Statement As To Replacement Cost Coverage
A legal form stating the values used to calculate cost coverage for repair or replacement of a property loss.
PDF (26KB)
Forms Property & Casualty
Statement Of Loss W/O Enclosures
An adjuster's statement of a loss using Schedules A, B & C.
PDF (51KB)
Forms Property & Casualty
Customer's Claim & Affidavit
Damage to customer's property is included under a commercial general liability policy; this form describes items lost, seller, purchase date and depreciation. The claim amount is submitted with signature of customer and adjuster.
PDF (59KB)
Forms Property & Casualty
Hold Harmless Agreement
This is a contract that releases one party from any legal and financial responsibility for all loss or damage or future claims by the other party in exchange for a settlement.
PDF (20KB)
Forms Property & Casualty
Structural Fire - Investigating Officer
Statement guideline for interviewing the investigating officer in a structural fire claim. Includes initial questions and follow up questions based on responses given.
PDF (17KB)
Statement Guides
Denial - Less Than Deductible
A denial letter used when the value of a claim submitted is determined to be less than the insured's deductible.
DOC (17KB)
Letters
Structural Fire - Witness
Statement guideline for interviewing a witness to a structural fire. Includes initial questions and follow up questions based on responses given.
PDF (19KB)
Statement Guides
Coinsurance Definition And Formula
Coinsurance formula and sample calculation for a property claim where the insured did not maintain the required minimum coverage (usually 80% of value) on a structure.
PDF (38KB)
General Reference
Property Arbitration Contentions Sheet
A property subrogation arbitration form.
DOC (28KB)
Forms Property & Casualty
Non-Waiver Agreement / Reservation Of Rights
The non-waiver agreement is signed by the policyholder; its purpose is to protect the insurer. Insurer reserves all of its rights under the policy to investigate and defend a claim without admission of any liability for loss.
PDF (36KB)
Forms Property & Casualty
Subrogation Receipt
A subrogation receipt is signed by the insured upon payment of a claim, and assigns the insurer to the right to recovery for the loss.
PDF (27KB)
Forms Property & Casualty
