Main Office
1212 Court St NE
Salem, OR 97301
Phone: 503-763-3800
Fax: 503-763-3900
Claims Office
PO Box 1469
Lake Oswego, OR 97035
Phone: 503-763-3875
Fax: 503-763-3901
Legal Office
280 Liberty St SE
Suite 206
Salem, OR 97301
Phone: 503-779-1070
Fax: 503-779-2716
CIS is a member service of the League of Oregon Cities and Association of Oregon Counties
|
 |
 |
|
If we have provided a quote for your entity in the past, please contact us before filling out these forms.
 |
|
|
Property/Liability Application
Excess Crime Coverage - $50,000 crime coverage is automatically included in the basic property
program. If a higher limit of coverage, or if faithful performance of duties coverage
is desired as an addition to the basic coverage, please complete this application.
|
|
|
|
|
Application Cover Page - Includes information on who the applicant is, who their
agent is and related contact information.
Named Member List - New Request For Information
Certificate of Eligibility - Describes information required to be included with
any applications from entities other than cities or counties.
Loss History and Additional Exposures - Describes prior loss information that is
required for all applications. Boiler and Machinery coverage is available only when
CIS currently profices or is quoting property coverage.
Prior Carrier History - Describes prior carrier information that is required for
all applications. |
|
|
|
|
|
|
General Liability Schedule - Includes exposure and operation information. Please
include any additional information you believe appropriate to better explain responses.
Auto Schedule - You may substitute your own schedule in lieu of the CIS form, however,
it is critical you include CIS Auto Codes and Equipment Descriptions in order for
us to prepare an Auto Liability or Auto Physical Damage proposal for you.
Definition of an "Auto" - Describes differences between Autos and Mobile Equipment
within CIS coverage structure. |
|
|
|
|
|
|
Property Schedule - Please list all buildings and contents including site
specific information as listed on the schedule. You may substitute your own schedule
in lieu of the CIS form provided it includes all of the requested information. If
your data is available in an Excel or similar electronic format, that is preferable.
Mobile Equipment Schedule (Inland Marine) - Please include all mobile equipment
to be covered including make, model and value. You may substitute your own schedule
in lieu of the CIS form provided it includes all of the requested information. If
your data is available in an Excel or similar electronic format, that is preferable.
|
|
|
|
|
|
|
|