Quotes

Inspector Renewal Application

Application must be completed in full in order to obtain
a quote from the Elite InspectInsure Program.

STEP ONE

Business Name:
Year Business Established:

First Name:

Last Name:

Street Address:

City:

State:

Zip Code:

Phone Number:

Fax Number:

Email Address:

Website (if available):

STEP TWO

Effective Date Requested:

Total Number of Inspectors:

Estimated Annual Gross Revenue $:

Estimated Commercial Gross Revenue $:

E&O Liability Limit Requested: $100,000 $250,000 $500,000 $1,000,000

Deductible: $1,500 $2,500 $5,000

Pool and Spa Inspection: Yes No

Premises Liability: Yes No

Radon Inspection Liability: Yes No

Termite Liability: Yes No

Is there a pre-inspection agreement signed prior to each inspection? Yes No

Are you a member of an association?: Yes No

If Yes, what is the name of the Association?:

If no, do you participate in a formal risk management or continuing education program?:

Current Insurance Company:

Since?:

Active Lapsed

Retro Date:

Need Help?

Claim History

Any claims in the past 5 years? Yes No

If yes, was the amount paid over $5,000 Yes No

Currently Insured?
Please choose:

Additional Comments:

Spam protection:
Is fire hot or cold?

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