Home Inspectors Coverage Application

Company Name

Contact Person

Street Address

Zip

City

County

State

Telephone

Fax

E-mail

Web Address

Year Established

How many Inspectors are to be covered by this policy? (not support staff)

Form Of Business

Proposed Effective Date of Policy

Is your Business a Franchise?

Yes No

If Yes, Franchise company

Is the Applicant or any other proposed insured

(a)

Owned by, controlled by or act as a Director or Officer of any other business or organization?

Yes No

If YES, Please explain

(b)

Engaged in any other business or employed by any other business or organization?

Yes No

If YES, Please explain

If YES, what percentage of inspection services are performed for such Please explain business(es)?

In the past FIVE years has the name of the Applicant been changed or has any other business been purchased, merged or consolidated with the Applicant?

Yes No

If YES, Please explain

Please detail the number of partners and staff

(a)

Principals/Partners/Inspectors (owners)

Full Time

Part Time

(b)

Professional Staff /Inspectors (non-owners)

Full Time

Part Time

(c)

Other Employees (helper/apprentices)

Full Time

Part Time

Please detail the following for all owners, officers, directors, partners and inspectors: Owner, Employee and Independent Contractor

	Name	Designation
# {{$index + 1}}

Inspections by year

	Gross Revenue	# of Inspectors	Total Inspections
Next 12 Months	$
Last 12 Months	$
12 to 24 Months ago	$

What was the Applicant’s largest fee for an individual inspection job ever done

What type of inspection was it?

What is your average fee?

Do you take pictures during your inspection?

Yes No

How many

10.

What type of inspection report does the Applicant use? (Select all that apply)

NARRATIVE

VERBAL

CHECKLIST

Computer Program

All Apply

If yes to a computer, which program do you use

Do you have a customer service follow up program in place

Yes No

11.

What inspection standards are used

12.

Is the Applicant affiliated with any professional home inspection organizations?

Yes No

If yes. please list

13.

Please list the states where the Applicant performs inspection services:

14.

Indicate the types of inspections performed and the percentage of gross income derived from each

Residential home inspection – less than 4 units

Residential home inspection – over 4 units

Industrial/Restaurent

Soft Commercial (retail, business parks, office buildings)

Wind Mitigation

Bank/Draw Inspections

Radon

Pest/WDO/WDI/Termite

Lead

Code

Mold/Indoor Air Quality

Septic/Sewer

Pools/Spa's

EIFS/STUCCO

Green Certification

Energy Audits

Water Quality Testing

Other 1

Other 2

Total

{{TypesofInspections.Total | currency:"":2}} %

15.

Indicate the percentage of inspections performed for the following types of clients

Individual purchasers

Mortgage lenders

Municipalities

Governmental agencies including, but not limited to HUD and FHA

Other (please specify)

Total

{{Application.TotalInspectionPerformed | currency:"":2}} %

16.

Is the Applicant a licensed real estate agent?

Yes No

If Yes, Do you inspect any homes that you have listed as a real estate agent? Does the real estate operation carry separate professional liability coverage?

Yes No

17.

Is the Applicant an exclusive home inspector for any one Realtor or real estate company:

Yes No

If Yes, please explain

18.

Does the Applicant currently offer estimates or do repair work on properties you have inspected?

Yes No

If Yes, please explain

19.

Does the Applicant use a pre-inspection agreement when performing home inspection?

Yes No

Is the agreement signed in advance by your customer?

Yes No

If YES, Please include a copy with your application

20.

Does the Applicant offer warranties or guarantees of any type?

Yes No

If Yes, Please furnish details.

21.

Does the Applicant:

(a)

Have an in-house office policy/procedures manual in place?

Yes No

Please explain

(b)

Use a contract for services or letter of engagement for all clients

Yes No

Please explain

(c)

Require professionals to attend continuing education classes?

Yes No

Please explain

(d)

Use an in-house counsel, counsel on retainer and/or risk manager?

Yes No

Please explain

(e)

Perform audits of work performed by each professional? Please explain

Yes No

Please explain

If YES, how often?

22.

Does the Applicant hire subcontractors?

If YES:

Yes No

(a)

What percentage of gross income is performed by subcontractors:

(b)

What type of work do subcontractors perform?

(c)

Do you review the work performed by subcontractors?

Yes No

(d)

Do you verify the qualifications of subcontractors?

Yes No

(e)

Are any services performed by subcontractors outside of the U.S.A.?

Yes No

(f)

Are subcontractors required to have their own E&O insurance?

Yes No

23.

Has the Applicant or any other proposed insured been involved in or have knowledge of any disciplinary or investigative action or license revocation by any local, state or federal licensing board, court, regulatory authority or professional association?

Yes No

If YES, please give full details

24.

Has the Applicant carried Professional Liability Insurance previously under the existing name or any predecessor in business?

Yes No

If YES, Include current Declarations page with your application

	Insurer	Limits	Deductible	Premium	Period
# {{$index + 1}}				$

Is the Applicant’s expiring policy issued on a CLAIMS MADE basis?

Yes No

If YES, please provide the Retroactive Date of the expiring policy.

25.

(a)

In the past 5 years, has any application for this type of insurance completed by the Applicant or any other predecessor in business been declined? Or has any insurance of this type been cancelled, non-renewed, or refused?

Yes No

(b)

In the past 5 years, has any CLAIM been made against the Applicant or any of their past or present owners, officers, partners, directors or employees either individually or otherwise for professional services?

Yes No

(c)

Is the Applicant or any other person proposed for insurance aware of any incident or circumstance which may result in a CLAIM being made against the Applicant or any past or present owners, partners, officers, directors, employees or predecessors in business?

Yes No

If YES to (a), (b), and/or (c), You'll need to fill the Claim/Incident/Circumstance Information Sheet for each claim.

26.

Limit Options: Professional Liability (Errors & Omissions) Coverage:

$100,000/$300,000

$250,000/$500,00

$300,000/$300,000

$300,000/$600,000

$500,000/$500,000

$500,000/$1,000,000

$1,000,000/$1,000,000

27.

Deductible

$1,000

$2,500

$5,000

$10,000

$15,000

$25,000

$50,000

28.

Please select any additional coverages that you might want

Name

Title

Date

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Confirmation