Application – Online – Process Server

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:

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 (%)

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

$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

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

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

Is the Applicant aware of any circumstance, allegation, contention, or incident which may result in a claim or suit against the Applicant?

Yes

Has any insurer canceled or refused to renew any similar insurance during the past five(5) years?

Yes

Does any operation require you to carry and/or use of a firearm? (IF YOU CARRY FOR YOUR OWN PROTECTION,ANSWER NO)

Yes

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

b. Does the applicant rent or hire auto in excess of 10 times per year?

Yes

c. Does the applicant use any auto to transport clients?

Yes

d. Does the applicant own any auto registered in the company's name or leased on a long term basis?

Yes

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

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.

Call (800) 683-1226 or email us at info@yergeyins.com

5941 Parsons Lane, King George, VA 22485, (800) 683-1226

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Application – Online – Process Server

Operations (Please provide the percentage of revenue from each type of operation below:)

If your operations are not listed above, Please Call 800-683-1226

Your companies expected annual revenue

Desired Liability Limits

Desired Property Limits

Underwriting

Optional Coverage

Other Coverage (Quote Request)

Applicant's Warranty Statement:

We are a firm that is looking out for your assets

For more information call
(800) 683 -1226

Helpful Links

Request a Certificate of Insurance

Privacy Statement

Application / Forms

Conferences & Events

October 15-17, 2023 - OSMOSIS - OSMOSISCon

October 19, 2023 - MCPI - Michigan Council of Professional Investigators

November 13, 2023 - SCFIA - Southern California Fraud Investigators

November 13-15, 2023 - NCAPI - The North Carolina Association of Private Investigators

Call (800) 683-1226 or email us at info@yergeyins.com

5941 Parsons Lane, King George, VA 22485, (800) 683-1226

Application – Online – Process Server

Operations (Please provide the percentage of revenue from each type of operation below:)

If your operations are not listed above, Please Call 800-683-1226

Your companies expected annual revenue

Desired Liability Limits

Desired Property Limits

Underwriting

Optional Coverage

Other Coverage (Quote Request)

Applicant's Warranty Statement:

We are a firm that is looking out for your assets

For more information call(800) 683 -1226

Helpful Links

Request a Certificate of Insurance

Privacy Statement

Application / Forms

Conferences & Events

October 15-17, 2023 - OSMOSIS - OSMOSISCon

October 19, 2023 - MCPI - Michigan Council of Professional Investigators

November 13, 2023 - SCFIA - Southern California Fraud Investigators

November 13-15, 2023 - NCAPI - The North Carolina Association of Private Investigators

Call (800) 683-1226 or email us at info@yergeyins.com

5941 Parsons Lane, King George, VA 22485, (800) 683-1226

For more information call
(800) 683 -1226