Brokers Letter of Market Authorization

By Darrell Reynolds,2014-07-09 20:08
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Brokers Letter of Market Authorization ...

To: Jody A. Harris, ARM, RPLU

    Arthur J. Gallagher & Co.

    125 S. Wacker Drive, Ste. 500

    Chicago, Illinois 60606

    Telephone: (312) 803-7395

    E-mail: Fax #: 312-803-6383/Pages ___________________


    Re: Broker’s Letter of Market Authorization

    To Whom It May Concern:

    This confirms effective immediately, we have appointed Arthur J. Gallagher & Co. as our exclusive insurance broker with respect to our entire Lawyers Professional Liability

    Insurance Program in negotiations with all Lawyers Professional Liability Insurance Carriers. The appointment of Arthur J. Gallagher & Co. rescinds all previous appointments, and the authority contained herein shall remain in full force until canceled in writing.


    (Name of Firm)

(Authorized Signature)

    (Title of Officer)

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    Premium Estimate Request

    Completed application required for a firm quote

    Fax back to: Fax No.: Firm: Contact: Street Address: City: State: Zip: County: Email: Website: Telephone: Fax:

    Current Policy Expiration Date: 1. Please tell us about your firm’s current coverage or attach a copy of your current policy. A. Number of years of continuous coverage: E. Annual premium for how many attorneys? B. Current Professional Liability Carrier/Program: F. Deductible: C. Current Limits: G. Per Claim or Annual Aggregate: D. Retroactive Data (if any): H. Does your current policy modify or exclude coverage? 2. Please provide information about the attorneys in your firm. (Attach additional sheet if necessary)

    4. Claims Information 3. If “of counsel” and part-