SPMGA logo Southern Preferred MGA, Inc.
13465 Midway Road, Suite 202
Dallas, TX 75244
214-703-9900 - Fax 214-703-9624

HOME INSPECTOR 2022 ERRORS & OMISSIONS APPLICATION
  1. Applicant's name
  2. Business name
  3. Physical Address
    City  State  Zip 
  4. Phone  Fax  Email 
  5. Year Established

    6. Licensed Inspectors TREC License # or File ID # Percent Ownership Years licensed
    %
    %
    %
    %
    %
  6. In addition to yourself, how many employees do you have?    
  7. Y   N Is applicant engaged in any other business other than Home Inspection?
    If yes, explain
  8. Y   N Does the applicant currently have an Errors and Omissions insurance policy in force?
    Expiration Date    Retroactive Date   Carrier 
  9. Y   N Has the applicant ever had an E & O policy declined, renewal refused, or canceled?
    If yes, explain
  10. Y  N Is the applicant the exclusive inspector for any real estate agent/agency, developer and/or builder?
  11. Y  N Does the applicant utilize independent contractors?
  12. Y  N If so, does the applicant require independent contractors to carry Errors & Omissions insurance?
  13. Y  N Does the applicant require a signed pre-inspection agreement for all home inspections?
  14. Y  N Does the applicant always provide a written inspection report for all inspected properties?
  15. Y  N Does the applicant provide referrals or recommendations for remediations needed?
  16. Y  N Does the applicant provide any inspections for the following services: Wood Destroying Insects, Radon, Pools and Spas, Stucco & EIFS, Septic Systems and Water Wells, Wind Mitigation, Green Building Auditing, Infrared Thermography?
  17. Y  N Does the applicant perform Mold inspections?
  18. What was the total gross revenue in the last 12 months from inspections?   $
  19. What was the total number of inspections performed in the last 12 months? 
  20. Please provide a break-down by percentage of the types of inspections you conduct (total 100%):
    % Residential   % Commercial   % Other
  21. How many years do you maintain your files? 
  22. If accepted by the insurer, what is the requested effective date? 
  23. Requested Errors & Omissions limits $ per claim, $ Aggregate $ Deductible
  24. Requested General Liability limits $ per claim, $ Aggregate $ Deductible
  25. Y  N Has the applicant or any listed inspector been subject to disciplinary action by any State Agency?
  26. Y  N Have any claims or suits been made against the applicant or any listed inspector in the last five years?
  27. Y  N Is the applicant or any listed inspector aware of any issues, circumstances, errors, omissions, or offenses which may result in a claim being made against the applicant, any listed inspector, or the business?

  28. Please describe any recent claims or issues which might result in a claim:

    29. APPLICANT CERTIFICATION

    I certify that I have read the questions above, and have answered each truthfully and completely to the best of my knowledge

    I further herein certify that I understand and agree as follows:

    1. This is a CLAIMS MADE policy form, and any claim or suspected claim must be reported during the policy period for coverage to be in effect.
    2. Each and every loss shall be subject to the DEDUCTIBLE stated in the policy declarations.
    3. Coverage is only in effect for the TYPE OF BUSINESS stated in the declarations.
    4. Any material misrepresentations, failure to disclose material facts, or failure to disclose any pre-existing condition or incident may result in denial of coverage and/or rescission of the policy by the company.
    5. The policy contains EXCLUSIONS for situations not intended for coverage by the company, and it is the responsibility of the applicant to read the policy.

    By placing the initials of the applicant in the box below, the applicant acknowledges acceptance of the above, and understands that the initials carry the effect of a signature.


    Initials Date Name of applicant Title
     
    Rev. 7.1.2022