Personal Care & Assisted Living Insurance Center, LLC

Change Request Form

Make changes to your existing insurance policies with the PCALIC QUICK CHANGE FORM below. Any change in ownership will require speaking to a representative of PCALIC and may not be completed by using the QUICK CHANGE FORM.

ADD OR CHANGE A LOCATION

Mailing Address
Physical Address


Address of premises to be removed



Address of premises to be added



NEW PREMISES COVERAGE:

Amount of Coverage



NEW BUILDING EXPOSURES:











NEW BUILDING USE:


ADDING OR DELETING A MORTGAGE TO A BUILDING













MEMBERS ONLY

Username

Password


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Adult Residential Care Facilities are in good hands with PCALIC, not just for insurance, but also for vital educational materials we receive from them that enhances staff training and program evaluations. We thank you!

- MILLER & SON PCH, INC.

Target Markets Program Administrators Association

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