Underwriting

​​Department Personnel

Underwriting Manager
Vacant
ext 

 
Underwriter
Jeffrey Lawrentz    
ext 20234    
 
Underwriter    
Tonya Martinez    
ext. 20236    
 
Administrative Services Assistant I     
Deanne Stevens    
ext. 20240     

Office Assistant II     
Jason Stover   
ext. 20243    


Online Forms

Renewal Questionnaire
(Authorized Agents Only)
Instructions


Certificate Request Form (PDF)

(Please allow 48 hours)

State of West Virginia Auto Insurance

 

Please print a duplicate copy of the certificate and submit to BRIM.

Workbased Learning Program
(Work-Based Coordinators Only)

 

Supplemental Forms

Click HERE to access supplemental forms.