Quotes

Home Inspectors E&O Application

Application must be completed in full in order to obtain
a quote from the Elite InspectInsure Program. If a policy is issued, this application will attach to and become part of the policy, therefore, it is important all questions are answered accurately.

• indicates a required field

Step #1

Are you an insurance agent applying on behalf of your client?	No Yes Agency Name: Agency Address: Agency City: Agency State: Agency Zip Code: Agency Phone: Agency Email Address: Agency Contact Name:
Full Legal Name of Applicant:
Year Business Established:
Principal First Name:
Principal Last Name:
Business Street Address:
City:
County:
State:
Zip Code:
Phone Number:
Cell Number:
Email Address:
Web Site Address:
Are there any other locations?	No Yes Please provide address:
Is the Applicant a franchisee?	No Yes Please provide full legal name of franchisor:
List all states in which the owner does business:
Applicant is:
During the past 5 years has the name of ownership of the applicant changed or has there been an acquisition, merger, consolidation or other changes? No Yes Please provide details:
Is the applicant owned by, controlled by or affiliated by any other entity or does the applicant own or control any other firm? No Yes Please provide details:

Step #2

Effective Date Requested:

Number of full-time inspectors:

Number of part-time inspectors:

Does the application utilize Independent Contractors?

No
Yes

Please indicate how many and for what services:

Does the applicant contractually require them to carry E&O insurance?

No
Yes

Are all home inspectors licensed?

Yes
No
N/A

Have you, your company, or staff ever had your license revoked, suspended or been formerly reprimanded, or been the subject of a disciplinary action?

No
Yes

Details:

Does the applicant or any inspectors hold other professional licenses?

No
Yes

What license?

Estimated Annual Revenue

	Income	# Transactions
Residential 1–4 units	$	#
Residential over 4 units	$	#
Commercial	$	#
Other (Please explain)	$	#

Breakdown of annual income from the following sources: (percentage)

Individual Seller / Prospective Buyer / Real Estate Agency:
Lender / Mortgage Company / Mortgage Broker:
Developer / Investor / Syndicator / Relocation Company :
Other:

Does any single client represent more than 10% of the Applicant’s gross annual revenue?

No
Yes

Is the applicant the exclusive inspector for any real estate agency, developer, and/or builder?

No
Yes

E&O Liability Limit Requested:

$100,000
$250,000
$500,000
$1,000,000

Deductible:

$1,500
$2,500
$5,000

Pool & Spa Inspection?

No
Yes

Premises Liability?

No
Yes

Radon Inspection Liability?

No
Yes

Termite / WDI Liability?

No
Yes

Does the Applicant’s current policy have any endorsements or exclusions or coverage limitations tailored specifically to the Applicant?

No
Yes

Please describe endorsements:

Is there a pre-inspection agreement signed prior to each inspection?

Yes
No

This program mandates that a pre-inspection/inspection agreement be used/signed for every inspection. Failure to do so with every inspection would disqualify you from the program/negate coverage.

Indicate type of inspection report used:

Type of Computer Software used to Generate Reports:

Are pictures included on all reports?

No
Yes

What Professional Associations are you a member of?

ASHI
NACHI
NAHI
CREA
TAREI
Other

If none, do you participate in a formal risk management or continuing education program?

No
Yes

What program?

What inspection standards / SOP is used?

Step #3 — Professional Liability Insurance History

Prior Insurance Company
During the past 5 years, have you are any of your inspectors had professional liability or similar coverage cancelled, declined, or non-renewed?	No Yes
Current Insurance Company:
Effective Date:
Expiration Date:
Active?	Yes No Why?
Retro Date:
Current Premium:
No prior insurance
Prior Insurance Company:
Effective Date:
Expiration Date:
Retro Date:
Premium:
Has the Applicant ever purchased an extended reporting period endorsement?	No Yes

Step #4 — Claim History

During the past five (5) years, has any professional liability claim or suit ever been made against the Applicant, Prior Owners or any of the Applicant’s current or former staff?

No
Yes

How many claims?

Claim #1

Open or closed:

Date of inspection:

Date claims report:

Description of loss:

Amount Paid Indemnity:

Amount Paid Defense:

What actions have been taken to prevent future similar losses?

Claim #2

Open or closed:

Date of inspection:

Date claims report:

Description of loss:

Amount Paid Indemnity:

Amount Paid Defense:

What actions have been taken to prevent future similar losses?

Claim #3

Open or closed:

Date of inspection:

Date claims report:

Description of loss:

Amount Paid Indemnity:

Amount Paid Defense:

What actions have been taken to prevent future similar losses?

Does applicant, staff or prior owner know of any pending or possible claims, incident, negligent act, error or omission or other circumstance that could result in a claim or suit against the Applicant?

No
Yes

Please indicate how many and describe:

Step #5 — Other

Required applicants in Florida, Iowa & New Hampshire
How did you hear about us?
Additional information that might be helpful in quoting/writing your professional liability insurance:
Digital Signature: (print name)
Date:
SPAM Protection: Is fire hot or cold?
Name of Broker:
Broker License No:
Broker Address:
Broker Signature: (New Hampshire only)

I have read and agree to the Fraud Warning Statements (below) •

Fraud Warning Statements Click here to download PDF

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Quotes

Home Inspectors E&O Application

Estimated Annual Revenue 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020

Breakdown of annual income from the following sources: (percentage)

Prior Insurance Company

Claim #1

Claim #2

Claim #3

Required applicants in Florida, Iowa & New Hampshire

Estimated Annual Revenue