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Insurance Agency Application: This form needs to be completed and return to Cory Tiebout’s attention with a copy of your Agency’s State Insurance License and a copy of your Agency’s E&O Declaration Page.
PDF version
Word version
Mover’s Choice Moving & Storage Program
Moving & Storage Supplemental Application (Download PDF or Word): This application must be included on all new business submission to the Mover’s Choice Moving & Storage Program.
PDF version
Word version
Moving & Storage Long Haul Application: This application needs to be included when the moving operation does moves over 250 miles under their own authority or if the mover is affiliated with Mayflower, United, or Atlas Van Lines.
PDF version
Word version
All Risk Cargo & Storage Certificate Supplemental Application: This application is required on moving and storage operations who individual issue “all risk” certificates to customers to increase coverage for their move.
PDF version
Word version
Moving & Storage Program Driver Requirements: Information is provided on the minimum driver requirement for this program.
PDF version
Moving & Storage Workers’ Compensation Program Supplemental Application: This application must be included on all new business submissions to the Moving & Storage Workers’ Compensation Program.
PDF version
Word version
Independent Contractor Work Injury Program Sponsoring Motor Carrier Application: This application must be included on all new business submissions for this program.
PDF Version
Word Version
Independent Contractor Work Injury Program – “Non-Trucking Liability/Auto Physical Damage Application”: This application must be provided when requesting Mover’s Choice to provide NTL and/or APD on Independent Contractor’s Vehicles in conjunction with quoting their work injury coverage.
PDF Version
Word Version
Military Cargo Application: This form is used when submitting business to Mover’s Choices Military Household Goods Cargo Program.
PDF Version
Word Version
Moving & Storage Bond Program: This application is needed on all new business submission to provide a surety bond quotation.
PDF Version
Word Version
Debit Authorization Form: This form is used to request to have funds accessed electronically to pay for premium due.
PDF Version
Mover Choice DAY Movers Program
Day Movers Underwriting Guidelines: Information is provided on the guidelines and underwriting information needed to qualify for the Mover’s Choice Day Movers Program.
Day Movers Supplemental Application (Download Word): This application must be included on all new business submission for Mover’s Choice Day Movers Program.
Day Movers Driver’s Criteria (Download PDF): Information is provided on the minimum driver requirements for the Mover’s Choice Day Movers Program.
Claim Reporting Forms
Transportation Loss Notice: This form gives you the ability to report a Auto/Truck Liability or Physical Damage Claim. In addition this form needs to be completed, when an auto or non-auto related claim occurs to the customers physical property (i.e. carpet/hardwood floor damage claim, driveway damage, stairway damage, etc.)
PDF version
Word version
Presentation of Loss and Damage Form: This form is designed to be downloaded and printed. It needs to be completed when a Inland Marine Cargo/Warehouse Legal Liability has occurred. In addition to this form, our office will need the following information: A copy of both sides of the Bill of Lading or Warehouse Receipt involved in the loss, a copy of the inventory information, and a copy of the shippers loss or damage form (if applicable). Please fax 707-252-5905 or email this information to Sandy Quiett at sandraq@paulhanson.com.
MC version (PDF)
PHP version (PDF)
Business Property Claims Reporting Form: This form gives you the ability to a report a Business Personal Property or Real Property claim directly on our website.
General Liability Claim Reporting Form: This form gives you the ability to report a General Liability claim directly on our website.
BizCHOICE Program Auto Claim Reporting Form: This form gives you the ability to report an Auto Liability or Physical Damage claim. Once we are in receipt of the claim we will get it set up with an adjuster at York Claims Service. You should hear from that adjuster within 24-48 hours of claim submission.
PDF Version
Word Version
Unique Customer Forms
All Risk Cargo/Warehouse Certificated Coverage Program
All Risk Coverage Definition: Explains the difference between valuation coverage and “all risk” certificated coverage.
All Risk Certificate Program Process: Current Customer use this link to have potential “all risk” certificates processed and approved.
Other Forms
High Value Shipment Request Form (Download PDF): This form is used to request our underwriters to provide a quotation on a one time move which limit is higher then the movers current cargo limit.
Location Addition Request Form: This form is used to request the addition of a new location to your current insurance policy.
PDF version
Word version
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