GL Application
...and other supplemental forms
Listed below you will find our forms in both Word and PDF format. Please select the best format for your computer system, click the link and save the document. After you have completed filling out your form(s) you may fax it to (225) 927-3295. You may also scan and email your form to info@lipca.com.
If you would prefer to mail the forms please send to:
LIPCA, Inc.
3042 Old Forge Drive, Suite A
Baton Rouge, LA 70808
- General Liability Application
Word | PDF - Lawn & Landscape Supplement
Word | PDF - Fumigation Supplement
Word | PDF - Commercial Property Supplement
Word | PDF - Umbrella Supplement
Word | PDF
EFFECTIVE IMMEDIATELY!
ANY NEW OR RENEWAL SUBMSISSIONS FOR GL, EXCESS OR UMBRELLAS WHERE THE INSUREDS ARE PROVIDING CLEANING/DISINFECTING/SANITIZING SERVICES TO REMOVE NON PEST RELATED VIRUSES DISEASES WILL BE DECLINED AND/OR NON-RENEWED. PLEASE CONTACT OUR OFFICE FOR ANY ADDITIONAL INFORMATION. THANK YOU.
