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Applications & Forms
The following applications & forms are available for downloading as PDF files:
Acord Applications
ACORD 125 Application for Commercial Insurance
ACORD 126 Application for Commercial General Liability
ACORD 128 Application for Garage and Dealers
ACORD 130 Application for Workers Compensation
ACORD 131 Application for Umbrella/Excess
ACORD 140 Application for Property
ACORD 146 Application for Equipment Floater
Supplemental Applications & Forms
Workers’ Compensation Atlas Supplemental Form (PDF)
Waiver of Subrogation Request Form (PDF)
Electronic Payment Authorization Form (PDF)
New Venture Supplemental Application (PDF)
Atlas Contractors GL Supplemental Application (PDF)
Atlas Transportation Supplemental Application (PDF)
Atlas Amazon Supplemental Application (PDF)
States Exclusion/Inclusion Forms
Arizona Employees Notice of Rejection of Terms
California SB189 Corp Waiver
California SB189 General Partner/Managing Member
California SB189 Professional Corp Waiver
Colorado Rejection of Coverage by Partners and Sole Prop Perfomong Construction Work Sites WC045 Construction Coverage Rejection TEMPORARY May 2020
Colorado 171 CO Rejection of Coverage by Corporate Officer of members of an LLC
Florida Form DWC-250 Instructions Notice Election to be Exempt
Florida Form DWC-250-Notice Election to be Exempt
Florida Form DWC-250R Notice Revocation Election Exempt
Florida Form DWC-251 Notice Election of Coverage
Florida Form DWC-251-R Revocation Election of Coverage
Kansas WC-113 Election of Individual
Kansas WC-114 Cancellation of KWC113
Kansas WC-50 Exclusion Form
Kansas WC-50a Cancellation of KWC-50
Louisiana Notice of Election Revocation of Coverage
North Carolina Notice of Election or Rejection Form
Nebraska Work Comp Corporate Owner Rejection and Election Form
New Jersey ACORD FORM Notice of Election Proprietors and Partners
New Jersey Form PP-1B Notice of Election Proprietors Partners Election
New Mexico CID Sole Proprietor Election Form
Nevada Sole Proprietor Coverage
Nevada Rejection of Coverage Form
New York Form C-105_32 Notice of Election of a Partnership
New York Form C-105_51 Exclude Shareholders and Executive Officers
New York Form C-105_52 Non for Profit Exclude Unsalaried Executive Officer
New York Form_C-105 53 Revoke Election for Non for Profit Organization
New York Form C-105_55 Revoke Shareholders Executive Officers Exclusion
Pennsylvania Form LIBC 509-Application for Executive Officer Exception
Pennsylvania Form LIBC_513 Executive Officers Declaration
South Carolina Form Corporate Officer Notice to Reject
South Carolina Form Corporate Officer Notice To Reject
Tennessee Form Initial WC Exemption Registration Application
Tennessee Form I-4 Election of Sole Proprietor or Partner
Tennessee Form_I-5 Notice of Withdrawal Sole Proprietor
Tennessee Form I-6 Notice of Corporate Officer to Employer
Tennessee Form I-7 Notice Corporate Officer’s Revocation of Exemption
Tennessee Form I-8 Notice of Acceptance by Employer
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