Healthcare Professional Services, Inc. - Quality. Professional. Medial Liability Insurance.

Agent / Producer
Information

Surplus Lines Affidavits by State

updated 10-06-08

ALABAMA*	MASSACHUSETTS	TENNESSEE*
ALASKA*	MICHIGAN*	TEXAS*
ARIZONA*	MINNESOTA*	UTAH*
ARKANSAS	MISSISSIPPI*	VERMONT*
CALIFORNIA*	MISSOURI	VIRGINIA*
COLORADO*	MONTANA	WASHINGTON*
CONNECTICUT*	NEBRASKA*	WEST VIRGINIA
DELAWARE	NEVADA*	WISCONSIN*
DISTRICT OF COLUMBIA*	NEW HAMPSHIRE*	WYOMING*
FLORIDA	NEW JERSEY*
GEORGIA*	NEW MEXICO
HAWAII	NEW YORK
IDAHO*	NORTH CAROLINA
ILLINOIS*	NORTH DAKOTA*
INDIANA*	OHIO
IOWA*	OKLAHOMA*
KANSAS	OREGON
KENTUCKY*	PENNSYLVANIA
LOUISIANA	RHODE ISLAND
MAINE*	SOUTH CAROLINA*
MARYLAND*	SOUTH DAKOTA*

* Indicates the Generic Declination Form is to be filled out by the producing agent.