Renew Certificates of Insurance

Renewal Process

Below is the information that was submitted on your previous Market Application. Please review the information and make changes to the information as needed.

Vendor Renewal Application

Requested policy effective date

Effective Date

Policy end date *

Expiration Date

Administrator - Override Policy Dates

Estimated gross annual sales *

Up to $25,000

$25,001 - $100,000

$100,001 - $250,000

Over $250,000: We will contact you with a customized price quote

Choose your limits of insurance *

$1,000,000 per occurrence / $2,000,000 aggregate limit

$2,000,000 per occurrence / $4,000,000 aggregate limit

Policy Holder Information

Contact & Mailing Information

First Name *

Last Name *

Street Address *

Address (Suite, Apt #)

City *

State *

Zip Code *

Business Information

Select Business Type: *

Vendor's Individual or Business Name (include DBA if applicable) *

Email Address: *

Phone *

Website/URL (if applicable)

CLAIMS HISTORY

Have you had any liability insurance claims in the past 5 years? *

Yes

Please provide claim details

Have there been any recent incidents that could result in a claim? *

Yes

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.

Are you in compliance with all County, State, and Federal Food and Safety Regulations? *

Yes

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

Please list types of products sold (if you are making bath or body products please list the ingredients as well): *

Do you sell any of the following? Finished products that are directly imported, herbal remedies, items targeted toward infants, children's toy's or children's furniture, Alcoholic beverages, Tobacco related products including e-cigarettes or smokeless products, Marijuana or products containing THC, Herbal remedies or medicinal products claiming healing properties. *

Yes

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

Total

Total Amount($)

Total Renewal Cost

Payment Information

Please make sure to enter the correct billing address of the cardholder. An incorrect billing address can result in a problem processing your payment information.

Credit Card Billing Address *

Credit Card Billing Address

City

State/Province

Zip/Postal

Credit Card *

Credit Card

Exp Month

Exp Year

CVC/CVV

Renewal Confirmation

The information above is accurate. Please renew my policy with the information above. *

Yes

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.

RISK PURCHASING GROUP NOTICE

This FM & V Purchasing Group Policy is protected by the insurance insolvency guaranty fund in the state of Illinois. You may also have rights under your state of domicile's insurance solvency guaranty fund. However, the insurer or Risk Purchasing Group may not be subject to all the insurance laws and rules 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

Acceptance of Terms and Conditions *

By Clicking this box, I am accepting the terms and conditions.

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

If you are human, leave this field blank.

We have a great deal for you

We noticed that you’re policy is currently set up with limits of only 1,000,000 per occurrence / 2,000,000 aggregate.

Would you like to upgrade your limits to 2,000,000 per occurrence /4,000,000 aggregate for just a few dollars more?

Select the $2,000,000 per occurrence / $4,000,000 aggregate limit to see the difference.

Renew Certificates of Insurance

Renewal Process

Administrator - Override Policy Dates arrowup6

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

Total

Payment Information

Please make sure to enter the correct billing address of the cardholder. An incorrect billing address can result in a problem processing your payment information.

Renewal Confirmation

Terms & Conditions

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

We have a great deal for you

Administrator - Override Policy Dates

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.

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.

This form will not process if you continue.

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