Tomchesson Insurance Agency, LLC is an independent insurance agency licensed to do business only in the State of Texas. We provide insurance products for people and property located in Texas. Because we are independent we have access to multiple carriers to help serve your unique insurance needs.

Company Information

Name of Company:  

Location Address:  

Mailing Address (if different):  

Type of Company:   

Federal Tax ID/Social Security Number:  

Business Description:  

Type of Coverage Desired

Building:  

Business Property:  

Commercial General Liability:  

Texas Business Owners Policy:  

Commercial Auto:  

Commercial Farm Liability:  

Directors and Officers Liability:  

Professional Liability:  

Flood Insurance:  

Commercial Umbrella:  

Coverage Information

Current Carrier:  

Effective Date:  

Policy Number:  

Last year's premium:  

Number of years with this carrier:  

Number of years of constant coverage:  

Deductibles:  

Losses in the last 5 years:  

General Information

Are you a subsidiary of another company?  

Do you have any subsidiaries?  

Do you have a formal safety program?  

Exposure to flammables, explosives, or   chemicals?  

Have you been cancelled, declined or  
non renewed in the last 3 years?:  

Any past losses or claims relating to sexual   abuse or molestation allegations,   discrimination or negligent hiring?:  

Indicted or convicted of fraud, bribery, arson   or arson related crime in last 5 years?  

Uncorrected fire code violations?:  

Bankruptcies, tax or credit liens in the last 5   years?:  

Is the business a trust:   

Any foreign operations, foreign products   distrubuted in USA, or USA products  
sold / distributed in foreign countries?:  

Your Contact Information

Cell Phone:  

Work Phone:  

Email Address: