Heritage Insurance Holdings, Inc.
2600 McCormick Dr.
Clearwater
,
FL
33759
USA
Products
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General Information
Agency Name
*
IRS Tax ID
*
Mailing Address
*
Street Address
City
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Armed Forces Americas
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State
ZIP Code
Do you have a Retail Location?
Yes
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Main Telephone
*
Toll-Free Telephone
Fax
Office location is different from mailing address
Office Location
*
Street Address
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
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Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
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Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Agency Principals
Name
Title
DOB
Date Format: MM slash DD slash YYYY
+ Add Principal
Name
Title
DOB
Date Format: MM slash DD slash YYYY
+ Add Principal
Name
Title
DOB
Date Format: MM slash DD slash YYYY
+ Add Principal
Name
Title
DOB
Date Format: MM slash DD slash YYYY
Marketing Profile
Year Established
Total Agency Premium Volume $
Personal $
Commercial $
Life & Health $
Do you carry Errors and Omissions Insurance?
Yes
No
Name of E&O Carrier
E&O Policy #
Other Business Involvements
None
Accounting
Banking
Real Estate
Life Insurance
Mortgage Loan
Premium Financing
Other
Other (Explain)
Do you have a formal Marketing / Operational Plan?
Yes: Please attach a copy
No
File
Do you have an Agency Brochure?
Yes: Please attach a copy
No
File
Do you advertise in the Yellow Pages?
Yes
No
Do you have any other advertising in place?
Yes
No
Please explain any other advertising medium
Total # of Employees
Office Profile
Include up to 8 Producers Below
Key Personnel & Personal Lines Producers
Title / Position
Date of Hire
Date Format: MM slash DD slash YYYY
Years in Insurance
Professional Designation
+ Add Personnel Officer
Key Personnel & Personal Lines Producers
Title / Position
Date of Hire
Date Format: MM slash DD slash YYYY
Years in Insurance
Professional Designation
+ Add Personnel Officer
Key Personnel & Personal Lines Producers
Title / Position
Date of Hire
Date Format: MM slash DD slash YYYY
Years in Insurance
Professional Designation
+ Add Personnel Officer
Key Personnel & Personal Lines Producers
Title / Position
Date of Hire
Date Format: MM slash DD slash YYYY
Years in Insurance
Professional Designation
+ Add Personnel Officer
Key Personnel & Personal Lines Producers
Title / Position
Date of Hire
Date Format: MM slash DD slash YYYY
Years in Insurance
Professional Designation
+ Add Personnel Officer
Key Personnel & Personal Lines Producers
Title / Position
Date of Hire
Date Format: MM slash DD slash YYYY
Years in Insurance
Professional Designation
+ Add Personnel Officer
Key Personnel & Personal Lines Producers
Title / Position
Date of Hire
Date Format: MM slash DD slash YYYY
Years in Insurance
Professional Designation
+ Add Personnel Officer
Key Personnel & Personal Lines Producers
Title / Position
Date of Hire
Date Format: MM slash DD slash YYYY
Years in Insurance
Professional Designation
Any recent changes in ownership?
Yes
No
Please explain
Any plans for mergers or acquisitions?
Yes
No
Please explain
Any memberships in professional organizations?
Yes
No
Please explain
Do you have a perpetuation plan or buy/sell agreement?
Yes
No
Please explain
Top 5 Personal Lines Appointments
Company
Appointment Date
Date Format: MM slash DD slash YYYY
Rolling 12 month new business policy applications
Total Premium
12 month loss ratio
+ Add Appointment
Company
Appointment Date
Date Format: MM slash DD slash YYYY
Rolling 12 month new business policy applications
Total Premium
12 month loss ratio
+ Add Appointment
Company
Appointment Date
Date Format: MM slash DD slash YYYY
Rolling 12 month new business policy applications
Total Premium
12 month loss ratio
+ Add Appointment
Company
Appointment Date
Date Format: MM slash DD slash YYYY
Rolling 12 month new business policy applications
Total Premium
12 month loss ratio
+ Add Appointment
Company
Appointment Date
Date Format: MM slash DD slash YYYY
Rolling 12 month new business policy applications
Total Premium
12 month loss ratio
Personal Lines Information
How many new home policies does the agency average per month?
Do you have a separate Personal Lines Department?
Yes
No
... How many employees?
How many outside sales personel actively solicit Personal Lines
How are your Customer Service Representatives compensated
Salary
Commission
Incentive
Blend
Are there plans to add Producers and / or CSRs?
Yes
No
Mix of Personal Lines Policies in force
Homeowner
Auto
Other
Primary Marketing Territories
Do you have a New Business Prospecting Program in place?
Yes
No
Do you have a Renewal Retention / Account Development program?
Yes
No
Are you involved in Direct Mail programs?
Yes
No
Do you use Telemarketing Solicitors?
Yes
No
Is there potential for a Book Transfer?
Yes
No
What is your average annual policy premium for homeowners?
Do you have an Agency Management System?
Yes
No
Name of your Agency Management System
Version of your AMS Software
Is your rating/quoting software integrated with your Agency Management System?
Yes
No
Do you have download capabilities with any companies?
Yes
No
Name of Company
Do you have upload capabilities with any companies?
Yes
No
Name of Company
Do you have an internet website?
Yes
No
Website
Email
*
Agency Signature
By
First
Last
Date
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Title
Phone
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