Program Access
Producer Profile
Submission Checklist
(including Supplemental Applications)
Quote Release Information
Broker Cover Letter and
Agreement


Submissions must include the following:

  • Completed Acord applications, signed by the insured, including detailed property information to include construction, occupancy, square footage and age
  • WellGuard Supplemental Application, signed by the insured
  • 5 years of recently valued company loss runs
  • Details on losses over $10,000
  • Updated driver information, including MVR's
  • Expiring premiums and target premiums for all lines of coverage
  • Federal Employer Identification Number (FEIN)
  • Complete vehicle identification numbers (VIN)

If you are not yet appointed with Willis of New Hampshire, Inc., please include the following:

  • Completed and signed Broker Agreement with the following:
    • Proof of E&O showing a minimum of $1,000,000 limit per occurrence.
    • Copy of licenses in all states you plan to broker the WellGuard Program

For More Information on the services and products offered by WellGuard, and to learn more about the best ways to address insurable business risks specific to the ground water industry, contact:

Tim Sullivan, tim.sullivan@willis.com
Willis HRH Programs
One New Hampshire Avenue Suite 200
Portsmouth, NH 03801
Ph: 1-603-334-3078
Fax: 1-603-334-3090