SECTION MENU

Agency Access Form

Agency Name

Agency License Number

Agency DBA Name

Please note: Agency name must read the same as the Louisiana State Property & Casualty License. If none, please enter NONE.

License Expiration Date

Agency Administrator Information

This email address will be used as the email address associated with the user who is responsible for setting up system users, deactivating users, and resetting password for agency staff.

Administrator E-Mail

Please verify that this is a valid email address. Most of Louisiana Citizen's e-mail correspondence will go to this email address.

Administrator Name

Agency Mailing Address

Mailing Street Address 1

Mailing Street Address 2

Mailing City

Mailing State

Mailing Zip

Agency Physical Address

Physical Street Address 1

Physical Street Address 2

Physical City

Physical State

Physical Zip

Agency Contact Information

Agency Telephone Number

Agency Fax Number

Agency Email Address

Agency Principal Information

Agency Principal

Example: Owner, Office Manager, Principal Contact

Principal Email Address

Agency Company Affiliation Information

Company Affiliate

Subscriber Agreement

Please review the Louisiana Citizens Subscriber Agreement and check "I Agree"to continue.

This Subscriber Agreement ("Agreement") is a legal document that outlines the rights and obligations of the Producer's user of any and systems and applications of Louisiana Citizens Property Insurance Corporation and the Fair and Coastal Plans (herein collectively referred to as "LCPIC") to bind or otherwise service policies on behalf of LCPIC. For the purposes of this Agreement, the term Producer refers to the business entity or agency which has or will receive a producer code from LCPIC. The Producer accepting this Agreement agrees to ensure compliance of this Agreement by each individual agent, producer, broker or solicitor representing the Producer and placing business with LCPIC under the Producer’s producer code (hereinafter collectively referred to as “Representatives”). The Producer and its Representatives do not have authority to bind any coverage on behalf of LCPIC until the Producer has accepted this agreement.

By accepting this Agreement, accessing EPIC and binding coverage via EPIC the Producer and its Representatives agree to comply with the standards, guidelines and requirements established by LCPIC, as well as the requirements of Regulation 87 in Title 37 of the Louisiana Administrative Code and the Louisiana Revised Statutes. All LCPIC standards, guidelines and requirements, as well as Regulation 87, shall be available at https://epic.lacitizens.com, the LCPIC EPIC system. LCPIC retains the right to amend those standards, guidelines and requirements at any time. Continued use of EPIC by the Producer and its Representatives to bind coverage on behalf of LCPIC, and/or continued use of any other LCPIC systems and applications, is evidence of Producer’s continued agreement to comply with the standards, guidelines and requirements as they may be amended from time to time.

Each user, the Producer, its Representatives or customer service representatives accessing LCPIC’s systems and applications will receive user names and passwords. Users are not permitted to share user names or passwords with any other unauthorized persons or entities. This Agreement shall be governed by and construed in accordance with the laws of Louisiana. Any action brought by either party to enforce this Agreement shall be brought in East Baton Rouge Parish, Louisiana. If for any reason a court of competent jurisdiction shall find any provision of this Agreement to be unenforceable, the remaining provisions of the Agreement shall continue in full force and effect. LCPIC reserves the right to terminate this Agreement and Producers’, including its Representatives, right to bind coverage on behalf of LCPIC immediately if the Producer or its Representatives fail to comply with the terms of this Agreement, including, but not limited to, the standards, guidelines and requirements established by LCPIC, as well as the requirements of Regulation 87 in Title 37 of the Louisiana Administrative Code and the Louisiana Revised Statues.

Louisiana Subscriber Agreement

I AGREE

Enter your first and last name

Regulation 87

This Agreement shall be governed by and construed in accordance with the laws of Louisiana. Any action brought by either party to enforce this Agreement shall be brought in East Baton Rouge Parish, Louisiana. If for any reason a court of competent jurisdiction shall find any provision of this Agreement to be unenforceable, the remaining provisions of the Agreement shall continue in full force and effect.

LCPIC reserves the right to terminate this Agreement and Producers', including its Representatives, right to bind coverage on behalf of LCPIC immediately if the Producer or its Representatives fail to comply with the terms of this Agreement, including, but not limited to, the standards, guidelines and requirements established by LCPIC, as well as the requirements of Regulation 87 in Title 37 of the Louisiana Administrative Code and the Louisiana Revised Statutes.

Term Agreement

By typing in your first and last name, you agree to the terms above.

After the form has been submitted, and before your registration can be completed. The following documents must be emailed or faxed to the Agent Administration Department.
Please email the following documents to Policy Admin or Fax to (504) 831-6676.

Completed W-9 Form
Agency Property and Casualty License
E&O Coverage Certificate

Registration will not be complete until these documents have been received.

Please Note: These documents are for the Agency and do not need to be submitted for each individual producer.