• EXPRESS APPLICATION FOR FLORIDA

    EXPRESS APPLICATION FOR FLORIDA

    Real Estate Professional Errors and Omissions Insurance

  • IMPORTANT! To be eligible for the Express Application, you must be able to answer "True" to Eligibility Statements 1-9 below. If you are not eligible for this program, please use the Standard Application.

  • Entity Type*
  • NEW BUSINESS ACCOUNTS: Desired Effective Date
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  • Retroactive Date
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  • TRUE/FALSE ELIGIBILITY STATEMENTS (1-9)

    To be eligible for the Express Application, you must be able to answer "True" to Eligibility Statements 1-9 below. If you are not eligible for this program, please use the Standard Application.

  • 1. 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.*
  • 2. 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*
  • 3. 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.*
  • 4. No owner or agent of the company has an exclusive listing agreement with any builder/developer.*
  • 5. The Applicant’s total gross revenues did not exceed $500,000 for the past 36 months. (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.)*
  • 6. 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.*
  • 7. 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.*
  • 8. No more than 50% of the Applicant's transactions are dual agency.*
  • 9. No more than 50% of the Applicant's transactions are from agent-owned property sales.*
  • Did you answer "True" to all True/False Eligibility Statements 1-9 above?*

  • IMPORTANT!

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

    If you answered "False" to any of the True/False Eligibility Statements 1 through 9 on the previous page, then you are NOT eligible for the Express Program and you must apply using the Standard Application.

  • SELECT YOUR DESIRED ANNUAL PREMIUM OPTION

    AND REMIT PAYMENT WITH YOUR APPLICATION

  • Florida Taxes and Surcharges

    Premium includes FLORIDA FIGA ASSESSMENT Surcharges. Please see notes below regarding FL state taxes or surcharges required.

  • Claim Expenses are Outside the Limits of Liability

    Deductible Loss & Expense.
  • $100,000/$300,000 Limits Annual Premium and Deductible Options:
  • $250,000/$250,000 Limits Annual Premium and Deductible Options:
  • $500,000/$500,000 Limits Annual Premium and Deductible Options:
  • $500,000/$1,000,000 Limits Annual Premium and Deductible Options:
  • $1,000,000/$1,000,000 Limits Annual Premium and Deductible Options:

  • FLORIDA STATE TAXES AND SURCHAGES

    *** PREMIUM INCLUDES FLORIDA FIGA ASSESSMENT SURCHARGE OF 1%***

  • Florida Residents:

    Companies writing property and casualty insurance business in the State of Florida are required to collect a Florida Hurricane Catastrophe surcharge. This is total premium and surcharge due is included in your total.

  • 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.

     

    I, the undersigned, certify that I have no knowledge of any claims, legal, or otherwise, which have been or may be made, against any entity or individual for which insurance is requested, which has not been reported previously to you or another insurance company. In addition, after making reasonable inquiries, I am not aware of any act, error or omission, or allegations of any act, error or omissions, or any other circumstances or incidents which could give rise to a claim as a result of the Company’s operations or any individual’s activities on behalf of the Company.

    I understand that the insurance Company’s willingness to provide coverage was based on the understanding that there are no known unreported claims or incidents. I also understand that all such unreported claims or incidents which later result in a claim will not be covered by the Company’s policy.

    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
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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 1-9, DO NOT PAY ON THE NEXT PAGE!

    Insurance Agent/Producer Name: RealCare Insurance Marketing, Inc., License #: L088539

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