Utica National E&O Easy Estimate
Please completely fill out the questionnaire for the best consideration.
This questionnaire is for premium indication only and is NOT an offer of coverage NOR is it bindable. If premium indication is acceptable, you will be forwarded to underwriting for further consideration.
If you have any questions, please contact Ronnie Roy @ email@example.com (910-366-4504) or Lisa Farnham @ firstname.lastname@example.org (804-486-4222).
Are you currently a contracted Utica National P&C agent? *
Is 50% or more of your premium volume crop insurance? *
Is more than 25% of your business surety bonds, long haul trucking, aviation, wet marine or professional liability? *
Have you had any E&O claims/incidents over $500 in the last three years? *
Percentage of total agency commissions by line:
Percentage of non-standard / assigned risk placed by line:
Staff count (include owners and principals):
Percentage of your agency's property & casualty premium volume placed:
Percentage of your agency's property & casualty premium volume that is received or assumed from the following:
Does 60% or more of your staff, including owners, have an insurance designation (CIC, CPCU, AAI, CISRF, LUTCF, CPIA)? *
Expiration Date *
Retroactive date: *
submissions or payments made via this website do not constitute a
binding agreement to your policy or coverages. Changes and
payments to policies are not effective or binding until you, or any
party involved, receive official notice from either your insurance agent,
or your insurance company. If you have any questions, please feel free to
Per the terms of our
we will not resell your information to any third-party.