» Member Insurance Program

IPAA is offering its members a special insurance program designed specifically for independent producers to help stabilize their insurance costs. This program is underwritten by an A+ insurance carrier (currently AIG) and it offers general liability, workers compensation and commercial auto tailored to independents. It also has many special advantages for IPAA members, such as:

• Risk free to IPAA members (the most you pay is that years premium)
• Industry specific coverages with competitive pricing
• Allows members to keep their current agent if they desire
• When members support this program – the program financially supports IPAA. (Providing an overriding royalty interest to IPAA.)

Please print out and fill in the information below and return by fax to:
Therese McCafferty    FAX: 202-330-5628

IPAA Insurance Information Request

Company Name: ___________________________________________________

Contact Person: ___________________________________________________

Type of Business:
___ Independent Producer non-operator/royalty owner
___ Drilling contractor Specialty tool operator
___ Workover/completion contractor Pipeline contractor
___ Other ______________________

Do you want us to work with your current agent? Yes ___ No___
May we contact your agent on your behalf? Yes ___ No___

Agents Name: ______________________________ Phone # _________________

Agency Name: ______________________________