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Manufacturing Insurance
Public Entities
Risk Management
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Tribal
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Our Services
Employee Benefits
Dental Insurance
Health Insurance
HRA-Veba
Life Insurance
TPA Services
Vision Insurance
Personal Insurance
Automobile Insurance
Home Insurance
Rental Insurance
Recreational Vehicles
Umbrella Policies
Get a Quote
WHA Insurance Agency Request a Quote Form
Please Note: the information submitted in this form will be sent to our Team for review, and one of our Agents will reach out to your District to finish the official quoting process.
District Information
District Name
Contact Person
Title
PO Box
State
Zip
Street Address:
City
State
Zip
Phone
Fax
E-Mail
Internet Address
Which of the following categories best describes your district?
Ambulance District
Cemetery Maintenance District
County Road District
County Service District
Community College
Council of Government
Diking District
Drainage District
Education Service District
Emergency Communications District
Fire Protection District
Health District
Irrigation District
Library District
Lighting District
Mass Transit District
Metropolitan Service District
Park & Recreation District
Port District
People’s Utility District
Road Assessment District
Sanitary Authority
Sanitary District
School District
Soil & Water Conservation District
Special Road District
Transportation District
Translator District
Vector Control District
Water Authority District
Water Control District
Water Supply District
Water Improvement District
Water Service Corporation
Other
Additional District Information
District’s Attorney
Board Meets
Number of Employees
Number of Volunteers
District Demographics
County
District Size
Area Population
Population Served
Prepared by
Phone number
Which of the following Coverages and/or Services is your district seeking?
Risk Management Services
Insurance Consulting/Broker Services
Insurance Services
Property & Casualty
Auto/Vehicle/Apparatus Liability
Auto/Vehicle/Apparatus APD
Bond & Surety
Crime
Cyber Liability
Directors & Officers Liability
Employers Liability
Equipment Breakdown
Errors & Omissions
Excess Limits
General Liability
Professional Liability
Property Insurance
Property Owned & Non-Owned
Workers’ Compensation
Excess Workers’ Comp
Dividend Plans
Group Discount Plans
Loss Portfolio Transfer
Multi-State Policies
Occupational Accident Policies
Retrospective Rating Plans
Employee Benefits
Medical, Dental, Vision, & Rx
Life & Disability
HRA VEBA
FSAs & HSAs
Voluntary Benefits
Employee Notices
Retirement
District’s Current Policy
Existing Policy Line
Policy Number
Total Premium Amount:
Property & Liability
Workers’ Compensation
Employee Benefits:
Other
Prepared by
Phone number
Make sure to upload the following items:
Completed membership application, if printed and filled out
Copy of your district’s 2022-2023 LB-1 form or budget
Copy of your district’s current policies
Send
WHA Insurance
