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 firstname.lastname@example.org
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 + prior 3 years loss runs valued no more than 90 days prior to the effective date. If submitting more than 90 days prior to the effective date, loss runs should be currently valued within 30 days of the submission date and updated as noted below.
- Target Premium & Need By Date
- Agency Code
Kinetic agency partners may submit risks up to 120 days before the policy effective date. Any submission sent between 91 and 120 days before the policy effective date must include fully valued loss runs dated within 30 days of the submission. In order to maintain market reservation and to receive a quote, all submissions must include fully valued loss runs within 90 days of the policy effective date. The first agency with a complete submission within the 90 days will earn the market reservation.
Broker of Service and Broker of Record notices are not accepted.
- Agriculture Questionnaire
- Auto Dealer Questionnaire
- Country Club Questionnaire
- Home Health Care Questionnaire
- Hospital Questionnaire
- Janitorial Questionnaire
- Manufacturing Questionnaire
- Nursing Home Questionnaire
- Parcel Delivery Questionnaire
- Physician Questionnaire
- Restaurant Questionnaire
- Towing Questionnaire
- Wholesale Questionnaire
- Nationwide Officer Exclusion Form
- Nationwide Officer Inclusion Form
- Appetite Guide NCCI
- Appetite Guide CA
- Target Class Code List – All States
Note that our minimum premium size is $50,000