Producer Agreement

Insurance agents licensed in Indiana, Illinois and Ohio can submit applications for quotation. Quotations may not conform to the application or specifications submitted. Requirements for binding will be listed on the quotation. Agents have no binding authority for any line of business. Binder requests must be submitted in writing to Roush Insurance Services, Inc. The following documents are required to be on file before we will bind coverage:

  • Producer Agreement/Questionnaire (must be signed and dated by agency principal)
  • Errors & Omissions Policy Declarations or Certificate of Insurance
  • Agency License
  • Producer License

Click the above underlined link to download the producer agreement/questionnaire. The completed document can be mailed, faxed or emailed to Please be sure to include the required attachments.

About Us

Roush Insurance Services, Inc. is a wholesale general insurance agency that has been in business since 1990. We offer licensed insurance agents access to the excess and specialty market for risks domiciled in Indiana, Illinois and Ohio.

Industry Links

Our memberships in WSIA, PIA of IN, IIA of IN and IIA of IL enable us to stay abreast of industry developments and better serve your insurance needs.

Contact Us

Roush Insurance Services, Inc.
18077 River Road, Suite 107
Noblesville, IN 46062-8311
Toll Free: (800) 752-8402
Phone: (317) 776-6880
Fax: (317) 776-6891