Property & Casualty

Adult Day Care General Liability Application

PDF icon Adult Day Care GL App (8/21)

Adult Daycare Centers Professional and General Liability Application

PDF icon Adult Daycare Centers Professional and General Liability App (6/03)

Alarm Installation, Servicing, Monitoring or Repair General Liability Application

PDF icon Alarm Installation, Servicing, Monitoring or Repair GL App (12/15)

Amusement Program General Liability Application
(Complete in addition to ACORD General Liability Application)

PDF icon Amusement Program GL App (11/15)

Animal Services Program Supplemental Application
(Complete in addition to ACORD Application)

PDF icon Animal Services Program Supp (10/13)

Apartment Building/Habitational Application

PDF icon Apartment Building/Habitational App (03/21)

Apartment Building/Habitational Security Supplement
(Complete in addition to Apartment Building/Habitational Application when Security Guard on premises)

PDF icon Apartment Building/Habitational Security Supp (05/20)

Apartment Building/Habitational Swimming Pool Supplement
(Complete in addition to Apartment Building/Habitational Application when Swimming Pool on premises)

PDF icon Apartment Building/Habitational Swimming Pool Supp (05/20)

Artisan Contractors General Liability Application

PDF icon Artisan Contractors General Liability App (05/20)

Artisan Contractors Renewal Application

PDF icon Artisan Contractors Renewal App (11/13)

Auto Repossessors Questionnaire
(Complete in addition to General Liability Application)

PDF icon Auto Repossessors Quest (4/12)

Bailees Customers Application

PDF icon Bailees Customers App (5/16)

Bar, Restaurant or Tavern General Liability Application

PDF icon Bar, Restaurant or Tavern General Liability App (05/20)

Bar, Restaurant or Tavern Package Application

PDF icon Bar, Restaurant or Tavern Package App (03/21)

Beauty Salon, Barber Shop and Day Spa Application

PDF icon Beauty Salon, Barber Shop and Day Spa App (03/21)

Blasting Contractors Supplemental Application
(Complete in addition to ACORD General Liability Application)

PDF icon Blasting Contractors Supp (12/14)

Boat Marinas or Yards/Boat Repair/Boat Storage Supplemental Application
(Complete in addition to ACORD General Liability Application)

PDF icon Boat Marinas or Yards/Boat Repair/Boat Storage Supp (7/12)

Builders Risk Application

PDF icon Builders Risk App (03/21)

Caterers and Halls General Liability and Miscellaneous Articles Application

PDF icon Caterers and Halls GL and Miscellaneous Articles App (10/15)

Church/House of Worship Application

PDF icon Church/House of Worship App (03/21)

Clergy Counseling Errors and Omissions Application
(Complete in addition to Church Application)

PDF icon Clergy Counseling E&O App (12/15)

Climbing Wall Questionnaire
(Climbing, Tread, and Bouldering)

PDF icon Climbing Wall Quest (9/08)

Club Program Supplemental Application
(Complete in addition to ACORD General Liability Application)

PDF icon Club Program Supplemental App (3/14)

Commercial Fine Arts Application

PDF icon Commercial Fine Arts App (4/11)

Commercial General Liability Additional Insured Questionnaire

PDF icon Commercial General Liability Additional Insured Quest (9/13)

Commercial General Liability Application

PDF icon Commercial General Liability App (05/20)

Commercial General Liability Renewal Application

PDF icon Commercial General Liability Renewal App (11/06)

Commercial Inland Marine Application
(Animal Floater, Golf Carts, Signs)

PDF icon Commercial IM App (2/12)

Commercial Inland Marine Contractor's Equipment Application

PDF icon Commercial Inland Marine Contractor's Equipment App (05/20)

Commercial Package Application

PDF icon Commercial Package App (03/21)

Commercial Property Application

PDF icon Commercial Property App (03/21)

Condominium and Homeowners Association D&O Liability Application
(Complete in addition to Condominium and Homeowners Association GL App)

PDF icon Condominium and Homeowners Association D&O Liability App (8/14)

Condominium and Homeowners Association General Liability Application

PDF icon Condominium and Homeowners Association GL App (8/14)

Consultant Liability Application

PDF icon Consultant Liability App (6/14)

Contractors Equipment Rental General Liability Application

PDF icon Contractors Equipment Rental GL App (10/13)

Convalescent Homes/Residential Care/Homes for the Aged GL Application

PDF icon Convalescent Homes/Residential Care/Homes for the Aged GL App (11/06)

Cyber Cafes/Internet Auctions/Internet Retailers Supplemental Application

PDF icon Cyber Cafes/Internet Auctions/Internet Retailers Supp (9/12)

Dam Questionnaire

PDF icon Dam Quest (7/16)

Day Care Application

PDF icon Day Care App (03/21)

Demolition Contractors (Annual Policy) General Liability Application

PDF icon Demolition Contractors (Annual Policy) GL App (7/14)

Demolition Contractors (Per Job Basis) General Liability Application

PDF icon Demolition Contractors (Per Job Basis) GL App (7/14)

Detective or Investigative Agencies (Private) & Process Servers Supplemental
Application (Complete in addition to ACORD General Liability Application)

PDF icon Detective or Investigative Agencies & Process Servers Supp (12/14)

Distributors and Wholesalers Program General Liability Supplemental
Application (Complete in addition to ACORD General Liability Application)

PDF icon Distributors and Wholesalers Program GL Supp (8/14)

Employment Agencies (Temporary Clerical or Retail) Application

PDF icon Employment Agencies (Temporary Clerical or Retail) App (4/14)

Employment-Related Practices Liability Supplemental Application

PDF icon Employment-Related Practices Liability Supp (2/13)

Energy Operator/Non-Operator Supplement

PDF icon Energy Operator/Non-Operator Supp (5/16)

Event and Party Planners Supplemental Application

PDF icon Event and Party Planners Supp (12/15)

Excavators and Grading of Land Supplemental Application
(Complete in addition to ACORD General Liability Application)

PDF icon Excavators and Grading of Land Supp (10/13)

Exercise and Health Studio and Personal Trainer Supplemental Application
(Complete in addition to ACORD Application)

PDF icon Exercise and Health Studio and Personal Trainer Supp (12/14)

Exhibition Application

PDF icon Exhibition App (4/11)

Exterminators General Liability Application

PDF icon Exterminators GL App (8/15)

Fire Sprinkler Contractor General Liability Application

PDF icon Fire Sprinkler Contractor GL App (9/08)

Fitness Center/Health Club Application

PDF icon Fitness Center/Health Club App (03/21)

Flea Markets/Swap Meets/Bazaars General Liability Application

PDF icon Flea Markets/Swap Meets/Bazaars GL App (10/13)

Foreclosure/Eviction Cleanup Supplemental Application
(Complete in addition to ACORD General Liability Application)

PDF icon Foreclosure/Eviction Cleanup Supp (1/15)

General Contractors/Developers General Liability Application

PDF icon General Contractors/Developers GL App (11/14)

Grocery/Convenience Store Application

PDF icon Grocery/Convienence Store App (08/21)

Halfway House General Liability Application

PDF icon Halfway House GL App (7/15)

Hole-In-One Coverage Application

PDF icon Hole-In-One Coverage App (7/08)

Home Health Care and Miscellaneous Home Services GL Application

PDF icon Home Health Care and Miscellaneous Home Services GL App (3/15)

Hunting Clubs, Preserves and Shooting Ranges General Liability Application

PDF icon Hunting Clubs, Preserves and Shooting Ranges GL App (7/16)

Janitorial Program General Liability Application

PDF icon Janitorial Program General Liability App (05/20)

Landowners Program Supplemental Application
(Complete in addition to ACORD General Liability Application)

PDF icon Landowners Program Supp (7/14)

Landscaping/Tree Trimming General Liability Application

PDF icon Landscaping/Tree Trimming General Liability App (05/20)

Liquor Liability (IL only) Application

PDF icon Liquor Liability (IL only) App (9/15)

Liquor Liability (IN only) Application

PDF icon Liquor Liability (IN only) App (10/14)

Liquor Liability (OH only) Application

PDF icon Liquor Liability (OH only) App (11/14)

Liquor Liability Hall Rental/Caterers (IN only) Supplement
(Complete in addition to IN Liquor Liability Application)

PDF icon Liquor Liability Hall Rental/Caterers (IN only) Supp (10/14)

Liquor Liability Policy (IN only) Renewal Application

PDF icon Liquor Liability Policy (IN only) Renewal App (10/14)

Liquor Liability Retail Store (IN only) Application

PDF icon Liquor Liability Retail Store (IN only) App (10/14)

Liquor Liability Retail Store Multi-Location (IN only) Supplement
(Complete in addition to IN Liquor Liability Application)

PDF icon Liquor Liability Retail Store Multi-Location (IN only) Supp (10/14)

Liquor Liability Special Event (IL only) Application

PDF icon Liquor Liability Special Event (IL only) App (9/15)

Liquor Liability Special Event (IN only) Application

PDF icon Liquor Liability Special Event (IN only) App (10/14)

Liquor Liability Special Event (OH only) Application

PDF icon Liquor Liability Special Event (OH only) App (5/13)

Logging and Lumbering Program Supplemental Application
(Complete in addition to ACORD General Liability Application)

PDF icon Logging and Lumbering Program Supp (11/06)

Logging General Liability Application

PDF icon Logging General Liability App (05/20)

Machine Shop Supplemental Application

PDF icon Machine Shop Supp (4/15)

Machinery & Equipment Supplemental Application
(Complete in addition to ACORD Application)

PDF icon Machinery & Equipment Supp (7/16)

Manufacturing Questionnaire

PDF icon Manufacturing Quest (3/02)

Martial Arts Studio Supplemental Application
(Complete in addition to ACORD Application)

PDF icon Martial Arts Studio Supp (10/13)

Medical Equipment Supply Stores Liability Application

PDF icon Medical Equipment Supply Stores Liability App (10/15)

Medical Marijuana General Liability Application

PDF icon Medical Marijuana General Liability App (1/15)

Medical Testing Laboratories Liability Application

PDF icon Medical Testing Laboratories Liability App (2/97)

Miscellaneous Articles Application

PDF icon Miscellaneous Articles App (4/11)

Mobile Agriculture Machinery and Equipment Application

PDF icon Mobile Agriculture Machinery and Equipment App (4/11)

Mobile Home Parks and Campgrounds Program Supplemental Application
(Complete in addition to ACORD General Liability Application)

PDF icon Mobile Home Parks and Campgrounds Program Supp (7/14)

Motel Program Supplemental Application
(Complete in addition to ACORD Application)

PDF icon Motel Program Supp (1/21)

Non-Owned and Hired Auto Coverage Supplemental Questionnaire

PDF icon Non-Owned and Hired Auto Coverage Supp (11/14)

Non-Owned and Hired Automobile Supplemental Application

PDF icon Non-Owned and Hired Automobile Supp (11/12)

Oil and Gas Application

PDF icon Oil and Gas App (8/14)

Oil and Gas Contractors and Consultants Application

PDF icon Oil and Gas Contractors and Consultants App (2/13)

Oil and Gas Contractors Supplement

PDF icon Oil and Gas Contractors Supp (8/14)

Oil Lease Operator/Non-Operator Supplemental Application

PDF icon Oil Lease Operator/Non-Operator Supp (11/12)

Outfitters and Guides Program Supplemental Application

PDF icon Outfitters and Guides Program Supp (9/15)

Owners/Contractors Protective Liability Application

PDF icon Owners/Contractors Protective Liability App (12/14)

Pipeline Operator Supplemental App

PDF icon Pipeline Operator Supp (11/12)

Plastic Manufacturing Questionnaire

PDF icon Plastic Manufacturing Quest (3/02)

Prize Indemnification Application

PDF icon Prize Indemnification App (9/11)

Products Liability Application

PDF icon Products Liability App (10/14)

Quarries and Mines Supplemental Application

PDF icon Quarries and Mines Supp (10/13)

Racing Special Events Supplemental Application
(Complete in addition to Special Events Application)

PDF icon Racing Special Events Supp (11/06)

Real Estate Property Management Supplemental Application
(Complete in addition to ACORD General Liability Application)

PDF icon Real Estate Property Management Supp (6/14)

Riggers Liability Questionnaire

PDF icon Riggers Liability Quest (3/02)

Roofers Questionnaire
(Complete in addition to General Liability Application)

PDF icon Roofers Quest (12/07)

Scaffolding Contractors Liability Application

PDF icon Scaffolding Contractors Liability App (4/08)

Schools - Private, Technical, Trade and Vocational Supplemental Application
(Complete in addition to ACORD General Liability Application)

PDF icon Schools - Private, Technical, Trade and Vocational Supp (11/14)

Security Guards and Related Operations General Liability Application

PDF icon Security Guards and Related Operations GL App (12/15)

Single Interest Commercial Property Application

PDF icon Single Interest Commercial Property App (03/21)

Snow Removal Supplemental Application

PDF icon Snow Removal Supp (1/18)

Special Event Application

PDF icon Special Event App (05/20)

Sports Camps/Clinics/Leagues General Liability Application

PDF icon Sports Camps/Clinics/Leagues GL App (9/15)

Stable Liability Application

PDF icon Stable Liability App (05/20)

Surfing/Paddle Board Instruction and Beach Equipment Rental Liability Application

PDF icon Surfing/Paddle Board Instruction and Beach Equipment Rental Liability App (5/15)

Swim and Racquet Club Program Application

PDF icon Swim and Racquet Club Program App (10/12)

Swimming Pool Contractors, Dealers and Installers Supplemental Application
(Complete in addition to ACORD General Liability Application)

PDF icon Swimming Pool Contractors, Dealers and Installers Supp (5/14)

Swimming Pool Maintenance and Management Supplemental Application
(Complete in addition to ACORD General Liability Application)

PDF icon Swimming Pool Maintenance and Management Supp (10/13)

Swimming Pool Survey

PDF icon Swimming Pool Survey (1/10)

Tanning Salon Program Supplemental Application
(Complete in addition to ACORD General Liability Application)

PDF icon Tanning Salon Program Supp (4/14)

Telecommunication Towers Supplemental Application
(Complete in addition to ACORD General Liability Application)

PDF icon Telecommunication Towers Supp (7/16)

Theatrical Property Application

PDF icon Theatrical Property App (5/15)

Transportation Services Program Supplemental Application

PDF icon Transportation Services Program Supp (12/15)

Trip Transit Application

PDF icon Trip Transit App (4/11)

Truckers Program Supplemental Application

PDF icon Truckers Program Supp (6/17)

Unmanned Aircraft System (UAS) Application

PDF icon Unmanned Aircraft System (UAS) App (1/15)

Vacant Building Application

PDF icon Vacant Bldg App (05/20)

Vacant Building Program Supplemental Application
(Complete in addition to ACORD Application)

PDF icon Vacant Building Program Supp (11/15)

Warehouse Operators Legal Liability Coverage Questionnaire

PDF icon Warehouse Operators Legal Liability Coverage Quest (12/11)

Warehouse Program Supplemental Application
(Complete in addition to ACORD General Liability Application)

PDF icon Warehouse Program Supp (3/15)

Water Park Liability Application

PDF icon Water Park Liability App (4/08)

Water Supply Companies and Irrigation Systems Supplemental Application
(Complete in addition to ACORD General Liability Application)

PDF icon Water Supply Companies and Irrigation Systems Supp (11/06)

Welding, Brazing and Cutting General Liability Supplemental Application
(Complete in addition to ACORD General Liability Application)

PDF icon Welding, Brazing and Cutting General Liability Supp (11/14)

Wind & Solar Energy Liability Application

PDF icon Wind & Solar Energy Liability App (6/16)

Zoo Liability Supplemental Application
(Complete in addition to General Liability Application)

PDF icon Zoo Liability Supp (11/15)

About Us

Roush Insurance Services, Inc. is a wholesale general insurance agency that has been in business since 1990. We offer licensed insurance agents access to the excess and specialty market for risks domiciled in Indiana, Illinois and Ohio.

Industry Links

Our memberships in WSIA, PIA of IN, IIA of IN and IIA of IL enable us to stay abreast of industry developments and better serve your insurance needs.

Contact Us

Roush Insurance Services, Inc.
18077 River Road, Suite 107
Noblesville, IN 46062-8311
Toll Free: (800) 752-8402
Phone: (317) 776-6880
Fax: (317) 776-6891
Submissions: quote@roushins.com
Claims: claim@roushins.com
Accounting: accounting@roushins.com
Information: info@roushins.com