Some of our staff is working remotely from their homes. We are committed to continuing to provide the service you have come to expect, and will still be answering phone calls and responding to emails in a timely manner.
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JMG

Personal, Business & Specialty Insurance Brokerage

Our Locations 1-844-304-7332
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Police Protective Liability Insurance Form

Home › Police Protective Liability Insurance Form

Qualify and Purchase Insurance

JMG’s police protective liability insurance policies help by offering law enforcement officials a sense of ease. By offering three coverage options we are able to meet varying needs. Below are the pricing that applies for each.

  • Plans requiring $100,000 in coverage: $479
  • Plans requiring $250,000 in coverage: $935
  • Plans requiring $500,000 in coverage: $1,612

At JMG, we care for the safety and mental well-being of our police officers. Seek out our police liability insurance coverage, and stay safe while on the job! Fill out our short application form to qualify and purchase insurance today.

Once you submit your answers and if you qualify you will automatically be redirected to the payment page. Here you can put in your payment information to purchase coverage. Once this is done, your coverage goes into effect immediately.

Address(Required)
Member for SWAT or a Task Force(Required)

Section II. Department Information

Department Address(Required)

Section III. Incident Disclosure

Have you ever used deadly force or been present during a deadly use of force incident?(Required)
Have you ever been involved in civil litigation/actions?(Required)
Have you ever been subject to an internal affairs investigation?(Required)
Have you ever been under review for a use of force incident?(Required)
Have you ever been demoted in the last five years?(Required)
Have you ever been terminated from law enforcement?(Required)
Have any claims been brought against you as an individual police officer in the last five years?(Required)
Drop files here or
Accepted file types: pdf, pages, docx, doc, Max. file size: 100 MB, Max. files: 5.
    Requested Liability Coverage Limit(Required)

    Individual Attestation

    The authorized signer of this application attests to the best of his/her knowledge that statement set forth herein are true; that no fact, circumstances or situation indicating the probability of a claim or action now known or has not been declared; and it is agreed by all concerned that omission of such information shall exclude any such claim or signing of this application does not bind the signer to purchase the insurance, but is agreed this form shall be the basis of the contract should a policy be issued, and this form will serve as the basis of and will be referenced in the policy. Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any materially false information or conceals for the purpose of misleading, information concerning any fact material thereto commits a fraudulent insurance act, which is a crime and subjects such person to criminal and civil penalties.

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    JMG Insurance Corp has been serving the insurance needs of our clients in Connecticut, New York, New Jersey, Massachusetts, Rhode Island and Hawaii since 1916.

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    JMG Insurance Corp 29 Haviland Street Norwalk, Connecticut 06854 1-844-304-7332 1-203-857-7848

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