AGENCY/BROKER PROFILE FORM
Name __________________________________________________________________________
Mail address _____________________________________________________________________
________________________________________________________________________________
Location address _________________________________________________________________
________________________________________________________________________________
ITEMS:
1. 19__ 19__ FORECAST 19__
Written premiums $________ $________ $________
Gross commissions $________ $________ $________
2. Estimated Agency Mix of Business - Property/Casualty
PERCENTAGE OF TOTAL
19__ 19__ 19__
Fire/Allied/Marine ________% ________% ________%
Crime/Fidelity/Glass ________% ________% ________%
General Liability ________% ________% ________%
CPP/BOP/Package ________% ________% ________%
Commercial Auto ________% ________% ________%
Workers Compensation ________% ________% ________%
Other Commercial Lines ________% ________% ________%
Personal Auto ________% ________% ________%
Homeowners ________% ________% ________%
Other Personal Lines ________% ________% ________%
TOTAL 100 % 100 % 100 %
3. Estimated Agency Overall Loss Ratio
19__ 19__
Personal Lines ________% ________%
Commercial Lines ________% ________%
4. Total Number Of:
Personal Lines accounts _______
Personal Lines policies _______
Commercial Lines accounts _______
Commercial Lines policies _______
5. Commercial Accounts: Five Largest, written Premium
1. $___________
2. $___________
3. $___________
4. $___________
5. $___________
6. Staffing: Total Number Includes Principals
NUMBER % OF TIME SPENT
A. Personal Lines customer service
representative or underwriter ___________ ___________
B. Personal Lines clerical support ___________ ___________
C. Commercial Lines customer service
representative or underwriter ___________ ___________
D. Commercial placer ___________ ___________
E. Commercial clerical support ___________ ___________
F. Data input ___________ ___________
G. Receptionist/secretary ___________ ___________
H. Accounting/billing ___________ ___________
I. Outside sales personnel: total ___________ ___________
1. Principals - number ___________
Time breakdown: Principal Principal Principal
No. 1 No. 2 No. 3
Sales _________% _________% _________%
Administrative _________% _________% _________%
Written premium
directly handled $_________ $_________ $_________
2. Nonprincipal producers - total number ___________
No. of
Salaried accounts Written premium Gross commission
No. 1 ___________ $____________ $____________
No. 2 ___________ $____________ $____________
No. 3 ___________ $____________ $____________
No. of
Commissioned accounts Written premium Gross commission
No. 1 ___________ $____________ $____________
No. 2 ___________ $____________ $____________
No. 3 ___________ $____________ $____________
NOTE: If an employee or producer works in more than one area, allocate the percentage of time spent in each area.
7. What companies does your agency represent?
Current year Current year Loss
Name written premium gross comm. ratio %
A. ________________ $_____________ $_____________ ______%
B. ________________ $_____________ $_____________ ______%
C. ________________ $_____________ $_____________ ______%
D. ________________ $_____________ $_____________ ______%
E. ________________ $_____________ $_____________ ______%
F. ________________ $_____________ $_____________ ______%
G. ________________ $_____________ $_____________ ______%
8. Are you on a restricted-writing basis with any of the above? This question includes situations in which a contract or a portion of the contract has been withdrawn-that is, there is no longer an ability to write Personal Lines, but the ability to write Commercial Lines still exists, or a company has appointed the agency for Commercial Lines only.
____ Yes ____ No
If yes, please describe the circumstances on a separate page.
9. Please provide a breakdown of premium written by carrier on the following basis (only major carriers-or you may attach last year company loss runs if that is easier):
Current year: ___________
CARRIER A _________________________________
Personal Lines (Written premium/loss ratios):
Personal Auto Homeowners Other
$____________ ________% $____________ ________% $____________ ________%
Commercial Lines (Written premium/loss ratios):
CMP/BOP Commercial Auto Workers Comp
$____________ ________% $____________ ________% $____________ ________%
CARRIER B _________________________________
Personal Lines (Written premium/loss ratios):
Personal Auto Homeowners Other
$____________ ________% $____________ ________% $____________ ________%
Commercial Lines (Written premium/loss ratios):
CMP/BOP Commercial Auto Workers Comp
$____________ ________% $____________ ________% $____________ ________%
CARRIER C _________________________________
Personal Lines (Written premium/loss ratios):
Personal Auto Homeowners Other
$____________ ________% $____________ ________% $____________ ________%
Commercial Lines (Written premium/loss ratios):
CMP/BOP Commercial Auto Workers Comp
$____________ ________% $____________ ________% $____________ ________%
10. What companies did your agency represent in the last previous year?
Previous year Previous year Loss
Name written premium gross comm. ratio %
A. _______________________________ $_____________ $_____________ ______%
B. _______________________________ $_____________ $_____________ ______%
C. _______________________________ $_____________ $_____________ ______%
D. _______________________________ $_____________ $_____________ ______%
E. _______________________________ $_____________ $_____________ ______%
F. _______________________________ $_____________ $_____________ ______%
G. _______________________________ $_____________ $_____________ ______%
Please provide a breakdown of premium written by carrier on the following basis (only major carriers-or you may attach company loss runs, if that is easier):
First previous year: ___________
CARRIER A _________________________________
Personal Lines (Written premium/loss ratios):
Personal Auto Homeowners Other
$____________ ________% $____________ ________% $____________ ________%
Commercial Lines (Written premium/loss ratios):
CMP/BOP Commercial Auto Workers Comp
$____________ ________% $____________ ________% $____________ ________%
CARRIER B _________________________________
Personal Lines (Written premium/loss ratios):
Personal Auto Homeowners Other
$____________ ________% $____________ ________% $____________ ________%
Commercial Lines (Written premium/loss ratios):
CMP/BOP Commercial Auto Workers Comp
$____________ ________% $____________ ________% $____________ ________%
CARRIER C _________________________________
Personal Lines (Written premium/loss ratios):
Personal Auto Homeowners Other
$____________ ________% $____________ ________% $____________ ________%
Commercial Lines (Written premium/loss ratios):
CMP/BOP Commercial Auto Workers Comp
$____________ ________% $____________ ________% $____________ ________%
Remarks: _______________________________________________________________________
- What companies did your agency represent in the second previous year?
Previous year Previous year Loss
Name written premium gross comm. ratio %
A. _______________________________ $_____________ $_____________ ______%
B. _______________________________ $_____________ $_____________ ______%
C. _______________________________ $_____________ $_____________ ______%
D. _______________________________ $_____________ $_____________ ______%
E. _______________________________ $_____________ $_____________ ______%
F. _______________________________ $_____________ $_____________ ______%
G. _______________________________ $_____________ $_____________ ______%
Please provide a breakdown of premium written by carrier on the following basis (only major carriers-or you may attach company loss runs, if that is easier):
Second previous year: ___________
CARRIER A _________________________________
Personal Lines (Written premium/loss ratios):
Personal Auto Homeowners Other
$____________ ________% $____________ ________% $____________ ________%
Commercial Lines (Written premium/loss ratios):
CMP/BOP Commercial Auto Workers Comp
$____________ ________% $____________ ________% $____________ ________%
CARRIER B _________________________________
Personal Lines (Written premium/loss ratios):
Personal Auto Homeowners Other
$____________ ________% $____________ ________% $____________ ________%
Commercial Lines (Written premium/loss ratios):
CMP/BOP Commercial Auto Workers Comp
$____________ ________% $____________ ________% $____________ ________%
CARRIER C _________________________________
Personal Lines (Written premium/loss ratios):
Personal Auto Homeowners Other
$____________ ________% $____________ ________% $____________ ________%
Commercial Lines (Written premium/loss ratios):
CMP/BOP Commercial Auto Workers Comp
$____________ ________% $____________ ________% $____________ ________%
Remarks: _______________________________________________________________________
12. Is the agency automated? _____ Yes _____ No
If yes, what brand of hardware is used? ____________________________________________
13. What software system do you use? (Include company provided rating and product software.) If you use a service, please name the provider. ____________________________________________________________________________
____________________________________________________________________________
14. Did you design your own software or have someone custom design it for you? ____________________________________________________________________________
How long ago? _____________________
15. What agency functions does your automation system perform? (Check those that are applicable.)
rating _______ quoting _______
word processing _______ customer base _______
expiration lists _______ prospect database _______
marketing _______ demographic information _______
Accounting/client activity:
customer billing _______
accounts current _______
company direct-bill tracking _______
check writing _______
profit and loss statement _______
balance sheet _______
receivables report with aging included _______
complete client files, including history, coverage, etc. _______
CD-ROM, imaging, capability, etc. _______
other _______________ _______
For the principal:
16. What is your perception of agency automation programs? (Check those that are applicable.)
A. Too much work for the benefit received _______
B. Too complicated and too confusing _______
C. Too costly _______
D. Don't trust information provided _______
- No opinion _______
F. We don't really get much benefit from it because we don't use if fully _______
G. I don't know how to use it _______
17. Is the agency interfaced with any carriers? If so, which ones and for what lines? ____________________________________________________________________________
____________________________________________________________________________