Department Personnel

Underwriting Manager
Melody Duke
Jeffrey Lawrentz    
ext 57610    
Tonya Pugh    
ext. 57619    
Insurance  Assistant, Lead    
Deanne Stevens    
ext. 57621    

Online Forms

Renewal Questionnaire
(Authorized Agents Only)

State of West Virginia Auto Insurance

Certificate Request Form (PDF)

(Please allow 48 hours)


Cyber Liability Insurance Resource

Notice:   BRIM does not provide Cyber Liability Insurance for its insureds who participate in the "Senate Bill 3" program (political subdivioions, charitable or public service organizations, and emergency medical services agencies).  However, www.wvsb3cyber.com may be used by those customers to obtain a quite for Cyber Liability Coverage from a source other than BRIM.  By clicking on www.wvsb3cyber.com, you will leave BRIM's web page.  By providing access to a quote for this coverage, BRIM does not endorse the insurance porducer, the insurance carriers providing any coverage, their products or services, nor does BRIM guarantee the products and services of those insurance producers and carriers.


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.