CAA Confidential New Member Application
Please complete this form to apply for CAA membership. All information is confidential and used solely for evaluation purposes.
AGENCY INFO
Agency Name
Website
LinkedIn
Date Established
-
Month
-
Day
Year
Date
Tax ID
Type of Business Structure
Individual
Partnership
Corp
S Corp
LLP
Other
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OWNER/PARTNER INFO
List all Owners/Partners below with % of ownership:
Owner #1 Name
% of Ownership
Owner #2 Name
% of Ownership
Owner #3 Name
% of Ownership
Additional Owners/Comments:
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OFFICE LOCATION INFO
MAIN OFFICE LOCATION
City
State
Total Premium Volume
Commercial %
Personal %
LOCATION #2
City
State
Total Premium Volume
Commercial %
Personal %
LOCATION #3
City
State
Total Premium Volume
Commercial %
Personal %
Additional Locations/Comments:
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STAFF POSITIONS AT EACH LOCATION
List # of staff positions at each location:
Rows
Main Office
Location #1
Location #2
P&C Producers (Include Owners)
Financial Services Producers (Include Owners)
Commercial CSRs/Assistants
Personal CSRs/Assistants
Financial CSRs/Assistants
Accountants/Bookkeepers
Claims
Receptionist
File Clerk
Marketing/Communications
Other
TOTAL ON STAFF
Remote or Hybrid work policy?
Remote
Hybrid
No - Completely in-person.
Outsourcing or Virtual Assistant use? If so, what kind?
(e.g., CSR, back office support)
COMPANY CULTURE
Describe any community involvement or philanthropic programs.
Describe any professional development opportunities that you offer to your staff.
Do you have office incentives or competitions to boost morale?
Yes
No
Have you implemented a wellness program for your staff (e.g., fitness stipend, health group challenges, etc)?
Yes
No
How would you describe your company culture in a few words?
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E&O INFO
Name of E&O Carrier
Limits
List any significant claims for last 5 years:
CYBERSECURITY
Do you carry Cyber Liability Insurance?
Yes
No
If yes, name of Cyber carrier
Is your agency using MFA (multi-factor authentication)?
Yes
No
Have you had any data breaches in the last 3 years?
Yes
No
TECHNOLOGY USAGE
Agency Management System
Type of Agency Automation System
Number of Users
Do you use CRM tools? (e.g., Salesforce, HubSpot)
Yes
No
If yes, which ones?
Do you use digital marketing tools? (e.g., MailChimp for email campaigns, Sprinklr for social media content, paid Google search)
Yes
No
If yes, which ones?
LinkedIn
Facebook
X (Twitter)
Do you work with a marketing agency?
Yes
No - Someone internally does our marketing.
Describe your marketing strategy.
MARKETING AREA
What cities or counties do you consider your marketing area?
Are there any in Tier 1 (Coastal)?
Yes
No
AGENCY REVENUE
P&C Revenue from previous year-end.
P&C Revenue Total
Upload report from your AMS showing revenue by carrier:
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Life/Health Revenue Total
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GENERAL QUESTIONS
List any other agencies you are a part of, regardless of whether you have a minority or majority interest:
List any other groups/clusters you are a part of and have a contractual obligation to (i.e., Heartland, etc):
Do you presently have an agency perpetuation plan that would involve, acquisition, merger, brokerage arrangement, change in ownership or style of business? If so, please discuss your plan:
List any other agencies/individuals that you broker business for. Please include specifics (i.e., a copy of any contract in place & the amount of business brokered):
Do you specialize in any certain market or industry where policies are primarily placed through surplus markets? If so, explain (include MGA’s, Program Business, etc.):
Are you currently using any companies that have an AM Best’s rating of B+VII or lower? If so, please list them:
In the last 3 years, have you or any insurance companies terminated your relationship with them? If yes, please provide details:
What can CAA do to help you and your agency?
What can your agency do to help CAA?
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CARRIER PRODUCTION REPORTS
Please upload individual Carrier Production Reports for the following carriers.
Travelers
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Chubb
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Safeco
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Acuity
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Philadelphia
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Nationwide
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EMC
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Hartford
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Liberty Mutual
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REFERENCES
Name of Agency/Agent
Rows
Name
Phone
Email
Website
1.
2.
3.
4.
Name of Company/Contact
Rows
Name
Phone
Email
Website
1.
2.
3.
4.
Submit
Should be Empty: