Broker Application "*" indicates required fields Step 1 of 9 11% Welcome to a new application process We will ask simple questions about your office locations, key contacts, and portfolio. Your privacy is important. Click here to view our full privacy and security policy. Basic Information BrokerageLegal nameYear establishedWebsiteList any broker groups the brokerage is a member of below (if applicable).RepresentativeFirst nameLast namePositionEmail Phone Locations OfficesUse the 'Add Location' button below to list office locations:Locations Address Actions Edit Delete There are no locations. Add Location Maximum number of locations reached. People Key ContactsUse the 'Add Contact' button below to list key contacts:Key Contacts First name Last name Position Actions Edit Delete There are no Contacts. Add Contact Maximum number of contacts reached. Portfolio Commercial BusinessEstimated gross written premium (GWP)Arts and CultureDoes your brokerage write Arts and Culture establishments?* Yes No Which of the following businesses make up your portfolio? Theatre (except musical) companies Musical theatre and opera companies Dance companies Musical groups and artists Live theatres and other performing arts presenters with facilities Performing arts promoters (presenters) without facilities Festivals without facilities Non-commercial art museums and galleries Other museums Select AllEstimated GWPEstimated policy countCare and CommunityDoes your brokerage write Care and Community establishments?* Yes No Which of the following businesses make up your portfolio? Residential developmental handicap facilities Transition homes for women Residential substance abuse facilities Homes for the physically handicapped or disabled Nursing care facilities Child and youth services Community food services Community housing services Lessors of social housing projects Services for the elderly and persons with disabilities Select AllEstimated GWPEstimated policy countEducational FacilitiesDoes your brokerage write Educational Facilities?* Yes No Which of the following businesses make up your portfolio? Elementary and secondary schools Community Colleges and C.E.G.E.P.s Universities Business and Secretarial Schools Technical and Trade Schools Fine Arts Schools Language Schools Educational Support Services Child day-care services Select AllEstimated GWPEstimated policy countReligious InstitutionsDoes your brokerage write Religious Institutions?* Yes No Which of the following businesses make up your portfolio? Places of worship Estimated GWPEstimated policy countRecreation and LeisureDoes your brokerage write Recreation and Leisure establishments?* Yes No Which of the following businesses make up your portfolio? Fitness and recreational sports centres Nature parks and other similar institutions Bed and breakfast Boutique hotels Select AllEstimated GWPEstimated policy countHeritage and LandmarkDoes your brokerage write Heritage and Landmark establishments?* Yes No Which of the following businesses make up your portfolio? History and science museums Historic and heritage sites Heritage designated commercial offices and shops Buildings with cultural or architectural significance Select AllEstimated GWPEstimated policy countMember Groups and AssociationsDoes your brokerage write Member Groups and Associations?* Yes No Which of the following businesses make up your portfolio? Civic and social organizations Business Associations Professional Organizations Labour Organizations Select AllEstimated GWPEstimated policy countKey AccountsUse the 'Add Account' button below to list key accounts in the above segments:Key Accounts Account Renewal month Estimated GWP Actions Edit Delete There are no accounts. Add Account Maximum number of accounts reached. Markets Select the brokerage's top five (5) markets with associated GWP using the dropdowns below:MarketSelect from dropdownAIGAvivaChubbEcclesiasticalIntactMarkelNorthbridgeSovereign GeneralTrisuraWawanesaWynwardZurichEstimated GWPMarketSelect from dropdownAIGAvivaChubbEcclesiasticalIntactMarkelNorthbridgeSovereign GeneralTrisuraWawanesaWynwardZurichEstimated GWPMarketSelect from dropdownAIGAvivaChubbEcclesiasticalIntactMarkelNorthbridgeSovereign GeneralTrisuraWawanesaWynwardZurichEstimated GWPMarketSelect from dropdownAIGAvivaChubbEcclesiasticalIntactMarkelNorthbridgeSovereign GeneralTrisuraWawanesaWynwardZurichEstimated GWPMarketSelect from dropdownAIGAvivaChubbEcclesiasticalIntactMarkelNorthbridgeSovereign GeneralTrisuraWawanesaWynwardZurichEstimated GWPUse the space below to write any additional comments. Regulatory LicensingIn which of the following provinces and territories is the brokerage licensed: Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon Select AllInsuranceErrors and Omissions CarrierLimit of insurance Business Strategy Describe the brokerage's business strategy. Feedback ProductTell us how our product compares to the market in the following areas:PropertyUntitled*Select from dropdownBestAbove averageAverageBelow averageNeeds workGeneral LiabilityUntitled*Select from dropdownBestAbove averageAverageBelow averageNeeds workAbuseUntitled*Select from dropdownBestAbove averageAverageBelow averageNeeds workProfessional LiabilityUntitledSelect from dropdownBestAbove averageAverageBelow averageNeeds workDirectors and Officers LiabilityUntitledSelect from dropdownBestAbove averageAverageBelow averageNeeds workUmbrellaUntitledSelect from dropdownBestAbove averageAverageBelow averageNeeds workEquipment BreakdownUntitledSelect from dropdownBestAbove averageAverageBelow averageNeeds workCyberUntitledSelect from dropdownBestAbove averageAverageBelow averageNeeds workUse the space below to write any additional comments.Service LevelTell us how our service compares to the market in the following areas:ClaimsUntitledSelect from dropdownBestAbove averageAverageBelow averageNeeds workUnderwritingUntitledSelect from dropdownBestAbove averageAverageBelow averageNeeds workRisk ControlUntitledSelect from dropdownBestAbove averageAverageBelow averageNeeds workUse the space below to write any additional comments. Signed Understanding Please sign below to confirm the information provided is accurate.Signature 30-May-2025
