Become An Authorized Agency/Producer

 Be prepared. You will need the following information to complete & submit your authorization request

  • The legal name of the Agency including all DBA names

  • The Agency's FEIN number

  • The name & email address of the Agency's principal that is requesting the Agency's authorization

  • The names of all Agency officers, senior managers, directors, partners, and any persons who have the right to control 10% or more of the voting shares or other voting ownership interests of the Agency, including any and all of the Agency locations for which the Agency is seeking to designate a producer

  • The Agency's resident or non-resident license/registration number for each Agency location for which the Agency is seeking to designate a producer;

  • The physical address and phone number for each Agency location for which the Agency is seeking to designate a producer

  • The name of the "Agent in Charge" for each Agency location for which the Agency is seeking to designate a producer.   (This information is maintained under the Agency's license/registration number within the Florida Department of Financial Services' Insurance Agent & Agency Services licensing database.)

  • The name, resident or non-resident license number, phone number, email address and Agency location for each Producer that the Agency wishes to designate

  • The name, resident or non-resident license number, phone number, email address and Agency location for each CSR that will be supervised by a Designated Producer in conjunction with FWCJUA business

  • The name of a Florida licensed Insurer actively writing workers compensation and employers liability insurance in the state of Florida for which the Agency or, individually, each Designated Producer serves as an appointed insurance agent or insurance agency of, which can be verified under the Agency's or each Designated Producer's license/registration number within the Florida Department of Financial Services' Insurance Agent & Agency Services licensing database.   Alternatively, an appointment confirmation letter from such an Insurer issued on the Insurer's letterhead dated within the last 30 days and signed by an officer of the Insurer for either the Agency or, individually, each Designated Producer

A certificate of insurance naming the FWCJUA as the certificate holder that illustrates the Agency maintains errors and omissions insurance or professional liability insurance covering the Agency, all Designated Producers and Customer Service Representatives (CSRs) in an amount not less than $500,000 per occurrence with an Insurer authorized to do business in Florida.   This certificate must be issued and signed by an authorized representative of the Agency's Insurer or Broker and must provide the contact name and phone number of the Insurer. (We will not accept a policy declaration page, a policy information page or a binder as evidence of this insurance coverage.)


Fill Out Agency/Producer Agreement

No fees are required until notified.