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Principles & Personnel
Breakdown of Producer's Staff
Do you write business outside of State of Domicile?
List States with Licenses:
Please forward copies of all your current licenses.
List your volume by category:
List Major Companies/Wholesale Brokers in order of Premium
Production to Company
Anticipated volume to company from following sources:
Do you maintain E & O Coverage?
If yes, please indicate the the following:
Exp. Date (mm/dd/yy)
Has any member of your firm received disciplinary action
by the state Insurance department or any other regulatory
If yes, please explain:
Is there any pending or threatening litigation or judgements
within the past 5 years exceeding $5000.00?
How did you hear about Pro-Risk Solutions?
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© 2001-2003 Pro Risk Solutions, Llc. | 285 Davidson Avenue
Suite 101 | Somerset, New Jersey 08873
phone | 732-873-1300 | fax | 732-873-6989
For additional information, please e-mail us at email@example.com
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