Commercial Lines Forms & Applications

Following are Kimbrell Insurance Group's most commonly requested applications for your usage. Please feel free to print and fax, email or mail back to us. Be sure to keep in mind the following points:

• A complete application DOES NOT BIND COVERAGE. 
• A signed application must be received by Kimbrell for our permanent records. 
• Application cannot be changed in any way.
• Many of the applications on our website can be completed online and printed. In order to email the application or save a copy, a form-filling program is required. If you would like more information on form-filling programs, please contact our IT Department.

Fax Number for Commercial Lines applications:

(800)354-3573

Email Address for Commercial Lines applications and inquiries: pc@kimbrellcompany.com

Email Address for Workers' Comp applications and inquiries: wc@kimbrellcompany.com

General Forms & Applications

Property & Casualty Applications

Commercial Auto Applications

Workers' Compensation Applications

Miscellaneous Healthcare Applications

Miscellaneous Supplemental Applications

Certificates of Insurance Procedures

General Forms & Applications 

• AAC Insured Automatic Payment Form
• North Carolina Form F
• Property Loss Notice (ACORD 1) 
• Automobile Loss Notice (ACORD 2)
• General Liability Notice of Occurence (ACORD 3)
• Cancellation Request/ Policy Release (ACORD 35)
• Agent/Broker of Record Change Form (ACORD 36)
• Statement of No Loss (ACORD 37)

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Property & Casualty Applications

• Commercial Application (ACORD 125) 
• Commercial General Liability Application (ACORD 126)
• Commercial Umbrella/Excess Section Application (ACORD 131) 
• Commercial Property Application (ACORD 140)
• Commercial Equipment Floater Section Application (ACORD 146)
• Commercial Installation/Builders Risk Application (ACORD 147)
• Commercial Business Owners Application (ACORD 160) 

Commercial Auto Applications

• Commercial Application (ACORD 125) 
• Business Auto Application (ACORD 127)
• Garage & Dealers Application (ACORD 128)
• SC Garage & Dealers Supplemental (ACORD 138SC)
• Century Garage Application
• Century Heavy Truck Supplemental
• Century UM/UIM Form (NC)
• Century UM/UIM Form (SC)
• Century Motorcycle Supplemental
• Century Recreational Vehicle Supplemental
• Century Valet Parking Supplemental
• Century Scheduled Auto Supplemental
• Essex Physical Damage Application
• Markel Taxi Cab Supplemental
• USSI Dealer Supplemental

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Workers Comp Applications

• Workers Compensation Application (ACORD 130)
• Officer Exclusion Form: Florida
• Officer Exclusion Form: North Carolina
• Officer Exclusion Form: South Carolina
• Officer Exclusion Form: Virginia

Miscellaneous Healthcare Applications

• Allied Medical General Application
• Allied Medical - Assisted Living Supplemental (elderly)
• Allied Medical - Assisted Living Supplemental (non-elderly)
• Allied Medical - Adult Day Care Supplemental
• Allied Medical - Home Health Care Supplemental

Miscellaneous Supplemental Applications 

• Contractors Supplemental
• Homeowners Association Supplemental 
• Storage Tank Pollution Liability Application

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