Info for Nonprofit & Social Service Insurance Agents & Brokers

Items Needed to Obtain a Quote

  1. Completed Health Center FTCA Facility Medical Malpractice and CGL application for the named insured, a separate Health Center Physician Application and a Health Center Dentist Application for every physician and every dentist who requires coverage
  2. Latest audited financial statement
  3. Insurance company loss runs, at least 5 years
  4. FTCA deeming letter s
  5. Signed Brokerage Agreement and W9 Form

PLEASE RETURN ALL ITEMS TO

Alan Labadorf, CPCU
Managing Director
Sobel Affiliates Inc, a Brown & Brown Company
595 Stewart Ave
Garden City, NY 11530
alabadorf@sobelins.com
516-880-9250