insurance Applications and Applications not found elsewhere

This page contains many of the applications that can be found on our various web pages. Please read all instructions carefully and fill out all forms completely. If you have any questions, please call us toll-free at (800) 843-8550.

Application Categories

+ Excess/Umbrella Application

Available applications in this category

Note: Clicking on the link below will open the insurance application form in a new browser window or tab.

Go get the PDF Application form

+ General Liability and Errors & Omissions Applications

Available applications in this category

Additional Application Requirements: Along with the application, please fax us the Terrorism Form, a signed broker agreement, a copy of your broker license, and a copy of the declaration page of your E & O Insurance policy.

Note: Clicking on the links below will open the insurance application form or the web page for this program in a new browser window or tab.

Visit the web page for this program Go get the PDF Application form

+ Management Applications

Available applications in this category

Note: Clicking on the links below will open the insurance application form or the web page for this program in a new browser window or tab.

Visit the web page for this program Go get the PDF Application form

+ Miscellaneous Professional Liability Applications

Available applications in this category

Additional Application Requirements: Along with your application, we will need a signed Broker Agreement, a copy of your Broker License, and a copy of the declaration page of your E & O Insurance policy.

FOR − Mercantile and Governmental Classes of Business:

  1. Coverage Application (Choose one)
    • 125s ACORD General Info and 141s ACORD Crime
    • Surety Association Application for Forms A,B,O,P
    • Great American Insurance Companies? Commercial Crime Application
  2. Internal Controls Questionnaire
  3. Latest fiscal year end CPA Audit or Annual Report
  4. Latest CPA management letter and response
  5. Special Exposures and policy wording enhancements should be identified.

FOR − Financial Institution Classes of Business, Forms 24, 14,15, and 25:

  1. Coverage Application
    • Surety Association Application
    (Note: Other Companies' signed applications are usually acceptable)
  2. Internal Control Questionnaire
    3. (Please Note that a separate Financial Institution Internal Controls Questionnaire should be included if the application does not address Internal Controls in detail.)
  3. Financial Information
    • Latest Fiscal year end, CPA Audit or Annual Report
    • Latest CPA Management Letter and Response
    • 12-31 CALL Report
    • Latest Quarterly Call Report
  4. Special exposures and policy wording enhancements should be identified.

Application Notice: Additional Information MAY be required. Application requests do not guarantee automatic acceptance by Great American Insurance Companies.

Note: Clicking on the links below will open the insurance application form or the web page for this program in a new browser window or tab.

Application for limits OVER $1,000,000 Application for limits UNDER $1,000,000
Visit the web page for this program

+ Non-Profit Program Applications

Available applications in this category

Additional Application Requirements: Along with the application, please fax us two photographs of your buildings, a diagram of your building, and a three (3) year loss history from your prior insurance company.

Note: Clicking on the links below will open the insurance application form or the web page for this program in a new browser window or tab.

Visit the web page for this program Go get the PDF Application form

+ Technology Professional Liability Application

Available applications in this category

Note: Clicking on the links below will open the insurance application form or the web page for this program in a new browser window or tab.

Visit the web page for this program Go get the PDF Application form

Application Instructions:

All the applications must be completed on your computer or typed. We must be able to read the application clearly. To receive a quote, please:

  • complete the application on your computer
  • print and sign it
  • fax all materials to our office at: (760) 471-9378 or (800) 573-8550 (Toll Free)

Additional requirements: Some applications have additional information requirements. Those requirement will be listed near the application link

To protect your privacy, please do not email the PDF forms to us. If you have a problem viewing the PDF forms, make sure you have the Adobe Reader - Version 7.0 or later.

Need the Free Adobe Reader for those PDF files, or do you want to get the latest version? Get it here:  Adobe Reader Download.

NOTE: These applications are not insurance policies and do not bind any coverage. All applications must be underwritten and a quotation will be issued subject to underwriting guidelines. The quotation does not bind coverage.

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Category:

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Insurance Programs