• 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.

  • Entity Type:*
  • Desired Effective Date:*
     / /
  • Retroactive Date
     / /

  • 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.)

  • 1. The Applicant is a member of the California Association of REALTORS®.*
  • 2. No owner, agent or member of the Applicant company has had their license revoked, been investigated or been subject to any disciplinary action by any licensing board, real estate association or other regulatory body within the last 5 years.*
  • 3. No owner, agent or member of the Applicant company has been cancelled, refused insurance or declined by an insurance carrier during the last 5 years (except due to loss of market or non payment of premium).*
  • 4. No owner, agent or member of the company is involved in business brokering, mortgage brokering, appraisals, commercial real estate sales, escrow services, property manager services, development or construction*
  • 5. No owner or agent of the company has an exclusive listing agreement with any builder or developer.*
  • 6. The Applicant’s total gross revenues did not exceed $500,000 for the past 36 months COMBINED. (Gross revenues are defined as all fees and commissions received by the insured entity before expenses are paid to any employees, agents, or independent contractors.)*
  • 7. The Applicant and anyone to whom this insurance will apply is not aware of any professional liability claim or any acts, errors, omission or Personal Injuries which might reasonably be expected to be the basis of a claim made against them within the past 5 years.*
  • 8. No owner, agent or member of the Applicant has provided services related to properties that included involvement in any eviction procedures, delivering or negotiating cash for keys offers or property rehabilitation.*
  • 9. No more than 50% of the Applicant's transactions are dual agency.*
  • 10. No more than 50% of the Applicant's transactions are from agent-owned property sales.*
  • Did you answer "TRUE" to all Eligibility Statements 1 - 10 above?*

  • 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
  • Annual Premium and Deductible Options for $100,000/$300,000 Limits
  • Annual Premium and Deductible Options for $250,000/$250,000 Limits
  • Annual Premium and Deductible Options for $500,000/$500,000 Limits
  • Annual Premium and Deductible Options for $500,000/$1,000,000 Limits
  • Annual Premium and Deductible Options for $1,000,000/$1,000,000 Limits

  • 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.

  • Date
     - -

  • 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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