SAFA Insurance Services 911 Park Ave | St. Louis, Mo 63104 | p. 314.436.2682 or 1-800-342-2601 | f. 314.436.1532  
 Call Us: 314.436.2682
 Toll Free:1-800-342-2601
 Fax US: 314.436.1532
 Auto Dept Fax: 314.333.3376 or 314.436.7180


  Applications
      Feel free to print these applications and fax or scan & e-mail them back to us. Please note that a completed and returned application does not bind coverage. These applications may not be altered in any way.

Fax applications to (314) 436-1532 or (314) 621-0560
Auto Dept Fax: 314.333.3376 or 314.436.7180
For more information, call us at 1-800-342-2601
Or email us at: info@safains.com


   



        Select a category to browse.
Commercial Auto



ACCEPTANCE - OCCIDENTAL - IAT
  • Commercial Auto Download PDF PDF
  • UM UIM Rejection Form IL Download PDF PDF


ACORD
  • Auto Accident Information Form 11 Download PDF PDF
  • Auto Loss Notice 2 Download PDF PDF
  • Commercial Auto Application 127 Download PDF PDF
  • Commercial Insurance Application 125 Download PDF PDF


CANAL


CAROLINA CASUALTY


EMPIRE FIRE AND MARINE
  • Non-Owned Auto Download PDF PDF
  • UM UIM Rejection Form IA Download PDF PDF
  • UM UIM Rejection Form IL Download PDF PDF


NATIONAL CASUALTY


NATIONAL INDEMNITY
  • UM UIM Election Form IL Download PDF PDF
Pollution

  • Environmental Contractors & Consultants Download PDF PDF
  • Site Specific Download PDF PDF
  • Storage Tank Combined UST AST Download PDF PDF
Commercial Umbrella & Excess



ACORD
  • Commercial Insurance Application 125 Download PDF PDF
  • Umbrella Section 131 Download PDF PDF


USLI - MT VERNON
  • Commercial Umbrella Download PDF PDF
Garage



ACORD
  • Garage & Dealers 128 Download PDF PDF


BURLINGTON - FIRST FINANCIAL


ESSEX
  • Dealers Open Lot & Garage Keepers Legal Download Word Document Word  Download PDF PDF


NATIONAL INDEMNITY
  • Expanded Classes Garage Supplement Download PDF PDF
  • Motorcycle & RV Dealer Download PDF PDF
  • Non-Owned Supplement Download PDF PDF


SCOTTSDALE


WILSHIRE
  • No UL Paint Booth Questionnaire Download Word Document Word  Download PDF PDF
General Liability



ACORD
  • Businessowners 160 Download PDF PDF
  • Certificate of Liability Insurance 25 Download PDF PDF
  • Commercial Insurance Application 125 Download PDF PDF
  • Contractor 186 Download PDF PDF
  • General Liability Loss Notice 3 Download PDF PDF
  • General Liability Section 126 Download PDF PDF
  • Restaurant Tavern 185 Download PDF PDF


BURLINGTON - FIRST FINANCIAL
  • Special Event Download PDF PDF


CAPITOL INDEMNITY - CAPITOL SPECIALTY
  • 3 B (Beauty Barber & Body) Program Download Word Document Word  Download PDF PDF
  • Private Investigators & Security Guards Download Word Document Word  Download PDF PDF
  • Roofer Residential Download PDF PDF


CENTURY SURETY
  • Construction Contractor Download PDF PDF
  • Restaurant Bar Tavern & Nightclub Download PDF PDF


NATIONAL INDEMNITY
  • Construction Contractor Download PDF PDF
  • General Liability Download PDF PDF


SCOTTSDALE


USLI - MT VERNON
  • 1 - 4 Family Dwelling Download PDF PDF
  • Bar & Restaurant Download PDF PDF
  • Beauty Salons, Nail Salons & Barber Shops Download PDF PDF
  • Clothing Store Download PDF PDF
  • Convenience Deli & Grocery Store Download PDF PDF
  • Electronics Store Download PDF PDF
  • Fitness Center Download PDF PDF
  • Lessors Risk Only Download PDF PDF
  • Mobile Home Park Download PDF PDF
  • Premises Preferred Download PDF PDF
  • Special Event Download PDF PDF
  • Specialty Non Profit Download PDF PDF
  • Truckers Package Download PDF PDF
  • Vacant Package Download PDF PDF
Inland Marine



ACORD
  • Commercial Insurance Application 125 Download PDF PDF
  • Electronic Data 148 Download PDF PDF
  • Equipment Section 146 Download PDF PDF
  • Installation Builders Risk 147 Download PDF PDF


ESSEX


USLI - MT VERNON
  • Contractors Choice Equipment Download PDF PDF
Liquor Liability



CAPITOL INDEMNITY - CAPITOL SPECIALTY


CENTREX
  • Liquor Liability Download PDF PDF


USLI - MT VERNON
  • Catering Plus Liquor Liability Download PDF PDF
  • Convenience Deli & Grocer with Liquor Liability Download PDF PDF
  • Liquor Liability Download PDF PDF
  • Liquor Liability Incident Report Form Download PDF PDF
  • Special Event with Liquor Liability Download PDF PDF
Miscellaneous

ACORD
  • Additional Interest Download PDF PDF
  • Agent or Broker of Record Letter Download PDF PDF
  • Cancellation Request - Policy Release Download PDF PDF
  • Change Request Download PDF PDF
  • Fraud Statement Download PDF PDF
  • Loss Notice - Automobile Download PDF PDF
  • Loss Notice - General Liability Download PDF PDF
  • Loss Notice - Property Download PDF PDF
  • Statement of No Losses Download PDF PDF


SAFA FORMS
  • Geovera Webquoting Agreement Download PDF PDF
  • SAFA Producers Agreement Download PDF PDF


SURPLUS LINES
  • Evidence of Diligent Search Download PDF PDF
  • Surplus Lines Risk Affidavit IL Download Word Document Word  Download PDF PDF
Commercial Property



ACORD
  • Accounts Receivable - Valuable Papers 145 Download PDF PDF
  • Businessowners 160 Download PDF PDF
  • Certificate of Property Insurance 24 Download PDF PDF
  • Commercial Insurance Application 125 Download PDF PDF
  • Crime Section141 Download PDF PDF
  • Evidence of Insurance 27 Download PDF PDF
  • Glass & Sign 144 Download PDF PDF
  • Property Loss Notice 1 Download PDF PDF
  • Property Section 140 Download PDF PDF
  • Schedule of Property Limits Download PDF PDF
  • Schedule of Values 139 Download PDF PDF
  • Supplemental Property 190 Download PDF PDF


BURLINGTON - FIRST FINANCIAL


CAPITOL INDEMNITY - CAPITOL SPECIALTY


CENTURY SURETY
  • Restaurant Bar Tavern & Nightclub Download PDF PDF


SCOTTSDALE


USLI - MT VERNON
  • 1 - 4 Family Dwelling Download PDF PDF
  • Bar Tavern Restaurant & Nightclub Download PDF PDF
  • Builders Risk Download PDF PDF
  • Building Renovation Download PDF PDF
  • Specialty Non-Profit Package Download PDF PDF
  • Truckers Package Download PDF PDF
  • Vacant Package Download PDF PDF


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Personal Lines



ACORD
  • Auto Loss Notice 2 Download PDF PDF
  • Certificate of Insurance 24 Download PDF PDF
  • Dwelling Fire 84 Download PDF PDF
  • Evidence of Property Insurance 27 Download PDF PDF
  • Homeowners 80 Download PDF PDF
  • Liability Loss Notice 3 Download PDF PDF
  • Personal Inland Marine Download PDF PDF
  • Personal Umbrella 83 Download PDF PDF
  • Property Loss Notice 1 Download PDF PDF


CHUBB
  • Consumer Report Form Download PDF PDF


FIRST MARINE - MARKEL AMERICAN
  • Boating Resume Download PDF PDF
  • First Marine Watercraft Download PDF PDF
  • Increased Limits Questionnaire Download PDF PDF
  • Markel Watercraft App Download PDF PDF
  • Personal Watercraft Download PDF PDF
  • Yacht & High Performance Download PDF PDF


LEXINGTON
  • Homeowners Supplement Download PDF PDF
  • Supplemental Heating Questionnaire Download Word Document Word  Download PDF PDF
  • Unprotected Home Questionnaire Download Word Document Word  Download PDF PDF
Terrorism Forms

  • Acceptance - Occidental - IAT - MCM - Wilshire Download PDF PDF
  • Atlantic Casualty Download PDF PDF
  • Capitol Indemnity - Capitol Specialty Download PDF PDF
  • National Indemnity Download PDF PDF
  • USLI - Mt Vernon Download PDF PDF
Watercraft & Marine



First Marine & Markel American
  • Boating Resume Download PDF PDF
  • Charter Vessel Download PDF PDF
  • Commercial Marine Download PDF PDF
  • Commercial Misc Marine Download PDF PDF
  • Commercial Watercraft Rental Download PDF PDF
  • High Performance Boat Download PDF PDF
  • Increased Limit Questionnaire Download PDF PDF
  • Personal Watercraft Download PDF PDF
  • Watercraft - First Marine Download PDF PDF
  • Watercraft - Markel American Download PDF PDF
Professional Liability

  • Advertising Agency Download PDF PDF
  • Physians & Surgeons Download PDF PDF
  • Pollution Consultant Download PDF PDF
  • Public Entity - General Liability Download Word Document Word  Download PDF PDF
  • Specified Medical Professional Download Word Document Word  Download PDF PDF
  • Title Abstractor & Escrow Agents Download PDF PDF


USLI - MT VERNON
  • Community Association Download PDF PDF
  • Employment Practices Download PDF PDF
  • For Profit D&O Download PDF PDF
  • Non Profit D&O Download PDF PDF
  • Real Estate E&O Download PDF PDF
  • Specified Professions Download PDF PDF


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