AGENCY APPOINTMENT

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PRODUCER QUESTIONNAIRE

PLEASE FILL OUT THE FOLLOWING FORM AND SUBMIT. PLEASE ALSO UPLOAD A COPY OF THE PRODUCER AGREEMENT AND A COPY OF AGENCY LICENSE AND PROOF OF E&O INSURANCE

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ONCE THE FORM ABOVE IS FILLED OUT AND SENT, PLEASE ALSO UPLOAD A COPY OF THE PRODUCER AGREEMENT AND A COPY OF AGENCY LICENSE AND PROOF OF E&O INSURANCE

APPLICATIONS

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CLAIMS

LOSSES MAY BE REPORTED DIRECTLY BY THE INSURED OR BY THE INSURED'S LOCAL INSURANCE AGENT OR BROKER. NEW LOSSES SHOULD BE REPORTED BY USING ONE OF THE FIRST NOTICE CONTACTS BELOW:

Ace Group; Ace American Insurance Company; Ace Property and Casualty Insurance Company;
Illinois Union Insurance Company; Indemnity Insurance Company of North America

Email: wsgchinewclaims@acegroup.com

Phone: 800-306-7743

Fax: 215-640-5044 or 877-746-4651

 

 

 

Clear Blue Specialty Insurance Company

Email: reportaclaim@narisk.com

Phone: 800-315-6090

Fax: 866-261-8507

Internet: http://narisk.com/partnerEtools.php

Mail: North American Risk Services, P. O. Box 166002, Altamonte Springs, FL 32716-6002

HDI-Gerling America Insurance Company; International Insurance Company of Hannover, SE

Email: reportaclaim@narisk.com

Phone: 800-315-6090

Fax: 866-261-8507

Internet: http://narisk.com/partnerEtools.php

Mail: North American Risk Services P. O. Box 166002 Altamonte Springs, FL 32716-6002

Rockhill Insurance Company; Plaza Insurance Company

Email: Core@yorkrsg.com

Phone: 866-391-9675

Fax: 800-393-8014

State National Insurance Company and United Specialty Insurance Company

Email: reportaclaim@narisk.com

Phone: 800-315-6090

Fax: 866-261-8507

Internet:  http://narisk.com/partnerEtools.php

Mail: North American Risk Services, P. O. Box 166002, Altamonte Springs, FL 32716-6002

Underwriters at Lloyds, London
CJW Associates

Attn: Robert Floyd

Email: rfloyd@cjw-assoc.com

Phone: 407-847-0044

Mail: 1420 Edgewater Drive, Suite 200, Orlando, FL 32804