Hendrickson Insurance · Sarasota, Florida

Directors & officers application.

For Gulf Coast nonprofits, associations, HOAs, and private companies in Sarasota, Bradenton, Tampa, and St. Petersburg. Directors and officers (D&O) insurance protects the personal liability of your board and officers when they are sued over a decision. Tell us about the organization and we build the quote. Estimates are fine where you are not sure.

A. Organization Information

Legal / organization name *

Required.

DBA (if any)

What does the organization do? *

Required.

Website

Contact name *

Required.

Phone *

Required.

Email *

Enter a valid email.

Address *

Required.

City

State

ZIP

Years in operation

B. Organization Profile

Annual revenue / budget

Total assets

# of employees

# of board members / directors

# of members (if association/HOA)

# of units (if HOA/condo)

C. Coverage Requested

Limit requested

$1,000,000 $2,000,000 $5,000,000 Not sure, advise me

Deductible / retention preference

D. Prior Insurance & Claims

Current D&O carrier (if any)

Policy expiration date

If yes, list date, type, and outcome/amount

E. Acknowledgement

I certify that the information above is true and complete to the best of my knowledge. Submitting this form does not bind coverage; coverage is subject to underwriting approval and payment of premium.

Typed signature (full name) *

Required.

Date *

Required.

I agree to the statement above. *

Please confirm to submit.

Back

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Thank you — application received

Dennis will review it and follow up shortly with your quote. Questions? Call or text 941-952-7991.

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