Policy Form

Vendor Application
Have you had this type of policy with Campbell Risk Management in the last 12 months? *

Administrator - Override Policy Dates

Over $100,000: We will contact you with a customized price quote

Policy Holder Information

Contact & Mailing Information

Business Information

CLAIMS HISTORY

We cannot process a new request for insurance while a potential claim is pending

This form will not process if you continue. Please resolve your issues before attempting to take out a new policy.

If you have questions, you can reach us here: 317-848-9075.

We cannot process a new request for insurance if you are not in compliance.

This form will not process if you continue. Please resolve any issues before attempting to take out a new policy.

If you have questions, you can reach us here: 317-848-9075.

Product Information

Thank you for you interest in this insurance program. Due to the nature of your products we are unable to offer a quote at this time.

This form will not process if you continue.

If you have questions, you can reach us here: 317-848-9075

Terms & Conditions

By filling out the preceding form, any farmers market or vendor is eligible to become a member of the FM&V RPG, managed by Campbell Risk Management.

The FM&V RPG has worked with the Hanover Insurance Company which is rated "A" Excellent by A.M. Best & Co. to make this program available.

RISK PURCHASING GROUP NOTICE
This policy is issued to the FM&V risk purchase group. Risk purchasing groups may not be subject to all of the insurance laws and regulations of your state of domicile.

IMPORTANT NOTICE REGARDING RISK PURCHASING GROUPS
Disclosure Pursuant to Federal Law Regarding Purchasing Groups [15 U.S.C. SEC. 3901, et seq] FM&V purchasing group is a "Risk Purchasing Group", as defined under Federal law, formed to purchase liability insurance on a group basis for its Members to cover the similar or related liability exposure(s) to which the Members of the Risk Purchasing Group are exposed by virtue of their related, similar, or common businesses or services. Members do not share limits and each member is provided with its own policy and/or evidence of insurance.

Read Terms & Conditions

Total

After purchasing this policy, you can add as many additional insureds as needed at no extra cost.