• Application for Property Inspection Professional Liability

    Application for Property Inspection Professional Liability

  • Please answer all questions and request for supporting documentation. If there is insufficient space to complete an answer, please provide the complete answer on attached documents. This form must be completed signed and dated by a principal, partner, or officer of the firm.

    Note: The insurance for which you are applying is written on a claims made and reported basis. The policy requires that a claim be first made against you during the policy period and reported to the Insurer, in writing, during the policy period or automatic extended reporting period. The policy applied for contains provisions which limit the amount of claim expenses the Insurer is responsible to pay in connection with claims. Claim expenses shall be subject to any deductible amount and the payment of claim expenses will reduce the limits of liability. If you have any questions about coverage, please discuss them with your licensed insurance representative.

  • Format: (000) 000-0000.
  • 1. Date firm was established*
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    2 digit month, 2 digit day, 4 digit year
  • Is the applicant a C.A.R. certified home inspector?*
  • 2. Has the applicant ever conducted business under a different name or entity?*
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  • 3. Do any other entities, or individuals not employed by your firm, have any ownership interest in the firm?*
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  • 4. Is your firm a franchisee?*
  • 5. Does your firm or any KEY PERSONNEL own any interest in any other entity?*
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  • 6. List the total Number of Personnel:*
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  • 7. Does anyone affiliated with your firm hold any other professional designations?*
  • 8. Provide the following information for all Independent Inspectors:
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  • 9. Does your firm have Branch Offices?*
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  • 10. What percentage of services provided by your firm were outside United States during the last complete fiscal year? (Attach geographic locations of all foreign projects)*
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  • 11. Provide your fiscal year end dates for last two years:*
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  • Provide your firm’s GROSS REVENUES attributable to this year, next year, and the past two years. (Gross revenues means the approximate dollar amount of your firm’s gross revenue, but not including interest income, rental income, or sales and service taxes.)*
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  • Provide your firm’s NUMBER OF INSPECTIONS attributable to this year, next year, and the past two years. *
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  • 13. Is the applicant the exclusive inspector for any real agency, developer, and/or builder?*
  • 14. Provide the percentages, based on your firms GROSS FEES, attributable to the following inspection services (if none, enter "0"):*
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  • 15. For the last fiscal year, please enter the approximate percentage of your firms GROSS REVENUES attributable to the following Client Types (if none, enter "0"):*
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  • 16. The following questions are applicable to your firm’s Business Practices:

  • a. Is there a pre-inspection agreement signed prior to each inspection?*
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  • b. i. Does your firm include photographs with all inspection reports?*
  • Is there a Limitation of Liability provision in your firm’s standard Inspection Agreement?*
  • d. What type of Inspection Report is typically generated by your firm? Check all that apply:*
  • h. Does your firm provide a recommended timeframe for necessary repairs noted in the inspection report?*
  • i. Does Applicant provide referrals or recommendations for remediation needed?*

  • 17. 

    Tier 1 – Commercial Inspections included in Standard Inspections: Apartment, Office, Retail, Warehouse

    Tier 2 – Other than Standard Commercial Inspections. Available with Qualifications (complete table below)

  • a. Does the applicant sub-contract out any part of the inspection service*
  • If yes to 17a, does the sub have their own Professional Liability (E&O) and General Liability coverage?
  • Tier 2 Table – Other than Standard Commercial Inspections
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  • 18. Provide the following about your firm’s Professional Liability insurance program:*
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  • b. Does your current policy have Specific Additional Limit Endorsements?
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  • c. Provide the following about your firm’s current General Liability insurance program:
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  • 18. Claim Awareness: Claim(s) means a demand received by the Insured for money or services and which alleges a wrongful act. Claim(s) includes but is not limited to lawsuits, petitions, arbitrations or other alternative dispute resolution requests filed against the Insured.*
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  • 18. Quotation Options:

    Indicate which options your firm wishes quoted for professional liability insurance:

  • First Dollar Defense?

  • Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or knowingly presents false information in an application for insurance is guilty of a crime and may be subject to fines and confinement in prison.

    I / We declare that if the firm or any of its members become aware of any information that would change answers furnished in the application, the firm will reveal such information in writing to the Company prior to the effective date of coverage.

    On behalf of the applicant firm, I declare that this application, including attachments, supplementary pages and other exhibits attached, is complete and correct to the best of my knowledge and belief. I understand that the application shall form the basis of the contract of insurance should the Company offer coverage and should the firm accept the Company’s quotation. I also understand that completion of this application does not bind the Company or broker to provide insurance.

  • Date of Application*
     / /
    2 digit month, 2 digit day, 4 digit year
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