Online Application: Pay Per Inspection Home Inspector Insurance - Exclusively for ITA Graduates

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Pay Per Inspection
Home Inspector Insurance

Revolutionary new program
making insurance affordable
for new home inspectors!

ADDITIONAL INSURED INFORMATION FORM FOR PROFESSIONAL INDEMNITY (E&O) and GENERAL LIABILITY INSURANCE - GRADUATE PROGRAM

Administered by: Allen Insurance Group
304 MLK Jr. Drive P.O. Box 1439 Fort Valley, Georgia 31030
Voice: (800) 474-4472 Facsimile: (478) 822-9149

Step 1: Online Application

After completing step 1 you will be asked to fax in additional documentation.

Answer all questions, use "NONE" or "N/A" where appropriate, use attachments as necessary. We cannot process incomplete forms.

1. Additional Insured Information:

Full Business Name:
Mailing Address:
City:
State:
Zip:
Location Address:
City:
State:
Zip:
Business Phone:
Facsimile Number:
Is this a dedicated fax line?	Yes No
Email Address:
Verify Email Address:
Individual to contact:

a. Date the real estate inspection business was established:
b. Type of entity:	Corporation/LLC Partnership Sole Proprietor Other

3. List the home inspector:

a. Name:
b. Years of Experience:	Inspector In construction Architect / Engineer
c. Inspection School Attended:

4. List all other staff and their positions:

a. Name:
Position:
b. Name:
Position:
c. Name:
Position:
d. Name:
Position:

Do you or your firm: a. perform any activities other than property inspections? i.e., Home repairs:	Yes No If Yes, describe:
b. engage in any Architectural or Engineering activities? (i.e. architectural design or analysis; or structural, mechanical, electrical, or civil design or analysis)	Yes No If Yes, you will need to provide a detailed description of these activities and E&O insurance declaration page(s)

Please indicate the limit of liability desired: a. LIMIT - Applies to claim expense and indemnity. (Per Claim/Aggregate all Claims):	$125,000/$250,000 $250,000/$500,000
b. E&O DEDUCTIBLE - Applies to each claim and is inclusive of defense costs, claim expenses and indemnity:	$1,500 Note: A $250 applies to General Liability Property Damage Claims

Please indicate if WDO/WDI (Termite) Inspection
coverage is needed (Additional cost):

WDO/WDI Inspections (per claim limit $50,000 – per claim deductible $3,500)

a. Has your name or ownership ever changed or has any other business been purchased, merged or consolidated with your firm?	Yes No
b. Is the firm owned or controlled by any other firm or individual?	Yes No
c. Do you, your firm, any owner or officer of this firm, own, engage in, operate, manage or act as a director or officer of any other business?	Yes No
If you answered Yes to any of these questions, provide details:

Have any claims been made against you, your firm, its predecessors, present or past owners, directors, officers or employees during the past five years? or are you or your firm aware of any circumstances, allegations or contentions which could result in a claim(s) being madeagainst you or your firm, its predecessors, present or past owners, directors or officers?

Yes No

If Yes, you will need to complete an application claim form with information for each claim and provide a loss run from the Company providing insurance at the time of the claim.

10.

Have you, your firm or any persons or firm proposed for this coverage ever been subject to disciplinary action by any state licensing board, court, regulatory authority, professional association or had their licensed revoked?	Yes No
If Yes, provide details:

11.

What professional organizations, associations or societies do you or your firm belong or planning to join?

12.

Any hold-harmless agreements entered into by you or your firm? (Other than Your Inspection Agreement)

Yes No

If Yes, you will need to provide a copy of same.

13.

What percentage of your business involves subcontracting work to others (other than listed in question 3?):	%
Please describe work subcontracted:
a. Do you require Certificates of Insurance from subcontractors?	Yes No

14.

In Step 2 you will be asked to provide copies of the following:

a. Any descriptive brochures being used

b. Resume for the inspector

c. Training provider graduation certificate

Check this box if No Brochures are being used.

15.

Choose Your Insured Report Packet Type:

Note: GL and E&O coverage limits must match.

Choose Your Insured Report Packet Type:

Matrix Deluxe
(scroll down for other report types)

10 Matrix Deluxe reports and Insured Inspection Report Contracts

Gold Program – Home Inspection and Radon Testing

$125,000 each claim/$250,000 all claims $470

$250,000 each claim/$500,000 all claims $574

Platinum Program – Home Inspection, Radon Testing and Termite Inspections

$125,000 each claim/$250,000 all claims $626

$250,000 each claim/$500,000 all claims $782

MATRIX
(scroll down for other report types)

10 Matrix (long form) reports and Insured Inspection Report Contracts

Gold Program – Home Inspection and Radon Testing

$125,000 each claim/$250,000 all claims $440

$250,000 each claim/$500,000 all claims $544

Platinum Program – Home Inspection, Radon Testing and Termite Inspections

$125,000 each claim/$250,000 all claims $596

$250,000 each claim/$500,000 all claims $752

InspectNOW

InspectNOW users - 10 Insured Inspection Report Contracts

Gold Program – Home Inspection and Radon Testing

$125,000 each claim/$250,000 all claims $310

$250,000 each claim/$500,000 all claims $414

Platinum Program – Home Inspection, Radon Testing and Termite Inspections

$125,000 each claim/$250,000 all claims $466

$250,000 each claim/$500,000 all claims $622

16. Agreement - Please read through the below agreement, accept the agreement and submit the application to continue to Step 2.

I/We;

1. understand and accept that the policy does not provide coverage for: appraising; real estate sales; inspections for compliance with codes or regulations; warranting or guaranteeing the present or future economic value of any home; warranting or guaranteeing the adequacy or performance of any structure, components or system; any engineering analysis; any architectural service; mold or other environmental hazards; course of construction inspections; construction draw inspections; 203k inspections; asbestos; inspections in Alaska, Alabama, West Virginia, New Jersey or Mississippi; estimated construction costs, cost to cure or repair costs; environmental site assessments; inspections for insurance companies; or log homes.

2. understand and accept that WDO/WDI (Termite) or Lead Based Paint or Radon claims are not covered by the policy unless you or your firm is NOT performing such inspections/tests and they are EXCLUDED in the inspection agreement and the agreement is signed by the client; or you or your firm is performing such inspections/tests and has requested coverage for each.
Lead based paint testing is not an option under this policy. Radon is included.

3. understand and accept that the policy only provides coverage for claims arising out of an inspection for which I/We have a properly completed inspection agreement. The inspection agreement must be one of the agreements of the training provider which has the special Insured Inspection Report code on it. The agreement must be signed by the client or the client’s representative. The inspection agreement must have been sent to the program manager (Allen Insurance Group) within thirty (30) days of the date of the inspection. I/We further understand and accept that the reporting system must be one of the systems of the training provider.

4. understand that defense costs, claims expenses and indemnity shall be applied against the deductible.

5. understand that the request to be an additional insured does not bind you or your firm, the agent, the general agent or the company to complete this insurance transaction by the issuance of an endorsement and that the agent, general agent, and the insurance company retain the right to request from you any additional information that is reasonably necessary or required in order to complete this transaction.

6. understand that all premiums and taxes associated with the additional insured endorsement are minimum premiums and are fully earned and cannot be cancelled or refunded. Additionally, other costs associated with the additional insured endorsement are NOT refundable.

7. understand that the insurance provided by this insurance policy is written on a claims made basis. That the policy shall indemnify the additional insured against any claim which is first made against the additional insured and reported to the Insurer during the additional insured’s coverage period (so stated on the Additional Insured Endorsement). The claim must arise out of an inspection or act performed during the Additional Insured’s coverage period and subsequent to the retroactive date (so stated on the Additional Insured Endorsement) and before the end of the additional insured coverage period. I/We understand policy does NOT have a provision for extended claims reporting nor may an Additional Insured apply for a second year of coverage. I/We understand that we will need to purchase a new insurance policy from the Allen Insurance Group or another provider which will maintain my Prior Acts Retroactive date.

Note: The policy contains other exclusions, provisions and conditions. Please read the policy carefully and call your representative if you have any questions.

I/We hereby warrant that the information contained herein is true and correct and that no material facts have been misstated, omitted or suppressed. I/We understand and accept that this application, attachments and supplements shall be the basis and form a part of the Additional Insured endorsement, if issued. I/We understand and accept that the Professional Indemnity (E&O) and General Liability sections of the insurance policy is written on a CLAIMS MADE BASIS. I/We understand and agree that no coverage will become effective until the policy holder and the additional insured are so notified and payment in full is received. Additionally I/We agree to hold the training provider harmless for any disputes between myself/us and the insurance company arising out of any policy coverage issues or any other issues arising out the insurance policy.

17.

I/We would like coverage to begin on:

(The start date must be within 45 days of application)

18.

Authorization: a. Name of owner, partner or executive officer submitting this application:
b. I certify that I am the above listed individual and I agree to all terms listed above:	Checking this box signifies your acceptance of this agreement A digital acceptance shall have the same validity as a signed agreement
c. Your unique IP address will be recorded to verify that this was submitted from your computer:	Your IP address: 38.103.63.17
d. Today's date: