Carrier Application

Before completing this application, please review the Carrier Membership Requirements.

This form must be completed within one hour. To avoid losing your data due to page timeout, we recommend reviewing the form in advance and gathering all required information before starting the application process.

Membership Selection *

Carrier – $ 10,000.00

Total Amount

Carrier Company Details

To ensure your application submits correctly, please avoid pasting any text with formatting (such as bold, italics, or special fonts). We recommend copying text only from plain text documents like Notepad, which removes any unwanted formatting.

General Information

Company Name *

Main Contact Email *

Street Address *

City *

State *

Zip *

Phone *

Company Website *

Please list any insurance companies with whom you are affiliated

Does your company grant binding/underwriting authority (delegated underwriting authority) to program administrators? *

Yes No

Please describe in detail the authority granted to program administrators *

AM Best Rating *

How many years has the company been in program business? *

How many program administrators do you work with? *

Total Number of Programs *

2-5 6-10 11-25 26-50 51-100 100+

Do you offer Fronting options?

None Pure Hybrid Both

Paper Status Offerings

Admitted

Non-Admitted

Both

Minimum annual written premium considered

Consideration of start-up programs

Yes No

Required 1st Year Minimum Premium

Do you have a carrier rating system available or is this an expectation of your program administrator?

Yes No

Do you provide claims handling or is this an expectation of the program administrator or an independent TPA?

Yes No

Do you provide loss control services?

Yes

Information About Program Business Strategy and Risk Appetites

Programs your company is most interested in pursuing (lawyers, contractors, etc.)?

Which lines of business your company is most interested in?

Programs your company will NOT consider

Lines of business your company will NOT consider

Other program considerations/submission criteria

Complete description of your program review/evaluation process including time frame for completion

Existing Programs

Check the states in which you are NOT licensed to write on Admitted Paper (primary carrier and other insurance companies)

Check the states in which you are NOT licensed to write on Excess and Surplus paper (non-admitted primary carrier and other insurance companies)

Please provide an overview of the 3 most significant programs you currently underwrite.

Program 1

1: Administered by

1: Product Lines

1: Approximate GWP

Program 2

2: Administered by

2: Product Lines

2: Approximate GWP

Program 3

3: Administered by

3: Product Lines

3: Approximate GWP

References

Please provide two written references – preferably from current TMPAA program administrators. Reference letters should contain the following elements:

Confirmation that the PA has binding and underwriting authority for your program
Brief description of the PA’s experience developing, implementing, and maintaining a program with your company
Support of your company’s membership in the TMPAA to work with other PA members

Reference 1

1: Name

1: Company

1: Phone

1: Email

Reference 2

2: Name

2: Company

2: Phone

2: Email

Email reference letters to Krista.Hardy@targetmkts.com.

Additional Comments/Questions

I understand that the application must be favorably considered by the membership committee before the applicant can participate in the Association. An invoice for the non-refundable membership fee will be sent after approval.

By submitting this application:

The applicant attests that all information in the application is correct.
The applicant will abide by the Association Bylaws as they may be amended from time to time.
The applicant is not aware of any reason why the Bylaws cannot be observed.
The applicant agrees to comply with the TMPAA Code of Conduct.

Account

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Username *

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Primary Contact

First Name *

Last Name *

Phone *

Email *

Payment Options

[x] Payment due upon approval