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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 — Home Inspector Information
Are you an insurance agent applying on behalf of your client?

Agency Name:

Agency Address:

Agency City:

Agency State:

Agency Zip Code:

Agency Phone:

Agency Email Address:

Agency Contact Name:

Full Legal Name of Applicant:
(Full Business Name)
Year Business Established:
Principal First Name:
Principal Last Name:
Business Street Address Line 1:
Business Street Address Line 2:
P.O. Box:
City:
State:
County:
Zip Code:
Phone Number:
Cell Number:
Email Address:
Web Site Address:
Are there any other locations?

Please provide address:

Is the Applicant a franchisee?

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 or ownership of the applicant changed or has there been an acquisition, merger, consolidation or other changes?


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?


Please provide details:

Step #2 — Coverage Information
Effective Date Requested:
Number of full-time inspectors:
Number of part-time inspectors:
Does the application utilize Independent Contractors?

Please indicate how many and for what services:

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


Are all home inspectors licensed?

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

Details:

Does the applicant or any inspectors hold other professional licenses?

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?

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


E&O Liability Limit Requested:



Deductible:


Pool & Spa Inspection?
Premises General Liability?
(Property Damage and Bodily Injury)

Radon Inspection Liability?
Termite / WDI Liability?
Does the Applicant’s current policy have any endorsements or exclusions or coverage limitations tailored specifically to the Applicant?

Please describe endorsements:

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

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?
What Professional Associations
are you a member of?





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

What program?

What inspection standards / SOP is used?
Step #3 — Professional Liability Insurance History
During the past 5 years, have you are any of your inspectors had professional liability or similar coverage cancelled, declined, or non-renewed?
Current Insurance Company:
Effective Date:
Expiration Date:
Active?

Why?

Retro Date:
Current Premium:

Prior Insurance Company

Prior Insurance Company:
Effective Date:
Expiration Date:
Retro Date:
Premium:
Has the Applicant ever purchased an extended reporting period endorsement?
Step #4 — Claim History
During the past 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?
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?

Please indicate how many and describe:

Step #5 — Other
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:
Fire is hot. Ice is ____.

Required applicants in Florida, Iowa & New Hampshire

Name of Broker:
Broker License No:
Broker Address:
Broker Signature:
(New Hampshire only)

Fraud Warning Statements Click here to download PDF

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