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Dave Johnson Insurance
324 W Heron St
Aberdeen, WA 98520

(360) 533-1741 
or Toll-free (866) 533-1741

Fax:  (360) 533-6656

Hours of Operation:

May 31 - Labor Day (Sept)      
Hours are 8:00 AM to 4:30 PM

Labor Day to May 31
Hours are 8:00 AM to 5:00 PM

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Broker of Record Procedure

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If you wish to have our agency take over the servicing of an existing policy please copy and paste the letter below to your company letterhead. If individual policies, please enter your Name, Address, City, State and Zip. Please note to replace date and list insurance companies and policy numbers you wish to have us assume. Once completed and signed, mail or fax the form to us as indicated in our contact page.


    Agent of Record Authorization
 

(Name)

(Address)

(City), (State), (ZIP) 

 

 

Effective Date of Authorization:__________________

 

This will notify you that I/we hereby appoint Dave Johnson Insurance, Inc. whose business address is 324 W Heron, Aberdeen, WA  98520 as my/our Agent of Record, and to act as my/our exclusive representative on the insurance policy(ies) shown below.
 
Insurance Company                              Policy Number                                Renewal Date
 
______________________________________________________________________
 
______________________________________________________________________
 
______________________________________________________________________
 
______________________________________________________________________
 
______________________________________________________________________
 
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________________________________________________      ___________________
Signature  & Title                                                                            Date
 
Contact Phone:___________________________
 
 
 
 
 
 
  We are licensed to do business in the following States: Washington, Oregon, Alaska, Arizona, California and Utah.
  AGENCY LICENSE WA-140091, OR-510913, AK-16898, AZ-968688, CA-0G11126 AND UT-315489
  Please note dba: for CA as Dave Johnson Insurance Agency.
Copyright © Dave Johnson Insurance, All Rights Reserved 
Note: Per our "Terms of Service" (TOS) agreement, descriptions of insurance coverage on this site are for informational purposes only and may not apply, or be included on your policy. Please contact us to confirm coverage provided on your insurance policy or policies your are contemplating purchasing.