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.
Agency Mailing Address
Agency Physical Address
Agency Contact Information
Agency Principal Information
Agency Company Affiliation Information
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.
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.
