Products & Services - Brown & Brown Garden City

Brown & Brown Group Personal Umbrella Form

Please use this form to purchase Brown & Brown Group Personal Umbrella Insurance.
See Coverage and Premium Summary

Participant's Name
First Last
Brown & Brown Company Title
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Home Phone
Cell Phone
Office Phone
Work Email
Enter Email Confirm Email
Personal Email
Enter Email Confirm Email
Limit of Liability Desired
* See Coverage & Premium Summary
Select UM Limits (if desired)
* See Coverage & Premium Summary

* Uninsured/Underinsured Motorist Rejection Form

Employment Practices Liability Insurance
is also available as follows:

	Plan A	Plan B
Occurrence	$250,000	$500,000
Aggregate	$500,00	$500,000
Deductible	$10,000	$10,000
Reputational Injury Limit of Insurance	$25,000	$50,000
Additional Premium	$952.00 plus SL tax (5.06%) $48.17	$1,426 plus SL tax (5.06%) $72.16

Employment Practices Liability Insurance - Select One
- Plan A
- Plan B
- Decline EPLI
Notes:

1. No individual commission is payable to any Brown & Brown employee for this product.

2. This premium cannot be deducted from your Brown & Brown Payroll.
Comments / Additional Info
By clicking SUBMIT, we will review your information and advise you of the pro-rated/annual premium that needs to be paid in advance in order to make the insurance effective. No coverage can be considered bound until you receive confirmation from this office.

For general inquiries & specific coverage questions, please call or email our staff: