Mid-Continent Insurance Co

We are a stock Pennsylvania domiciled property/casualty company licensed to transact business in Ohio, and Maryland, and Pennsylvania. We also conduct business in Indiana as an E&S company.

Our current agency force is made up of independent brokers and independent agents, most conducting business in a single state.

Our primary lines of business are commercial package polices written on main street mercantile risks including bars, taverns, and restaurants (we currently do not provide liquor liability coverage), and general liability for small contractors’ operations.

Please refer to our products section for more information regarding the above mentioned products as well as other product offerings.

Mid-Continent welcomes you to complete the new agent profile below that will be transmitted to our marketing department for follow-up.

Agency Contact Information

Agency Name:

Street Address:

Mailing Address:

City, State, Zip

Zip

Phone

Fax

E-mail

Officers and Key Personnel

Name:

Title:

% time
spent in
agency

How long
at agency?

Ownership type:

Territory currently covered by agency?

Expansion planned?YesNo Where? When ?

Companies/Lines/Volume (Volume - Highest to Lowest):

Company Name:

Line of Business

Annual
Premiums

Years
Written

Income from sources other than P&C Insurance:

Does your agency carry E&O insurance?yes no

If Yes, which carrier(s)?

How did you hear about Mid-Continent?

Do you or have you written through Mid-Continent? yes no

If yes through which broker?

What business do you propose to write through Mid-Continent?

Line of Business

Expected Annualized
Premium

What are your agency's strengths?

What are your agency's weaknesses?

How would affiliation with Mid-Continent help your agency?

Please list any professional organizations to which your or your organization belong.

Has this agency, any of its officers or partner, filed bankruptcy with the past five years?

yes no

If yes Explain:

Completed by:

Name: Title: