PIDIM Member Insurance Verification Form

PIDIM Member Insurance Verification Form

PIDIM requires that all Intern and Professional Members carry Professional (E&O) and Commercial General Liability (CGL) insurance as a condition of membership. For Professional Members the minimum amount of insurance required is: $1,000,000 for Professional Liability (E&O) insurance and $1,000,000 for General Liability (CGL) insurance. For Intern Members the minimum amount of insurance required is: $500,000 for Professional Liability (E&O) insurance and $1,000,000 for General Liability (CGL) insurance. Please provide your current insurance details below for compliance purposes for both your Professional Liability Insurance (E&O) and Commercial General Liability Insurance (CGL). All fields are required. Thank-you.
MEMBER INFORMATION
Member Full Name*

First NameLast Name
Member Phone Number*
Please enter a valid phone number.
Member Email Address*
example@example.com
Company Name*
Membership Status*
TYPE OF INSURANCE
Please select your insurance type*

Option A - I am covered by the Canada wide Prolink Interior Design Insurance programOption B - I am covered by my employer and do not provide Interior Design services outside of my employmentOption C - I have insurance policy through another companyOption D - I currently do not hold Interior Design insurance
If you choose Option D from above please indicate the reason below:

I am Non-Practicing Member of PIDIMCurrently unemployed in the field of Interior DesignI am an Educator Member and non-practicingI am a Retired Member of PIDIMOther (please contact PIDIM to discuss)
REQUIRED INSURANCE INFORMATION

Please note - If you chose Option D from above (no insurance) it is not a requirement to fill out the fields below.
Insurance Provider Name*
Policy Number*
Policy Start Date*

MonthDayYear
Date
Policy Expiration Date*

MonthDayYear
Date
Professional Liability Insurance (E&O) Amount*
Enter the amount of your Professional Liability Insurance (E&O) coverage
Commercial General Liability Insurance (CGL) Amount*
Enter the amount of your Commercial General Liability Insurance (CGL) coverage
Should be Empty:

PIDIM Member Insurance Verification Form

MEMBER INFORMATION

TYPE OF INSURANCE

REQUIRED INSURANCE INFORMATION