Brokerage Agreement

Broker Questionnaire

Become A Broker

 

Statehouse Casualty Managers operates on an "open brokerage" format; as such, we do not hold our retail agents to any minimum account volume or premium volume.

 

In order to become an appointed broker with Statehouse Casualty, we require the following items:

 

(1) Signed Brokerage Agreement;

(2) Completed Broker Questionnaire;

(3) Copy of your firm's License;

(4) Copy of the declarations page of your firm's in-force E&O policy, evidencing limits of $1,000,000 per occurrence;

(5) Copy of W-9 form.

 

Please e-mail or fax the above items to:

Heather Hysong, Compliance Administrator
Broker Relations Department

Fax:  440-333-3214
E-Mail: hhysong@mcgowaninsurance.com

 

 


 

 

 
IdeaStar Inc.