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Insurance Exception Risk Analysis

  1. Insurance Exception Risk Analysis
  2. Please fill out the form below to provide additional insight for the applicant and the scope of business between the applicant and The City of Frederick. If the applicant meets the City's general required limits there is no need to fill out this form, this form will be for exceptions only.

    All forms will be submitted by The City of Frederick employee who is working on the agreement with the applicant and will be reviewed by RSC, please allow up to 48 hours for a response. After RSC has reviewed the form and any attachments you provide, you will receive an email from RSC advising if we can move forward with the proposed insurance for the applicant. Please provide as much information as possible and fill out all fields, RSC may ask additional questions as we navigate through the review process.

    Our goal is to work together to try to minimize risk to our organization and provide a fair opportunity to work with those that are unable to meet our minimum required limits based on the descriptions provided. Any questions please contact
  3. 4. What type of agreement is this?*
  4. 6. Will the applicant have 1 or more employees on premise at any time?*
  5. Leave This Blank:

  6. This field is not part of the form submission.