Inspectors Online Application

Name

Company Name

Street Address

City

State

Zip Code

Phone Number

Fax Number

Email Address

Which home inspector’s associations do you belong to?

Policy Effective Date

What type of business formation?


Please Select individual Corporation LLC Partnership Other

How many years experience do you have in this field of business?

What year was this company established?

How many licensed inspectors (including yourself) are employed by your company?

How many licensed independent contractor inspectors will you be using this year?

What were your prior year total gross revenues?

What is your projected annual gross revenue from all inspections?

What is your projected annual gross revenue from commercial inspections only?

What percentage of your work includes the subcontracting of work to others?

How many inspections will you perform within the next 12 months?

Do you take pictures during your inspections?


Please Select Yes No

What type of reports do you use?


 Narrative
 Verbal
 Checklist
 Computer Program

Do you use the same reporting format for each client?

Please Select Yes No

What type of clients do you have? (List % in next question)


Please Select Individual Purchaser Mortgage Lender Other

What is the % of the above listed client?

Are you a builder, contractor or repair/remodeling contractor?


Please Select Yes No

Are you a licensed lead abatement contractor?


Please Select Yes No

Are you a licensed mold abatement contractor?


Please Select Yes No

Is a Pre-Inspection Agreement/Contract signed 100% of the time?


Please Select Yes No

Has your inspection agreement/contract been reviewed by legal counsel?


Please Select Yes No

Has your inspection agreement/contract been provided to you by a professional association or franchise?


Please Select Yes No

What level of coverage are you interested in?


Please Select 100,000 300,000 500,000 1,000,000

What are your current E&O Limits?


Please Select 100,000 / 500,000 150,000 / 500,000 250,000 / 250,000 250,000 / 500,000 300,000 / 300,000 500,000 / 500,000 500,000 / 1,000,000 1,000,000 / 1,000,000

What is your current E&O deductible?


Please Select 0 1,000 1,500 2,500 5,000 10,000 Over 10,000

Are you also seeking General Liability in addition to Errors and Omissions insurance?


Please Select Yes No

Are you seeking coverage for wood destroying organisms/termite inspections?


Please Select Yes No

Are you seeking coverage for radon inspections?


Please Select Yes No

Are you seeking coverage for septic and water purification testing?


Please Select Yes No

Are you seeking coverage for carbon monoxide testing?


Please Select Yes No

Are you seeking coverage for pool or spa inspections?


Please Select Yes No

Are you seeking coverage for mold testing inspections?


Please Select Yes No

Are you seeking coverage for lead paint inspections?


Please Select Yes No

Are you seeking coverage for wind mitigation?


Please Select Yes No

Are you seeking coverage for mortgage field services?


Please Select Yes No

If you are seeking a crime/fidelity bond, if so, please advise how much:


Please Select Not Requested 5,000 10,000 15,000 25,000

Would you be interested in coverage for your tools & equipment with an automatic limit of $10,000?


Please Select Yes No

In the past 5 years, has any professional liability claim or suit been made against your or any of the predecessor firms?


Please Select Yes No

Who is your current E&O carrier? If none, state NONE.

What is the retroactive date on your current E&O policy?

Current annual premium

Do you pay your insurance in installments throughout the year?


Please Select Yes No

How did you hear about us?


Please Select Internet Search Trade Publication Email Postcard Newspaper AD Friend Trade Show Facebook LinkedIn Other

Additional Comments:

Disclaimer Notice – The premiums quoted are estimates based on information you provided. This quotation does not constitute a contract of insurance, nor does it provide coverage for any loss or claim. Coverage can only be bound by an agent with a signed application and a down payment.

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