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Application Build
Business Entity Type:
Corporation
Limited Liability Company
Individual/Sole Proprietor
Other
APIA
LPDAM
SCALI
NCISS
NJLPIA
PIAI
PSACO
Operations
(Please Select All That Apply)
Background Investigations
Civil Investigations
Criminal Investigations
Attorney Service
Process Server
AOE/COE Investigations
Property/Arson Investigations
Sub-Rosa Investigations
Product Liability Investigations
Firearms Training - Range
Firearms Training - Classroom Only
Asset Searches
Constable Services
Conservator of Peace
Enrollment Agents
Fingerprint Analysis
Medical Mal-Practice Investigations
Fidelity Investigations/Domestic
Executive Protection - Low Profile
Activity Check
Locate/Skip Tracing
Under Cover Investigations
Exiting Interview(Employee Dismissed)
Exiting Interview(Inventory Only)
Genealogy
Juvenile Investigations
Debt Collection - Less than 10%
Record Retrieval
Accident Reconstruction
Threat/Vulnerability Assessment
Mortgage/Court - Auction Services
Security Training
Security Consulting/Survey
Expert Witness Services
Computer Forensic
Accounting Forensic/Bank Review
Copyright/Trademark Investigations
Debugging/Eavesdropping Detection
Drug Testing - Witness Only
Shopping Services/Mystery
Kidnap and Ransom
Insurance/Legal Investigations
Lie Detection/Polygraph
If your operations are not listed above, Please Call 800-683-1226
Your companies expected annual revenue
$0 to $150,000
$350,000 to $450,000
$650,000 to $750,000
$1,250,001 and $1,500,000
$150,001 to $250,000
$450,000 to $550,000
$750,000 to $1,000,000
$1,500,001 and $1,750,000
$2,000,001 and Above
$250,000 to $350,000
$550,001 to $650,000
$1,000,001 and $1,250,000
$1,760,000 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
Desired Property Limits
Request Limit of Property Coverage
$25,000 (included no cost)
$50,000
$100,000
Underwriting
Does the applicant have more than 5 employees?
Yes
No
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
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.
