Please attach a copy of your in force E&O Dec Page. You may also attach any other relevant documents at this time.
As a part of our normal procedure, a routine investigation may be made concerning the information provided in this application, which includes but is not limited to, general reputation, criminal background check and financial standing. Further information on the nature and scope of such inquiry, if one is made, is available to you upon written request. Additionally, V3 Insurance Partners LLC may ask you to complete a supplementary application
detailing your agency’s premium and loss history.
I hereby authorize V3 Insurance Partners LLC to conduct any investigation deemed necessary to substantiate my
application for a producer agreement. I understand that falsification of any answer to a question on this application
is grounds for cancellation of said agreement. If my application is accepted, I agree to comply with all rules and
regulations of V3 Insurance Partners LLC and its insurers.
The Violent Crime Control and Law Enforcement Act of 1994 Title 18 U.S.C.A. Sections 1033 and Section 1034
makes it a federal offense for an individual who has been convicted of any felony involving dishonesty or breach
of trust to willfully engage in the business of insurance if those activities affect interstate commerce.
This Producer Agreement (“Agreement”) is made and entered into as of the date set forth below between V3 Insurance Partners LLC (“V3”), a Delaware limited liability company, and the agent(s) or agency(ies) (“Producer”) set forth in the completed V3 Insurance Partners LLC Producer Application.
The parties desire to deal with each other relative to the placement of insurance coverage and therefore agree on the following mutual promises: