Please take a moment to fill out the form below and one of our representatives will contact you with a free, no-obligation quote. This information will be kept confidential and will be used for quote purposes only. * Please complete the below application in its entirety.
Your Full Name:
Resident Street Address:
Address Line 2
District of Columbia
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
Contact Email Address:
Are you currently a member of the District of Columbia Bar?
Number of youthful drivers in your household:
(Defined as individuals under age 21 living in your house and holding a valid Driver's License.)
When would you like coverage to start?
For your convenience, there are 12 monthly enrollment periods – starting on November 1st. To enroll in a given month, you MUST apply and request coverage before 12 midnight the night before the monthly enrollment date. Thus, to enroll in the May 1st period - you must apply and request coverage by midnight on April 30th.
Has any Member of your household had a major driving violation (i.e., DUI, Reckless Driving, etc.) or a license suspension in the past 3 years?
Select Liability Limit & Pricing:
$1M Limit - $290 Annually (plus tax)
$2M Limit - $375 Annually (plus tax)
$3M Limit - $465 Annually (plus tax)
$4M Limit - $550 Annually (plus tax)
$5M Limit - $640 Annually (plus tax)
Do you own any rental properties?:
If you answered "Yes" above that you own rental properties, please provide the following details: How many rental properties, Type of rental property (condo, apartment, dwelling, etc.), # families & # stories in the entire building(s)?
Also, please note that our policy includes coverage for one residential rental property. For coverage to be considered, the rental property must fit under our Policy's definition of "Tenant Property". Here is that definition: "Tenant Property" means a one, two, three or four family dwelling, including a condominium or cooperative in which you hold full legal title either as an individual or as a joint or common tenant with your spouse or "domestic partner" or hold in a trust you created for the purpose of transferring ownership to a family member, while rented to others.
Additional Comments or Questions
You confirm that you currently have (and will maintain) the Required Underlying Insurance.
Review the Required Underlying Insurance
You verify that all of your representations on this application are true and accurate to the best of your knowledge.
Please check the box to the left to confirm that you have been advised by the originating insurance producer and you understand that this policy is underwritten by an Excess & Surplus lines insurer and that an Excess and Surplus lines insurer is not subject to the filing or approval requirements of the District of Columbia’s Department of Insurance. Such a policy may contain conditions, limitations, exclusions and different terms than a policy issued by an insurer granted a Certificate of Authority by the District of Columbia’s Department of Insurance. Excess & Surplus tax is 2%.
Please click the "Submit Application" button to send your quote request. No coverage is in effect until bound by an insurance carrier. This is a request for quotation only.
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November 2nd, 2015
Sangamon Associates, Inc.