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Workers' Compensation -
Western Region/CA

Tools And Applications

Download everything you need for a complete submission.


Submission Requirements
Submission Checklist and Application
Submission Checklist Motor Truck Physical Damage and Cargo

Fillable ACORD® Forms Library & Samples
State Specific ACORD® Forms #137
State Specific ACORD® Forms #61 - 62
State Specific ACORD® Forms #63 - 65
State Specific ACORD® Forms #66 - 70
State Specific ACORD® Forms - Other
State Specific ACORD® Forms - Workers Compensation Loss Reports
State Specific ACORD® Forms - Workers Compensation Series

Allianz Motor Truck Cargo and Physical Damage Application
Great American Cargo Application
Insured's Statement of Losses and Compliance
Lloyds of London - Cargo
Lloyds of London - Terrorism
Lloyds of London Contingent Auto Liability Application
Truckers Physical Damage Application
Vehicle Inspection Report - Trucks
NITACA Membership Enrollment
NITACA 5Star Driver Occ Acc Enrollment
Occupational Accident Guidelines
Zurich Occupational Accident Group Application (10+ lives)
Zurich Contingent Liability Application (Occupational Accident)
Zurich Trucking New Venture Supplementary Application (min 1 year current insurance required)

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© 2015 5Star Specialty Programs is a division of and operates under the licenses of CRC Insurance Services, Inc. CA Lic No 0778135. No claim to any government works or material copyrighted by third parties. Nothing in this communication constitutes an offer, inducement, or contract of insurance. Financial strength and size ratings can change and should be reevaluated before coverage is bound. This material is intended for licensed insurance agency use only. This is not intended for business owner or insured use. If you are not a licensed agent please disregard this communication. 5Star Specialty Programs supports a diverse workforce and is an Equal Opportunity Employer who does not discriminate against individuals on the basis of race, gender, color, religion, national origin, age, sexual orientation, gender identity, disability, veteran status or other classification protected by law. Drug Free Workplace.