As a source of service and convenience, Keen Battle Mead & Company is pleased to offer the following for free and immediate download:
Downloading Forms:
Files located below are commonly available for download in Adobe Acrobat Reader format. If you do not have this program currently installed on your computer please click here to download it now for free.
PERSONAL LINES DOWNLOADS
- Agent/Broker Of Record Change: Use this form to provide authorization to move insurance policy management from your current insurance agent to Keen Battle Mead & Company.
- Statement Of No Loss: By completing & signing this form, the named insured certifies there were no losses, or circumstances that might give rise to a claim under the policy, during a period when a policy lapsed.
- Auto Accident Information Form: If you have an accident, use this form to record the facts about the accident, including names and address of all parties involved, and any witnesses to the accident. Give the completed form to your insurance agent of company, or provide the information by phone.
- Auto Accident Exchange Of Information Form: If you have an accident, use this form to help you provide your information to the other parties involved.
- Good Student Driver Training
- Young Driver Questionnaire
- Voluntary Election Not To Purchase Federal Flood Insurance
- Rejection/Election of Uninsured Motorist Coverage
- Florida Credit Report Disclosure
COMMERCIAL LINES DOWNLOADS
General Use Insurance Forms:
- Agent/Broker Of Record Change: Use this form to provide authorization to move insurance policy management from your current insurance agent to Keen Battle Mead & Company.
- Statement Of No Loss: By completing & signing this form, the named insured certifies there were no losses, or circumstances that might give rise to a claim under the policy, during a period when a policy lapsed.
- Voluntary Election Not To Purchase Federal Flood Insurance
Workers Compensation Insurance Forms:
- Application for Drug-Free Workplace Premium Credit Program
- Instructions for completing Notice of Election to be Exempt (DWC-250i)
- Notice of Election of Coverage Under Workers Compensation Law (Florida)
- Notice of Election To Be Exempt (DWC-250)
- Online Construction Policy Tracking Database
- Request for Policy Change Of Ownership form (ERM14)
- Revocation of Election To Be Exempt (Florida)
- Revocation of Election of Coverage
- Workers Compensation – First Report of Injury or Illness
- Florida Contracting Classification Premium Adjustment Program (FCCPAP)
Business Income & Extra Expense Worksheets:
- Colleges & Schools (not public schools) Worksheet
- Hospitals, Clinics & Health Care Centers Worksheet
- Manufacturers Worksheet
- Non-Manufacturers Worksheet
- Rental Property Worksheet
Bonds:
- Information Needed for Contract Bonds
- Schedule of Uncompleted & Completed Work
- Contractors Profile (or download in “Easy Type” MS Word format)
- Application for Contract or Bid Bond (or download in “Easy Type” MS Word format)
- Non-Contract (all other bonds) Surety Bond Application
Chubb’s Executive Protection Insurance Forms:
Linked to Chubb’s FormZoneSM, the following items enable you to download applications and specimen policies for Chubb’s most popular products.