About Mid Valley General Agency Applications
Most accounts can be quoted with the completion of ACORD applications only. There are times however when additional information is needed in order to review the account for quoting. Many of the risks that require additional applications are specialized accounts in which we have secured specialized programs and the additional information is extremely important in determining proper price and risk selection. Even though an application or supplemental application may be available for certain classes of business, we always recommend that you provide us with a properly completed ACORD application.
ACORD Applications
ACORD Forms are the primary applications used in the insurance industry. The standardization that ACORD has created increases the effectiveness and ease of completing an insurance transaction for you and your customers. We ask that you complete the proper ACORD Form for each submission you send to us.
For more information, please visit: www.acord.org
Appointment Applications
Thank you for your interest in becoming one of our appointed agencies. We offer access to many of the best carriers in the industry and provide unmatched service with no volume requirements. Our staff is dedicated to helping you and your staff succeed in writing profitable accounts. We take a more personal approach than other MGA’s and we believe you will enjoy the difference.
Appointment Documents (Please use the following):
Appointment Packet – DOC | PDF
Branch Supplement (only needed when multiple offices exist) – DOCX | PDF
W-9 Form – Required with appointment packet – PDF
Bond Application
Bonds play a vital role in your customers insurance portfolio and we’re here to help you get them placed. Please feel free to call our office with any questions you may have and do not forget that some bonds can be rated online.
To rate bonds online, please login
Bond Applications:
Certificate of Title Application – PDF
Contractor License Application – PDF
Contractor License Application – Washington – PDF
Dishonesty Bond Application – PDF
Janitorial Service Bond Application – PDF
Lost Securities Application – PDF
Probate – Deceased Application – PDF
Probate – Incompetent Application – PDF
Probate – Minor Application – PDF
Public Employee Blanket Bond Application – PDF
Public Official Bond Application – PDF
Receiver, Trustee in Bankruptcy or Other Insolvency Bond Application – PDF
Title Agents License Bond Application – PDF
Veterans Affairs Legal Custodian Application – PDF
Our applications and forms can be viewed using Adobe Acrobat Reader.
Commercial Transportation Applications
Our most popular classes are non-emergency medical transport, trucking (under 500 miles), log trucks, dump trucks and contractors.
We look for risks that have been in business for at least 2 years with profitable loss history and good experienced drivers.
Available applications. Note: The Word versions are fillable.
Commercial Auto App – DOC | PDF
Motor Truck Cargo App – DOCX | PDF
Supplementals (Please use in addition to the application chosen above):
Auto Mechanical Inspection Report Form (Completed by licensed mechanic) – DOCX| PDF
Driver Employment History Form – Public Auto – DOCX| PDF
Driver Schedule (Use if driver list does not fit on main application) – DOCX| PDF
For Hire Truckers GL Supplemental – DOCX| PDF
Hired and Non-owned Auto Supplemental – DOCX| PDF
Non-Emergency Medical Transportation Supplemental – DOCX| PDF
Public Auto Supplemental – DOCX | PDF
Vehicle Schedule (Use if vehicle list does not fit on main application) – DOCX | PDF
Dealers And Garage Applications
Applications and forms are provided for your convenience. Using our applications and forms greatly enhances our ability to serve you and your clients. Our applications and forms can be viewed using either Microsoft Word or Adobe Acrobat Reader. To download, simply click the icon that corresponds to the file type you wish to view.
Available applications. Note: The Word (Doc/Docx) versions are fillable.
Auto Service Risks Supplement – DOCX | PDF
Garage and Auto Dealer Application – XLS |PDF
Specialty Vehicle Supplement – PDF
Valet And Parking Lot Supplement – PDF
General Liability And Property Applications
Applications and forms are provided for your convenience. Using our applications and forms greatly enhances our ability to serve you and your clients. Our applications and forms can be viewed using Adobe Acrobat Reader. To download, simply click the PDF icon that corresponds to the file you wish to view.
Available applications. Note: The Word (doc/docx) versions are fillable. Please select from one of the icons:
Additional Insured Supplement – DOCX |PDF
Adult Day Care Supplement – DOCX |PDF
Alarm Installation Supplement – DOCX |PDF
Amusement Supplement – DOCX |PDF
Animal Services Supplement – DOCX |PDF
Artisan/Trade Contractors Supplement – DOCX |PDF
Artisan/Trade Contractors Supplement – Renewal App – DOCX |PDF
Auto Service Risks Supplement – DOCX |PDF
Bars-Restaurants-Taverns Supplement – DOCX |PDF
Beauty-Barber Shop Supplement – DOCX |PDF
Blasting Contractors Supplement – DOCX |PDF
Builders Risk Supplement – DOCX | PDF
Caterers and Halls Supplement – DOCX |PDF
Climbing Wall Supplement – DOCX | PDF
Condo and HOA Supplement – DOCX | PDF
Consultants- GL Supplement –DOCX | PDF
Contractors Equip Rental Supplement – DOCX | PDF
Dam Existence Hazard Supplement – DOCX | PDF
Day Nursery-Preschool Supplement – DOCX | PDF
Demolition Contractors- Annual Supplement – DOCX | PDF
Demolition Contractors- Per Job Basis Supplement – DOCX | PDF
Detective-Investigative Agencies Supplement – DOCX | PDF
Distributors and Wholesalers Supplement – DOCX | PDF
Employment Agencies- Temp-Clerical Supplement – DOCX | PDF
Event -Party Planners Supplement – DOCX | PDF
Excavators and Graders Supplement – DOCX | PDF
Exercise and Health Studio Supplement – DOCX | PDF
Exterminators Supplement – DOCX | PDF
Fire Sprinkler Contractor Supplement – DOCX | PDF
Flea Market Supplement – DOCX | PDF
Foreclosure-Eviction Cleanup Contractors Supplement – DOCX | PDF
General Contractors-Developers Supplement – DOCX | PDF
Habitational Liability Supplement – DOCX | PDF
Habitational Property Supplement – DOCX | PDF
Halfway House Supplement – DOCX | PDF
Home Health Care Supplement – DOCX | PDF
Hunting Clubs Supplement – DOCX | PDF
Janitorial Supplement – DOCX | PDF
Landowners Supplement – DOCX | PDF
Landscaping Supplement – DOCX | PDF
Liquor Liability Supplement – DOCX | PDF
Liquor Liability Special Event Supplement – DOCX | PDF
Machine Shop Supplement – DOCX | PDF
Machinery & Equipment Supplement – DOCX | PDF
Marijuana Related Supplement – DOCX | PDF
Martial Arts Supplement – DOCX | PDF
Medical Equip Supply Store Supplement – DOCX | PDF
Mobile Home Parks and Campgrounds Supplement – DOCX | PDF
Outfitters and Guides Supplement – DOCX | PDF
Owners Contractors Protective Supplement – DOCX | PDF
Plastic Mfg Supplement – DOCX | PDF
Prize Indemnification Supplement – DOCX | PDF
Products Supplement – DOCX | PDF
Racing Special Events Supplement – DOCX | PDF
Real Estate Property Mgmt Supplement – DOCX | PDF
Recycler Supplement – DOCX | PDF
Roofers Supplement – DOCX | PDF
Schools Supplement – DOCX | PDF
Security and Patrol Supplement – DOCX | PDF
Snow Removal Supplement – DOCX | PDF
Special Events Supplement – DOCX | PDF
Sports Camps-Clinics-Leagues Supplement – DOCX | PDF
Swim and Racquet Clubs Supplement – DOCX | PDF
Swim Pool Contractors-Dealers-Installers Supplement – DOCX | PDF
Swim Pool Maintenance and Mgmt Supplement – DOCX | PDF
Tanning Salon Supplement – DOCX | PDF
Telecommunication Contractors Supplement – DOCX | PDF
Transportation Services Supplement – DOCX | PDF
Tree Trimmers Supplement – DOCX | PDF
Truckers GL Supplement – DOCX | PDF
Vacant Building Supplement – DOCX | PDF
Warehouse Supplement – DOCX | PDF
Water Supply Companies and Irrigation Systems Supplement – DOCX | PDF
Welding-Brazing-Cutting-09-16 Supplement – DOCX | PDF
Inland Marine Applications
Applications and forms are provided for your convenience. Using our applications and forms greatly enhances our ability to serve you and your clients. Our applications and forms can be viewed using either Microsoft Word or Adobe Acrobat Reader.
Contractors Equipment Application – DOC | PDF
Loggers Broad Form Property Damage Application – PDF
Liquor Liability
Applications and forms are provided for your convenience. Using our applications and forms greatly enhances our ability to serve you and your clients. Our applications and forms can be viewed using either Microsoft Word or Adobe Acrobat Reader.
Liquor Liability Application – DOCX | PDF
Liquor Liability For Special Events Application – DOCX | PDF
Misc Docs
Applications and forms are provided for your convenience. Using our applications and forms greatly enhances our ability to serve you and your clients. Our applications and forms can be viewed using either Microsoft Word or Adobe Acrobat Reader.
Diligent Effort – PDF
Markel Terrorism Form – PDF
Scottsdale (SIC) Terrorism Form – PDF
Personal Lines Applications
Applications and forms are provided for your convenience. Using our applications and forms greatly enhances our ability to serve you and your clients. Our applications and forms can be viewed using either Microsoft Word or Adobe Acrobat Reader.
Dwelling Liability – DOCX | PDF
Farm & Ranch – Cov E Supplemental – DOCX | PDF
Farm & Ranch – Cov G Supplemental – DOCX | PDF
In Home Business Supplemental – DOCX | PDF
Personal Inland Marine – DOCX | PDF
Protection Class Supplemental – DOCX | PDF
Personal Umbrella – DOCX | PDF
Residential Builders Risk – DOCX | PDF
Trust, LLC, Partnership and Estate Supplemental – DOCX | PDF
Professional - DataBreach (Cyber)
Recovering from a breach is expensive and time consuming. Determining the cause and extent of the breach, complying with notice laws, correcting damage, minimizing losses, and addressing potential lawsuits can drain a business. That’s why MVGA has partnered with Markel to provide their one of a kind policy. Markel is a leader in this coverage area and we have specialists to help get your clients covered correctly.
App – DataBreach – MADB 5001 02 19
Supp – BI Reimbursement – MADB 5003 07 13
Supp – Contingent BI and System Failure – MADB 5006 11 18
Professional - Employment Practice Liability
Any company that has employees needs this coverage to protect the assets of the company. We have partnered with one of the strongest carriers in the nation with this line of coverage. We are one of only a few general agencies that have access to this program and we pride ourselves on pre-underwriting risks to ensure a proper fit for the carrier and insured.
Professional - Info Technology
IT professionals are providing service under a continually evolving standard of care. An appropriate risk management program must include an insurance solution built upon an understanding of current and coming exposures. We have carriers that are specialists in insuring IT related risks.
App – Info Tech E&O – MAEO 2009 03 19
Supp – Data Privacy & Security – ZZ-31009 09 08
Professional - Management Liability - For Profit
Our management liability offering is a modular set of products to cover all sorts of for-profit companies. The products are available monoline or blended in any combination. The suite of products includes:
• Directors & officers liability • Employment practices liability • Fiduciary liability
App – Management Liability – MAML 001 05 10
App – RN – Management Liability – MAML 002 01 16
Supp – Arbitration – MAML 019 02 19
Supp – Breach Mitigation Expense – MAML 0008 11 12
Supp – Employee Stock Ownership Plan (ESOP) – MAML 015 08 15
Supp – Fair Credit Reporting Act (FCRA) – MAML 013 02 17
Supp – Healthcare Org – MAML 014 05 15
Supp – Layoff-Reduction in Force – MAIL 006 01 11
Professional - Management Liability - Not For Profit
Our management liability offering is a modular set of products to cover all sorts of not-for-profit organizations. The products are available monoline or blended in any combination. The suite of products includes:
• Directors & officers liability • Employment practices liability • Fiduciary liability
App – Management Liability – MAML 003 01 16
App – RN – Management Liability – MAML 004 01 16
Supp – Arbitration – MAML 019 02 19
Supp – Association Risks – MAML 006 01 11
Supp – Breach Mitigation Expense – MAML 0008 11 12
Supp – Employee Stock Ownership Plan (ESOP) – MAML 015 08 15
Supp – Fair Credit Reporting Act (FCRA) – MAML 013 02 17
Supp – Healthcare Org – MAML 014 05 15
Professional - Misc Errors And Omissions
Errors and Omissions coverage is a much needed coverage for so many insureds. We have partnered with one of the strongest carriers in the nation with this line of coverage. We are one of only a few general agencies that have access to this program and we pride ourselves on pre-underwriting risks to ensure a proper fit for the carrier and insured.
App – Misc E&O – MAEO 2000 (02-19)
Supp – Associations – MAEO 2003 (05-18)
Supp – Building Inspectors – MAEO 2001 (05-18)
Supp – Business Appraisers – EO-31019 (05-06)
Supp – Collection Agencies – MAEO 2008 (08-17)
Supp – Environmental Consultant – EIC 1949-03 (01-02)
Supp – Mortgage Brokers – MAEO 2005 (05-18)
Supp – Property Appraisers – EO-31021 (02-08)
Supp – Real Estate Best Practices – MAEO 2004 (05-18)
Supp – Real Estate Services – MAEO 2006 (05-18)
Supp – Real Estate Services (RN) – MAEO 2007 (05-18)
Professional - Products Liability - Claims Made
MVGA covers products on a specified basis, so we can supplement traditional insurance policies or fill the gap for new product development. Our flexible coverage can be packaged to meet the needs of manufacturers, importers, repackagers, sellers, or distributors of a wide range of products. We have the ability to meet non-standard risks head-on and offer innovative terms to solve the policyholder’s insurance needs.
App – Specified Products – MAGL 2003 (05-11)
App – Specified Professions – MAEO 2000 (11-14)
Supp – Employee Benefits – MAGL 2021 (11-12)
Supp – Medical Marijuana – MAGL 003 (04-10)
Supp – Nutraceuticals – MAGL 2053 (05-16)
Professional - Tenant Discrimination
MVGA’s tenant discrimination policy provides industry leading protection for property owners and managers against claims brought by tenants alleging discrimination.