Producer Agreements

Be our Partner!

At AFC Insurance, our staff puts a high value on working closely with partnered agents and brokers. We would love to help your agency grow and partner with you to provide outstanding service to health and human services businesses. If you’re ready to work with us, please download and complete the following forms. You can submit producer agreements directly from the forms by sharing and emailing them to

File NameFormatDownload
Producer Agreement Download
Producer Profile Download
IRS W-9 Download
Producer Profile - Pizza Program Download

We also need:

  • A copy of your brokers license
  • A copy of your surplus lines license (if applicable)
  • *A copy of your E&O dec page or certificate of insurance

For submissions, please include the following:

  • Completed application
  • Currently valued loss runs (minimum 4 years) with any large losses explained
  • Due date of quote and effective date of policy
  • Narrative of account
  • Brochures
  • Financials

We look forward to working with you! Contact us with any questions.

*As a Value Added Service, AFC would like to offer you a special opportunity to receive an E&O Quick Quote Indication from one of our associates, CITA Insurance. It’s quick and easy! Just click here for coverage details on CITA’s E&O product. Once you have filled in the information, a CITA representative will contact you.