Workers’ Comp Apps

Forms

• PMC Producer Agreement
• Acord 130
• W-9 Form
• Broker of Record Letter

Supplemental Apps

Transportation

• Transportation Supplemental App
• Parcel Delivery Supplemental App
• Waste Hauler Supplemental App
• Transportation Supplemental App for Bus and Limos
• Non-Emergency Medical Transportation Supplemental Application Workers’ Compensation

Healthcare and Social Services

• Healthcare Supplemental App
• Social Services Supplemental App
• Nursing Homes Supplemental App

Staffing

• Temporary Staffing Supplemental App
• Medical Staffing Supplemental App

Defense Base Act & Foreign

• Foreign App
• DBA App

Other

• Construction Supplemental App
• USL&H Supplemental App
• PMC Supplemental COVID-19 App