For Appointed Agents Only

Ready to get smarter insurance coverage that keeps workers safe and reduces costs? We’re ready to get to work on your customized quote!

Please read the following instructions carefully and then email your submission to

Once we have received your submission we will get back to you promptly with a quote. Complete and submit the forms below and we’ll follow-up shortly with results.

Please include the following with your email

  • ACORD 130
  • Appropriate Kinetic Industry Supplemental Application (See Below)
  • Ex-Mod Worksheet (if available), current year + 3 prior year loss runs valued no less than 90 days of the proposed effective date
  • Target Premium & Need By Date
  • Agency Code

Supplemental Documents

Note that our minimum premium size is $50,000