Are you searching for a true partner in the transportation insurance space?

Retail agents, get appointed with Across America Insurance and get your clients covered.

Securing transportation coverage doesn’t have to be difficult. At Across America Insurance, our goal is to help retail insurance agents build strong relationships with their clients by providing quality service and competitive rates.

We understand that when it comes to protecting your clients’ businesses, you need an insurance provider who can move quickly and accurately. Our team of professionals is here to assist you every step of the way. With our extensive network of reliable carriers, we offer competitive rates and superior coverage options that fit your clients’ needs.

Get appointed with Across America Insurance today and get your clients covered!

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Step 1 of 4

25%

Brokerage / Agency Name*

FEIN #*

Do you have a DBA?*

Yes

DBA*

Address*

Street Address Address Line 2 City State ZIP Code

Phone*

Mobile

Email*

Website*

How is the brokerage licensed?*

Individual

Partnership

Corporation

Limited Liability Company

How many years has the entity been in business?*

List all owners of the entity (partners, officers, etc)*

Click the plus (+) to add additional rows.

Name

Title

License #

Has any brokerage principal ever filed for bankruptcy?*

Yes

If yes, please explain in detail.

Are any of the above people engaged in any other business or occupation outside of this brokerage / agency?*

Yes

If yes, please explain in detail.

Please provide a brief history of your brokerage / agency*

Date established, marketing efforts, branches, etc

Has your brokerage / agency been a plaintiff or defendant within the last 5 years?*

Yes

If yes, please state the state, case number, and result

Have you performed business under any other name?*

Yes

If yes, please give full details, including names and reasons.

Provide names of the current MGAs and insurance carriers you place business with.*

Top five (5) General Agents, MGAs, or Carriers by premium volume.

General/Managing General Agency

Insurance Co

LOB

$ Volume

Loss Ratio

What percentage of your business is direct bill?

What percentage of your business is premium financed?

Does your brokerage / agency specialize in any special LOB or classes of business?*

Yes

If yes, provide full details of specific classes and LOB.

What percentage of your gross income originates from commercial lines?

What percentage of your gross income originates from Workers Comp?

What percentage of your gross income originates from Other?

If your brokerage / agency has more than one location, provide details below.

Click the plus (+) to add additional rows.

Address

City, State, Zip

Contact Name

Title

Phone

Bank references:

Click the plus (+) to add additional rows.

Contact Name

Bank Name

Trust Account #

Address

City, State, Zip

Please check the following boxes to indicate consent*

Program commission is 10% for policies underwritten by AAIS’ affiliated carriers and 8% commission for policies placed with Accelerant, Fortegra, Allied World, and American Safety, subject to the Producer Agreement.

Box 2*

If the risk is materially misrepresented or is unacceptable, the binders / declaration pages / certificates will be rescinded. The policies will be terminated and there will be no coverage. AAIS will not be liable for any coverage. Coverage will not remain in effect.*

Box 3*

All ICC, State, or other filings, endorsements, etc will be issued by AAIS only.*

Box 4*

There will be no flat cancellation allowed except: Where duplicate coverages can be shown with a declaration page from another carrier and we must receive a "Hold Harmless" letter from the other carrier; or in the case where the insured's deposited check to the broker is NSF and a copy thereof is presented to AAIS. However, AAIS will retain the policy fee in the latter case.*

Box 5*

Brokerage / agency is responsible for the entire earned premium.*

Box 6*

All cancellations at the insured's request will be Short Rate, 25% earned premium or as otherwise stated in the policy.*

Box 7*

Beginning with the first policy expiration, brokers will receive a direct renewal offer from AAIS. If not received, AAIS is not obligated or responsible. You must contact AAIS.*

Box 8*

All endorsements must be paid in a timely manner. The amended finance agreement for the endorsement premium should be submitted at the time your agency requests endorsements.*

Box 9*

For non-financed policies, there will be monthly policy premium statements issued by AAIS. We require a 25% down payment prior to binding. Brokers can retain 10% commission for policies underwritten by AAIS’ affiliated carriers and 8% commission for policies placed with Accelerant, Fortegra, Allied World, and American Safety, subject to the Producer Agreement. The balance of the premium is due within 20 days from the binding date. On the premium statement, AAIS will report all outstanding balances. Premiums must be calculated on a policy basis. All positive balances are due promptly to AAIS. All negative balances will be remitted to your Brokerage by check from AAIS or to the finance company, if financed. The Broker cannot take credits from statements or requests to apply a credit to another account.*

Box 10*

All requests for reinstatements will be made at AAIS’ sole discretion. In the event of an error by AAIS resulting in policy cancellation, the policy will be reinstated without lapse in coverage. A reinstatement fee will be applicable if reinstatement is granted.*

Box 11*

All claims are to be reported immediately, (within 24 hours of the accident), to A.A.I.S. at our toll free number which is available 24 hours a day, 7 days a week and via fax or mail on a standard ACORD II claims form with the full details of accident. If the insured/claimant needs an Interpreter, this must be indicated.*

Box 12*

Submitting applications from anyone other than agents or solicitors listed on the “Producer Transaction List” are prohibited. This Producer Agreement shall be immediately terminated in the event Broker attempts to place any business or there is any loss or losses arising out of the non-disclosure of any sub-broker or sub-producer agreement and/or relationship. Additionally, Broker shall defend, indemnify and otherwise hold AAIS harmless from and against any and all such loss or losses.*

Box 13*

Current MVRs (within 30 days) for new and renewal business are required for all drivers and vehicle owners and must be submitted with the applications. If any drivers are added after the policy inception, a current MVR must be submitted with the endorsement request.*

Box 14*

You must submit the entire and completed application to AAIS along with MVR, down payment, finance agreement and other supporting documents.*

Box 15*

No coverage is bound until you have a written or emailed confirmation with a policy number, binder number and coverage information from AAIS.*

Box 16*

The broker or producer must submit the original application and all other supporting documents to AAIS within five working days from the date of the binding request or policy will be canceled.*

Box 17*

All changes in drivers must be approved by AAIS before hiring. All vehicles must be approved by AAIS before purchasing. Confirmation must be in writing or emailed.*

Box 18*

I have read and understand the above policies and procedures. Checking this box constitutes my signature on this form submission.*

Name

This field is for validation purposes and should be left unchanged.

By hitting “Save & Continue,” you can save your progress. You will be emailed a link to return and complete the form.

Get Appointed

Are you searching for a true partner in the transportation insurance space?

Retail agents, get appointed with Across America Insurance and get your clients covered.

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