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Applications

Welcome to the online application section of the First Western Insurance website. These applications have been added for your convenience. The applications may be viewed, downloaded and printed at any time. You may sort the applications by any of the three categories simply by clicking on the heading. All applications are in pdf file format. If you have trouble opening pdf files, please visit Adobe.com and download the current Adobe Reader. For technical assistance, please email John Hanke (jhanke@fwins.com).

Fillable forms require Adobe Reader 7 or higher.
Line of Business: 
App ID:
Company Name:
Application Name: 
Business Group:
indicates a fillable form

Admiral

AIG

American Bankers

American Live Stock

American Modern

AppID Application Name Line of Business
379 Custom & Classic / Antique Motorcycle Supplemental Personal Lines
241 Dwelling Fire Application (01/05) Personal Lines
381 Dwelling MN (03/03) Personal Lines
371 Dwelling WI (08/04) Personal Lines
321 Elite Collector Car Application (04/06) Personal Lines
244 Jet Ski Application (01/05) Personal Lines
367 Manufactured Home / Heating Source Questionnaire (11/92) Personal Lines
368 Manufactured Homeowners MN (03/05) Personal Lines
370 Manufactured Homeowners WI (06/05) Personal Lines
380 Motor Home MN (03/05) Personal Lines
375 Motor Home Supplemental Application (Rental) (01/94) Personal Lines
376 Motor Home WI (09/05) Personal Lines
372 Motorcycle / ATV MN (05/05) Personal Lines
378 Motorcycle / ATV WI (04/05) Personal Lines
242 Motorcycle Application Iowa Personal Lines
243 Motorcycle Application Nebraska Personal Lines
377 Motorcycle Custom Assembled Approval Form (06/03) Personal Lines
240 Motorhome Application - WI Personal Lines
271 Riders Choice Program Application Personal Lines
388 Snowmobile Application (WI) (11/06) Personal Lines
389 Snowmobile U/W Guide/Rates (WI) 12/05 Personal Lines
373 Travel Trailer MN (03/05) Personal Lines
374 Travel Trailer WI (09/05) Personal Lines
382 Watercraft & Personal U/W Guidelines (03/05) WI Personal Lines
369 Watercraft & Personal WC Application (03/05) WI Personal Lines
384 Watercraft & Personal WC Rates (MN) 9/1/04 Personal Lines
383 Watercraft & Personal WC Rates Chart (11/07) WI Personal Lines
387 Watercraft & Personal WC U/W (MN) 03/07 Personal Lines
385 Watercraft (Boat) Application (MN) 03/06 Personal Lines
245 Watercraft Application Personal Lines

American Reliable

AppID Application Name Line of Business
224 Collapse or Broad Coverage Questionnaire Farm Program
222 Dairy Barn Questionnaire Farm Program
349 Dog Questionnaire Farm Program
476 Dwelling / Homeowners Application - NE Personal Lines
398 Dwelling Application WI Personal Lines
468 Dwelling Fire App - IA (10/07) Personal Lines
408 Dwelling Fire Program - NE Personal Lines
416 Dwelling U/W & Rate Guide IA (12/07) Personal Lines
397 Dwelling U/W & Rate Guide WI Personal Lines
540 Dwelling Vacant App & Rates IA (12/07) Personal Lines
229 Employers Liability Questionnaire Farm Program
223 Equine Application Farm Program
230 Excess Liability Farm Program
218 Farm and Ranch Application Farm Program
282 Farm Premium Indication Farm Program
227 Hay Questionnaire Farm Program
399 HO-3 Application - WI Personal Lines
231 HO-3 Rate Guide - WI Personal Lines
326 Iowa Mobile Home Personal Lines
396 Manufactured Home U/W & Rate Guide - WI Personal Lines
405 Mobile Home Application - IA Personal Lines
406 Mobile Home Application - NE Personal Lines
419 Mobile Home Application - WI Personal Lines
228 Mobile Home Questionnaire Farm Program
403 Mobile Home U/W Rules & Rate Guide - IA Personal Lines
404 Mobile Home U/W Rules & Rate Guide - NE Personal Lines
390 Motorcycle / ATV (09/02) Personal Lines
280 Supplemental Transit / Cargo Application Farm Program
329 Travel Trailer Application - IA/NE Personal Lines
511 Trler app (WI) Personal Lines
225 Wood Stove Questionnaire Farm Program
391 Woodstove Inspection Report (04/93) Personal Lines

Berkley

Canal Insurance

Capitol

AppID Application Name Line of Business
247 3-B Program Questionnaire (01/06) General Liability
559 3B Program Brochure (06/06) Package
248 Alarm Installation Or Monitoring Questionnaire (01/07) General Liability
249 Artists & Crafters Program Questionnaire (04/07) General Liability
23 Athletic & Sports Participants Coverage Application General Liability
250 Bowling Center Questionnaire (09/07) General Liability
560 Child Care Brochure Package
251 Child Care Questionnaire (09/07) General Liability
263 Clubs - Veterans & Non-Profit General Liability
270 Community Based/Assisted Living Residential Care Application General Liability
252 Contractors Questionnaire General Liability
253 Detective & Security Agency General Liability
254 Fairground (04/92) General Liability
255 Fitness Club Questionnaire (10/02) General Liability
472 Golf Course Questionnaire (04/07) General Liability
257 Hunting Club Questionnaire (03/99) General Liability
269 Liquor Liability - Other than Iowa (07/07) Liquor Liability
265 Martial Arts Questionnaire (09/07) General Liability
537 Medical Professional Liability (12/07) Nurses
258 Mobile Home Park Questionnaire (01/07) General Liability
89 Private Investigation Agency (nd) General Liability
473 Probate Bond Application (11/04) Surety Bond
259 Resort / Campground Questionnaire (09/00) General Liability
267 Restaurant / Tavern Questionnaire (05/03) General Liability
260 Special Events & Sports Questionnaire (05/97) General Liability
261 Sports Club / Clay Target Questionnaire 03/99) General Liability
262 Swimming Pool Questionnaire (04/07) General Liability
541 Veteran & Non-Profit GL application (01/95) General Liability
264 Woodburning Stove & Furnace Questionnaire (01/95) General Liability

Capitol Specialty

Carolina Casualty

Essex

Euclid Managers

First Western

AppID Application Name Line of Business
555 Bed & Breakfast supplement (05/08) General Liability/Property
314 Beer Garden (Permanant) Application (11/07) Liquor Liability
533 Beer Garden (Temporary) Application (11/07) Liquor Liability
362 Boat Quote Request (0308) Personal Lines
83 Buggy/Carriage Ride Supplement (05/08) General Liability
562 Collector Car Quote Request (0308) Personal Lines
361 Corn Maze (04/08) General Liability
535 Crane and Rigging supplement (11/07) General Liability
366 Cycle & ATV Quote Sheet (0308) Personal Lines
22 Fireworks Display / Exhibition Supplement General Liability
246 Happy Hour Drink Prices Liquor Liability
84 Haunted House Supplement General Liability
365 Homeowner/Dwelling Application (04/08) Personal Lines
364 Manufactured Home (mobile home) Quote Sheet Personal Lines
27 Private Investigation Agency Application General Liability
24 Professional Nurses & Medical & Dental Technicians Comprehen Professional E & O
561 Racing Supplement (0308) General Liability
469 RailRoad Protective (01/07) Railroad Liability
415 Rain Insurance Inland Marine
239 Saddle Club Questionnaire General Liability
86 Salvage Yard Supplement Garage
85 Salvage Yard Supplement General Liability
87 Salvage Yard Supplement Property
363 Snowmobile Quote Sheet Personal Lines
315 Transfer Questionnaire (11/07) Liquor Liability

Founders

Illinois Casualty

Illinois RB Jones-Denver

AppID Application Name Line of Business
438 Boarding, Pasturing, Training or Breeding Horses - Section II - Supplemental App General Liability
439 Care, Custody, or Control Application General Liability
437 Commercial Equine Application General Liability
443 Equestrian School, Riding Instruction of Clinics - Section I - Supplemental App General Liability
447 Guided Recreational Activities Application General Liability
448 Haunted House/Maze Supplemental App General Liability
446 Horse Drawn Vehicle Rides - Section V - Supplemental Application General Liability
450 Horse Leasing & Rental Questionnaire General Liability
445 Horse Shows and Public Events - Section III - Supplemental App General Liability
444 Horse, Tack or Concessions Sales - Section IV - Supplemental App General Liability
449 Indoor Climbing Wall Application General Liability
440 Pleasure, Show Horse or Race Horse Owners Liability App General Liability
441 Pony Rides - Section IV - Supplemental App General Liability
451 Recreational Activities Supplemental Application General Liability
452 Recreational Equipment Liability Application General Liability
442 Riding Clubs and Associations Application General Liability
454 Rodeo Special Event Application General Liability
453 Special Event General Liability Application General Liability
455 Trespass Hunt Application General Liability
456 Water Rafting Application General Liability
457 Watercraft Suppliment General Liability
458 Waterpark Facility Insurance Application General Liability

J. H. Ferguson

AppID Application Name Line of Business
11 Abstractors / Record Searchers E & O Insurance (01/95) Professional E & O
9 Appraisers Errors & Omissions Insurance (01/95) Professional E & O
519 Auctioneer (01.95) Professional E & O
470 Consultants E&O (01/98) Professional
15 Electronic Data Processing E & O Insurance (01/98) Professional E & O
16 Employment Agents E & O Insurance (01/95 Professional E & O
360 Home Inspection Services (09/05) Professional E & O
318 Insurance/Inspection E&O App (09/05) Professional
413 Interior Designer E&O Insurance (01/98) Professional E & O
12 Tax Preparation & Bookkeeping E & O Insurance (01/95) Professional E & O
106 Translators and Interpreters Errors and Omissions Insurance (01/95) Professional Liability
13 Travel Agents E & O Insurance (01/95) Professional E & O

Markel

AppID Application Name Line of Business
165 Alarm & Fire Extinguisher Systems Installation, Servicing, or Repair General Liability Supplement (10/07) General Liability
166 Amusement Supplement (10/07) General Liability
337 Animal Mortality (12/03) Inland Marine
167 Bars / Restaurant / Taverns General Liability Supplement (10/07) General Liability
168 Beauty Parlor / Barber Shop Supplement (10/07) General Liability
169 Campgrounds Supplement (10/07) General Liability
170 Catering Supplement (10/07) General Liability
202 Commercial Marine Insurance Application General Liability
171 Condominium / Homeowner's Association Supplement (10/07) General Liability
172 Contractor's Supplemental (10/07) General Liability
173 Dam Supplement (10/07) General Liability
174 Day Care Supplement (10/07) General Liability
175 Excavation / Grading Of Land Supplement (10/07) General Liability
176 Exercise & Health Studio Supplement (10/07) General Liability
177 Exterminators Supplement (10/07) General Liability
178 Fire Extinguisher Contractors Supplement (10/07) General Liability
339 Hole in One (01/04) Inland Marine
179 Hunting Supplement (10/07) General Liability
180 Janitorial Supplement (10/07) General Liability
181 Landscaping General Liability Supplement (10/07) General Liability
284 Machine Shop Supplemental Application (10/07) General Liability
182 Mobile Home Park Supplement (10/07) General Liability
183 Non-Owned Auto Coverage Supplement (10/07) General Liability
196 Notice of Terrorism Insurance Coverage General Liability
184 OCP / Builders Risk Supplement (10/07) General Liability
521 Outbreak Extra Expense (09/06) Property
185 Outfitters & Guides Supplement (10/07) General Liability
203 Product Liability Supplemental Application (10/07) Products
186 Property Manager Supplement (10/07) General Liability
187 Recycling Supplement (10/07) General Liability
188 Roofing Contractors Supplement (10/07) General Liability
189 Security Guard / Detective / Patrol Supplement (10/07) General Liability
190 Special Event Supplement (10/07) General Liability
193 Swim & Racquet Supplement (10/07) General Liability
191 Swimming Pool Maintenence Supplement (10/07) General Liability
192 Swimming Pool Supplement (10/07) General Liability
194 Tanning Salon Supplement (10/07) General Liability
195 Temporary Employment Agencies Supplement (10/07) General Liability
197 Tree Trimmers Supplement (10/07) General Liability
338 Truck Cargo (02/04) Inland Marine
198 Truckers / Warehouse Supplement (10/07) General Liability
199 Vacant Building Supplement (10/07) General Liability
200 Welding Supplement (10/07) General Liability
201 Wrecking Of Building (Per Job Basis) General Liability Supplement (10/07) General Liability

Media Professional

Miami Mutual

National Casualty

AppID Application Name Line of Business
485 Commercial Auto Renewal App - IA (11/06) Transportation
553 Commercial Auto Renewal App - NE (11/06) Transportation
285 Commercial Automobile Application IA (11/06) Transportation
550 Commercial Automobile Application NE (11/06) Transportation
344 Garage Insurance App - IA (11/06) Garage
551 Garage Insurance App - NE (11/06) Garage
552 Hired & Non-Owned Auto Supplemental App (11/06) Transportation
286 Motor Truck Cargo Supplemental Application (11/06) Transportation
345 Public Auto Supplemental App Limo & Airport Shuttle (11/06) Transportation
346 Public Auto Supplemental App Social Service & Ambulance (11/06) Transportation
343 Public Auto Supplemental Application All Other Risks (11/06) Transportation
542 Tow Truck/Wrecker Supplemental Application (11/06) Transportation

National Environmental

National Indemnity

AppID Application Name Line of Business
514 Auto Renewal Questionnaire (11/03) Transportation
357 Auto Services Operations (11/03) Garage
355 Bobtail (11/03) Transportation
97 Cargo Transportation
513 Excell Auto Supplement Transportation
532 Hired & Non-Owned Auto Supplement (11/03) Transportation
100 Limousine Transportation
101