Rfp # 17-03-20 Boiler and Machinery/Equipment Insurance

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RFP # 17-03-20

Boiler and Machinery/Equipment Insurance

BROKER QUESTIONNAIRE/MARKET REQUEST

Brokerage/Agency: _____________________________________________________________


Address: ______________________________________________________________________

Street or PO Box City State Zip


Telephone: (_____) ________________________ Fax: (__ ) _________________________
Internet E-mail address: __________________________________________________________

Check one: Broker ____ Independent Agent ____ Direct Writer _____


Account Executive: ______________________________________________________________
Assistants: _____________________________________________________________________

AGENCY/COMPANY QUALIFICATIONS

1. Years of continuous operation: ____________________


2. Number of employees: ___________________
3. Number of public entity clients: ____________________
4. Premium volume (P&C): $____________________
5. Approximate total premium volume (all clients): $___________________
6. Support services available: __________________________________________
________________________________________________________________
________________________________________________________________

7. Errors and Omissions insurance limits: $___________________


8. Please enclose any pertinent agency/company brochures, annual reports, etc.

MARKETS





  1. List in order of preference those major markets you might consider approaching for HISD’s account. Identify those markets as listed by rating bureaus. Also, identify those markets that you have an exclusive arrangement with which will preclude other brokers from utilizing. If the market listed is part of a larger group, please list the parent group. If you need to go through another entity to reach this market, please list the name of this entity beside the market.

a. ____________________________________________________

Market Parent
b. ____________________________________________________

Market Parent


c. ____________________________________________________

Market Parent


d. ____________________________________________________

Market Parent


e. ____________________________________________________

Market Parent


f. ____________________________________________________

Market Parent


g. ____________________________________________________

Market Parent


h. ____________________________________________________

Market Parent


I. ____________________________________________________

Market Parent


j. ____________________________________________________

Market Parent


2. List major markets your organization normally works with. Identify all markets that you have an exclusive arrangement with which will preclude other brokers from utilizing.
a. _______________________________________________________
b. _______________________________________________________
c. _______________________________________________________
d. _______________________________________________________
e. _______________________________________________________
f. _______________________________________________________
g. _______________________________________________________
h. _______________________________________________________
I. _______________________________________________________
j. _______________________________________________________


ACCOUNT EXECUTIVE'S QUALIFICATIONS

Name: _______________________________________________________________


Number of public entity clients: ____________________________________________
Length of time with agency/company: ______________________________________
Length of career in insurance industry: ______________________________________
Professional/Associate designations: _______________________________________
Employment history includes experience in:
____ Commercial Underwriting ____ Personal Lines Underwriting

____ Commercial Claims ____ Risk Management


____ Agency Account Servicing ____ Agency Marketing Function
____ Commercial Property Ins. ____ Excess/Surplus Lines

ACCOUNT ASSISTANT'S QUALIFICATIONS
Name: _______________________________________________________________
Number of public entity clients: ____________________________________________
Length of time with agency/company: ______________________________________
Length of career in insurance industry: ______________________________________
Professional/Associate designations: _______________________________________
Employment history includes experience in:
____ Commercial Underwriting ____ Personal Lines Underwriting

____ Commercial Claims ____ Risk Management


____ Agency Account Servicing ____ Agency Marketing Function
____ Commercial Property Ins. ____ Excess/Surplus Lines

REFERENCES

Governmental Entities:


_____________________________________________

Name Contact Phone

_____________________________________________

Name Contact Phone

_____________________________________________

Name Contact Phone


Private Entities:
_____________________________________________

Name Contact Phone



_____________________________________________

Name Contact Phone

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