Welcome to Utica National Insurance’s unique E & O Program, designed specifically to meet the needs of the Independent Agent.

Getting a premium indication from Utica National couldn't be easier. If you meet the qualifications below, please continue on to our Quick Quote form.

Our program is designed for the Independent Agent who:

has been licensed for 2 or more years
is not an MGA
is not acting as a Reinsurance Intermediary

Should more than 50% of your services include surety bonds, long haul trucking or aviation, please click here to ask our local representatives to call you about other opportunities.

Our thanks to the many Independent Agents who have helped make our program such a success!

We have a special program for agents when more than 50% of your volume is in the Life, Accident and Health field. Please click here for the application.

It takes just a couple of minutes of your time to obtain a solid premium indication for your Agency's Errors & Omissions Coverage. your local affiliate

(Note: All fields are required to obtain a proper premium indication. This information will be used to predict a premium only, and is not an offer of a bind-able proposal.)

* Each field contains a help window. Please mouse over the field for a quick explanation.

Named Insured:

Physical Address Address: City: State: Zip Code:

Mailing Address (if different) Address: City: State: Zip Code:

Federal ID# / SSN#: Website:

Contact Information Name: Phone: E-Mail:

Independent Agent / Agency: Date Established:

Associations you are members of:

% of Total Agency Commission placed by line: P/L's % C/L's % L/H's %

% of Non-Standard or Assigned Risk placed by line: P/L's % C/L's %

Specialty Lines? If yes, what % of your income is placed as Specialty Lines? %

% of P&C Business placed THRU other Agents or Brokers: %

Staff CountFull Time (over 20 hours): Part Time (20 hours or less):

P & C PREMIUM VOLUME (excluding Contingency & Bonus Income): $

Commission Income (New & Renewal)P&C $ L&H $ Consulting Fees $

Exposure Analysis Checklist used on ALL accounts (P/L and C/L - active at least 1 year)?

Insurance Designations of staff equals or exceed 60% (CIC, CISR, CPCU, LUTCF, etc)?

E&O Loss Prevention Seminar last attended: # staff attended:

E&O Claims / Incidents in the last 3 years?

Current E&O Carrier: Expiration Date:

Retro-Active Date: Full Prior Acts Coverage?

Limits: $ per claim$ aggregatePremium: $

Deductible: $ per claim$ aggregate Type:

Optional Coverage / Information: