Integra Partner Agency Renewal Assistant Set Up Agency Name(Required) Name of primary contact(Required) First Last Email(Required) Select your Integra Agency Specialist(Required) Ana Salazar Ricki Goleman Marisa Gonzalez-Hodge Other Which tier do you need:(Required)Please SelectTier 1 – 25 customers per monthTier 2 – 50 customers per monthTier 3 – 75 customers per monthbased on the number of personal lines renewal per month on averageRetention Center SetupRetention Center requires some triggers to be set. These triggers are minimum premium increases. Please select those in the next two questions. What is the minimum % increase?(Required)Please Select15%20%25%30%35%40%45%50%What is the minimum $ increase?(Required)Please Select$500$550$600$650$700$750$800$850$900Please enter 15% or a higher number if you would like a higher percentage. NOTE: You may change this at a later time. Please enter $500 or a higher number if you would like a higher dollar amount. NOTE: You may change this at a later time.Once quoted, how do you want us to update the status in Retention?(Required)Please SelectAccount ReviewPendingClosedLeave as it isWho should receive the quote proposals?Employee’s Information(Required)Employee's Name:Employee Email Address: Add RemovePlease hit the plus sign to add more rows. Preferred Insurance CarriersWe will give priority in quoting to your 3 – 5 markets that you prefer to write insurance with. Please choose your top 3 – 5 preferred carriers. Carrier 1(Required)Please SelectAllStateKemper Personal InsuranceState Auto ConnectBristol WestMercury AutoTravelersNationwide InsuranceEncompass InsuranceProgressive InsuranceForemost Agent360SafecoProgressiveAllied TrustLemonadeBerkshire Hathaway GuardTapcoHagertyHippoSagesureHomeowners of AmericaASIMetlifeLiberty MutualBankersCentauriHartfordWellingtonUniversal North AmericaElephantCarrier 4Please SelectAllStateKemper Personal InsuranceState Auto ConnectBristol WestMercury AutoTravelersNationwide InsuranceEncompass InsuranceProgressive InsuranceForemost Agent360SafecoProgressiveAllied TrustLemonadeBerkshire Hathaway GuardTapcoHagertyHippoSagesureHomeowners of AmericaASIMetlifeLiberty MutualBankersCentauriHartfordWellingtonUniversal North AmericaElephantCarrier 2(Required)Please SelectAllStateKemper Personal InsuranceState Auto ConnectBristol WestMercury AutoTravelersNationwide InsuranceEncompass InsuranceProgressive InsuranceForemost Agent360SafecoProgressiveAllied TrustLemonadeBerkshire Hathaway GuardTapcoHagertyHippoSagesureHomeowners of AmericaASIMetlifeLiberty MutualBankersCentauriHartfordWellingtonUniversal North AmericaElephantCarrier 5Please SelectAllStateKemper Personal InsuranceState Auto ConnectBristol WestMercury AutoTravelersNationwide InsuranceEncompass InsuranceProgressive InsuranceForemost Agent360SafecoProgressiveAllied TrustLemonadeBerkshire Hathaway GuardTapcoHagertyHippoSagesureHomeowners of AmericaASIMetlifeLiberty MutualBankersCentauriHartfordWellingtonUniversal North AmericaElephantCarrier 3(Required)Please SelectAllStateKemper Personal InsuranceState Auto ConnectBristol WestMercury AutoTravelersNationwide InsuranceEncompass InsuranceProgressive InsuranceForemost Agent360SafecoProgressiveAllied TrustLemonadeBerkshire Hathaway GuardTapcoHagertyHippoSagesureHomeowners of AmericaASIMetlifeLiberty MutualBankersCentauriHartfordWellingtonUniversal North AmericaElephantPreferences for Auto QuotesPlease select the minimum required limits for auto coverages Liability Bodily Injury(Required)Please Select$100/$300$250/$500$500 CSLLiability Property Damage(Required)Please SelectKeep current limit$100,000$250,000$500,000Uninsured Motorist(Required)Please SelectKeep current limitMatch with the Liability Bodily Injury LimitUninsured Motorist Property Damage(Required)Please SelectKeep current limit$10,000$15,000$25,000$50,000$100,000Medical Payments(Required)Please SelectKeep current limit$5,000$10,000$25,000$50,000Personal Injury Protection(Required)Please Select$2,500$5,000$10,000$25,000$50,000$100,000Comprehensive(Required)Please SelectNone (Keep current limit)$500$1,000$2,000$2,500Collision(Required)Please SelectKeep current limit$500$1,000$2,000$2,500$5,000Towing and Labor(Required)Please SelectKeep current limit$25$50$75$100$200Rental Expense(Required)Please SelectKeep current limit$20/$600$25/$750$30/$900$35/$1050$40/$1200$50/$1500Telematics(Required) Yes No Preferences for Home QuotesPlease select the minimum required limits for home coveragesDwelling Coverage(Required)Please SelectKeep current policy limitFollow renewal limitRCE RequiredPersonal Liability(Required)Please Select$100,000$300,000$500,000All Other Perils Deductible(Required)Please SelectKeep current limit½%1%$500$750$1,000$1,500$2,000Wind/ Hail Deductible(Required)Please SelectNoneKeep current limit1%Medical Payments(Required)Please SelectKeep current limit$5,000$10,000$25,000EndorsementsPlease select the endorsements you like to be added in every quoteIncreased Replacement Cost Dwelling Percentage(Required)Please SelectNone(Keep current limit)$125$150$200Replacement Cost Content(Required) Yes No Loss AssessmentPlease SelectKeep current limit$10,000$50,000$100,000$Max limitPersonal Injury(Required) Yes No Ordinance or LawPlease Select$25$50$100Foundation Coverage(Required) Yes No Water Damage(Required)Please Select$10,000$20,000$100% – Cov AWater Backup(Required)Please Select$10,000$25,000$50,000Additional Notes / Instructions:Consent(Required) I have read and agree to the following statement.I consent to the above-selected setting for Retention Center and Automation Center. I understand that it is the agency’s responsibility to very any quotes for accuracy before presenting them to the client or binding coverage. I understand ia Blueprint is not responsible for incorrect quotes based on inaccurate information within the agent’s management system. We will make changes as you’ve asked for on this form to Retention Center and Automation Center to ensure timely renewal quote processing. We will ask for the following from your Integra Agency Specialist: A list of insurance companies and producer codes, an additional Ezlynx user with rating access, and your primary user to be duplicated so we have access to the insurance companies you wish us to quote.By clicking submit I agree to these terms and agreements and verify this information is correct.
