Additional Insured Request Form

Please fill out the form below to add an Additional Insured to your policy. Once completed, a member of our team will reach out to you.

DTPH Additional Insured Request Form

Thank you for contacting us regarding your request to add an Additional Insured endorsement to your policy.

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The Liability master policy is issued to the Healthcare Professionals Purchasing Group, LLC. The Identity Protection Plan is powered by Identity Fraud, Inc., Walnut Creek, CA, whose members include members of Healthcare Professionals Purchasing Group, LLC. Gallagher Affinity Insurance Services, Inc. is the insurance partner for Healthcare Professionals Purchasing Group, LLC. Gallagher Affinity Insurance Services, Inc., a 50-state licensed broker, is the broker for all coverage under Healthcare Professionals Purchasing Group, LLC. Gallagher Affinity Insurance Services, Inc. also serves as excess and surplus lines broker for Healthcare Professionals Purchasing Group, LLC. Professional Liability and Commercial General Liability coverage under Healthcare Professionals Purchasing Group, LLC is underwritten in the surplus lines market by an A rated (Excellent) insurance company, per A.M. Best Company. Persons insured by surplus lines companies are not eligible for recourse through any state guarantee fund for the obligations of an insolvent insurer. Healthcare Professionals Purchasing Group, LLC is for health, wellness and beauty professionals and students created for the purpose of providing valuable and important benefits and services to its members. Healthcare Professionals Purchasing Group, LLC is not an insurer. 8430 Enterprise Circle Suite 200, Lakewood Ranch, FL 34202.