Broker/Agent Information

License Information and Evidence of Insurance

All first-time producers requesting coverage through the DefensePro program will need to submit the following information prior to binding:

	Completed Agent Information Form (submit with initial application)
	Signed Lockton Producer Agreement*
	Completed W-9 Form
	Copy of your individual agent's license
	Copy of your surplus lines license
	Certificate of Insurance for your professional liability insurance (should provide evidence that your coverage is currently in force and state the limits of liability carried)
*The Lockton Producer Agreement will be sent to you for completion upon submission of the completed Agent Information Form

Binding Coverage

In order to bind coverage on a submission, the following items will be needed:

	A fully completed DefensePro New Business Application
	A formal quotation issued by our office
	A signed warranty letter from the applicant (one will be provided at the time of quote)
	Any additional information requested
	A copy of the completed premium finance agreement if financed by you
	At least 25%** of the net annual premium due (the remainder must be paid within 30 days)
Surplus Lines taxes/fees or any other surcharges or taxes required by law are the responsibility of the submitting producer to collect and pay as required by law. **Minimum earned amount of premium payable under the policy in the event of cancellation

Insurance Program Administered by Lockton Risk Services
P.O. Box 410679 / Kansas City, MO 64141-0679 / 800.250.7876 / info@defenseproliability.com