SURVEYOR ERRORS & OMISSIONS POLICY

GENERAL INFORMATION

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

PERSONNEL INFORMATION

GROSS RECEIPTS

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

PROFESSIONAL DISCIPLINES

SERVICES

CLIENTS

PROJECTS

CONTRACTS

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:

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

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.

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.