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Coverages
Applications
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Application – Online – Arson / Fire Investigators
Name of Applicant:
Business Entity Type:
Corporation
Limited Liability Company
Individual/Sole Proprietor
Other
Contact Name:
Email Address:
Physical Address:
Mailing Address:
Business Numbers:
Please list all Associations, Memberships and Certifications:
APIA
FAPI
IAAI
INTELLENET
LPDAM
NAFI
NAPPS
NCAPI
NCISS
NJLPIA
PALI
PAWLI
PIAI
PIAVA
PSACO
SCALI
WALI
Operations
(Please provide the percentage of revenue from each type of operation below:)
Accident Reconstruction (%)
Accounting Forensic / AML (%)
Arson / Property Investigations (%)
Attorney / Legal Investigations (%)
Background Investigations (%)
Computer Forensic (%)
Conservator of Peace (SCOP) (%)
Constable Services (%)
Consulting (%)
Copyright / Trademark Investigations (%)
CyberSecurity Investigations (%)
Debugging / TSCM (%)
Executive Protection (Low Profile) (%)
Exiting Interview (Corporate) (%)
Expert Witness Services (%)
Fidelity Investigations / Domestic (%)
Fingerprint Analysis (%)
Firearms Training - Classroom Only (%)
Firearms Training - Range (%)
Genealogy (%)
Insurance Investigations (%)
Juvenile Investigations (%)
Kidnap and Ramson (%)
Lie Detection / Polygraph (%)
Locate / SkipTrace (%)
Mortgage/Court - Auction Services (%)
Online Searches (%)
Process Service / Subpoena (%)
Security Training (%)
Shopping Services/Mystery Shopping (%)
Sub-Rosa Investigations (%)
Threat/Vulnerability Assessment (%)
Under Cover Investigations (%)
Other (%)
Other – Describe:
If your operations are not listed above, Please Call 800-683-1226
Your companies expected annual revenue
$0 to $150,000
$350,001 to $450,000
$650,001 to $750,000
$1,250,001 and $1,500,000
$150,001 to $250,000
$450,001 to $550,000
$750,001 to $1,000,000
$1,500,001 and $1,750,000
$2,000,001 and Above
$250,001 to $350,000
$550,001 to $650,000
$1,000,001 and $1,250,000
$1,750,001 and $2,000,000
Desired Liability Limits
$300,000/$600,000
$500,000/$1,000,000
$1,000,000/$3,000,000
$1,000,000/$5,000,000
$2,000,000/$2,000,000
$3,000,000/$3,000,000
$4,000,000/$4,000,000
$5,000,000/$5,000,000
Damage to Premises Rented to You Limit - $100,000 (Included)
Medical Expense Limit - $5,000 (Included)
Desired Property Limits
Request Limit of Business Personal Property Coverage (Office Equipment)
$25,000 (included no cost)
$50,000
$100,000
Underwriting
Total number of Employees? (Inclusive of all investigators)?
a. Number of Investigators?
Does the applicant subcontract any investigative work?
Yes
No
a.If Yes - What percentage of work is subcontracted?
b.If Yes - Are subcontractors required to maintain their own liability coverage at a minimum limit of $300,000/$600,000?
Yes
No
How many years have you maintained continuous General Liability and errors & Omissions Coverage?:
During the past five(5) years, has any claim been made or suit brought against the applicant?
Yes
No
Is the Applicant aware of any circumstance, allegation, contention, or incident which may result in a claim or suit against the Applicant?
Yes
No
Has any insurer canceled or refused to renew any similar insurance during the past five(5) years?
Yes
No
Does any operation
require
you to carry and/or use of a firearm?
(IF YOU CARRY FOR YOUR OWN PROTECTION,ANSWER NO)
Yes
No
Optional Coverage
Hired and Non-Owned Auto:
$300,000
$500,000
$1,000,000
a. Does the applicant have a commercial auto policy in place?
Yes
No
b. Does the applicant rent or hire auto in excess of 10 times per year?
Yes
No
c. Does the applicant use any auto to transport clients?
Yes
No
d. Does the applicant own any auto registered in the company's name or leased on a long term basis?
Yes
No
Blanket Additional Insured: INCLUDED
Private Eye Endorsement: INCLUDED
Waiver of Subrogation:
To Include - Additional Cost $150
Primary Wording:
To Include - Additional Cost $150
Nose Coverage:
To Include - Transition from Claims Made policy to an Occurrence Form policy - One Year Additional Cost
Retro-Active Date of Current Policy:
a. Does the applicant or any principals, directors, officers, partners, professional employees, or independent contractors of the applicant have knowledge or information of any actual or alleged acts, errors, omissions, offenses, or circumstances which might reasonably be expected to give rise to a claim against the applicant or any proposed insured entity??
Yes
No
Other Coverage (Quote Request)
Cyber/Privacy/Crime Coverage
Inland Marine Coverage (Schedule Personal Property)
Workers Compensation
Surety / License Bond
Commercial Auto
Directors and Officers Liability (D&O)
Employee Practice Liability (EPLI)
Drone / Unmanned Aircraft Liability
Applicant's Warranty Statement:
The undersigned represents to the best of his/her knowledge and belief the particulars and statements set forth are true and agree that those particulars and statements are material to the acceptance of the risk assumed by the Company. The undersigned further declares that any claim, incident or event taking place prior to the effective date of the insurance applied for which may render inaccurate, untrue, or incomplete any statement made will immediately be reported in writing to the applied for which may render inaccurate, untrue, or incomplete any statement made will immediately be reported in writing to the Company and the Company may withdraw or modify and any outstanding quotations and/or authorization or agreement to bind the insurance. The signing of the Application does not bind the undersigned to purchase the insurance, nor does the review of the Application bind the Company to issue a policy. It is understood the Company is relying on the Application in the event the Policy is issued. It is agreed that this Application, including any material submitted therewith, shall be the basis of the contract should a policy be issued, and may be attached dot and become part of the policy.