SURVEYOR ERRORS & OMISSIONS POLICY

  • SURVEYOR ERRORS & OMISSIONS POLICY

    Application 20240501
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  • GENERAL INFORMATION

    If you don't have your renewal application, please proceed with filling out the rest of the application.

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  • Format: (000) 000-0000.
  • Format: (000) 000-0000.

  • PERSONNEL INFORMATION

  • Rows

  • GROSS RECEIPTS

    Gross receipts to include reimbursable expenses and fees paid to subconsultants:

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  • Rows

  • PROFESSIONAL DISCIPLINES

  • Rows

  • SERVICES

  • Rows

  • CLIENTS

  • Rows

  • PROJECTS

  • Rows
  • Rows

  • CONTRACTS

  • Rows

  • FINANCIAL AND OTHER INTERESTS

    Please answer the following questions regarding you, your firm, or any principals participating in these activities during the past 12 months.

  • SUBCONTRACTORS / SUBCONSULTANTS

    Please provide, as a percentage of the Total Gross Receipts reported in GROSS RECEIPTS section, the fees paid to the firm's subconsultants in the following disciplines:

  • Rows

  • QUALITY ASSURANCE / CONTROL ISSUES

  • CLAIMS / LIABILITY ISSUES

  • LIMITS AND DEDUCTIBLES

    The firm would like a quotation based on the following limits and deductibles:

  • INSURANCE HISTORY

  • Rows
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  • Please provide current General Liability policy information:

  • Information To Be Submitted

    The following information may be requested prior to binding:

    • Claims history/loss summary for the past five years.
    • Resumes of key licensed land surveyors/professionals on staff.
    • Copy of current policy declaration page (if any) to confirm retro date.

    Mail to ANCO Insurance, 3103 Bee Cave Road, Suite 242, Austin, Texas 78746 or Fax to (512) 330-9856.

  • SUBMISSION INFO

    Must select "agree" to the following statements to continue quotation.

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  • Important: Please check the box below. You will need to sign (above) this application and then select "Submit" below. You will be emailed a copy of this application for your records to use as a reference for your renewal.

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