If you are running out of time, simply finish the current page & click next. We will email you a link to complete the application where you left off!
NOTE: Remember not to hit your back button or your refresh button so that you do not accidentally erase or wipe out any type of information that you have typed in.
Section 5: Premium Summary
Subtotal Premium Due:
(Please click on the box if you're from Florida) Florida applicants need to add a 1.3% state mandated Hurricane Catastrophe Fund Assessment fee to the amount due.
Florida Hurricane Catastrophe Fund assessment fee:
Total Premium Due
Section 5B: Certificate Requests
This certificate is for:
Evidence of Coverage
Relationship to insured:
If other, explain:
Special certificate language needed (please explain/attach):
Date certificate needed by:
If applicable: Date(s) of event/activity
Hours of event/activity
Type of event/activity:
Name of event/activity:
Location of event/activity:
Loss Payee:Type of equipment (please describe)
Please make sure that you have completed everything to the best of your knowledge before going to the next page.