• EXPRESS APPLICATION FOR CALIFORNIA

    EXPRESS APPLICATION FOR CALIFORNIA

    Real Estate Professional Errors and Omissions Insurance

  • To be eligible for the Express Application (and the premium options below) you must be able to answer "True" to ALL Eligibiliy Statements 1-10 below.  If you are not eligible for this program, please use the Standard Application.

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  • If you have a policy in force, you will need prior acts coverage. Please attach a copy of your current Declarations page below.

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    TRUE/FALSE ELIGIBILITY STATEMENTS (1-10):

    IMPORTANT!: To be eligible for this Express Application (and the premium options below), the responses to True/False Eligibilty Statements 1 - 10 must all be 'True.' (If you are not eligible for this program, please use the Standard Application.)

  • IMPORTANT! 

    Do not continue this application. DO NOT PAY on the next screen!

    If you answered "False" to any of the Eligibility Statements 1 through 10 on the previous page, then you are NOT eligible to apply with this application and must apply with the Standard Application.

  • SELECT YOUR DESIRED ANNUAL PREMIUM OPTION

    AND REMIT WITH YOUR APPLICATION

  • CALIFORNIA

    CLAIM EXPENSES ARE OUTSIDE THE LIMITS OF LIABILITY

  • CALCULATE TOTAL DUE

    Enter premium and add $50 broker fee to calculate total below.

  • RCIM Broker Fee: $50.00

  • DISCLAIMER

  • COMPLETION OF THIS FORM DOES NOT BIND COVERAGE. THE APPLICANT AND FIRM ACCEPTS NOTICE THAT ANY POLICY ISSUED WILL APPLY ON A “CLAIMS-MADE” BASIS. THE APPLICANT AND FIRM ACCEPTS NOTICE THAT THEY ARE REQUIRED TO PROVIDE WRITTEN NOTIFICATION TO THE COMPANY OF ANY CHANGES TO THIS APPLICATION THAT MAY HAPPEN BETWEEN THE SIGNATURE DATE BELOW AND ANY PROPOSED EFFECTIVE DATE. THE APPLICATION MUST BE SIGNED BY AN ACTIVE OWNER, PARTNER, PRINCIPAL, OFFICER, OR MEMBER OF THE APPLICANT.

    FRAUD WARNING: 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.

    The undersigned is authorized by, and acting on behalf of, the Applicant and represents that all statements and particulars herein are true, complete and accurate and that there has been no suppression or misstatements of fact and agrees that this application shall be the basis of, and becomes part of, the Applicant’s professional liability coverage.

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  • Your application will not be submitted until you click the green button below.

    REMEMBER YOUR TOTAL!

  • ATTENTION!

    • Payment and completion of this form does NOT bind coverage. Coverage is not bound until the application is reviewed and accepted by underwriting.
    • Please note: ACH/Credit Card fees are charged by the payment processor and fully earned.
    • IF YOU DID NOT ANSWER "TRUE" TO ALL ELIGIBILITY STATEMENTS 1-10 ABOVE DO NOT PAY ON THE NEXT PAGE!
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