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Professional Liability Indication Request

The form below is designed to gather enough information for us to provide you a quick premium indication. We will provide you with a professional liability policy quote from our most competitive carriers - within the state of Hawaii only..


 
Business Information:
Name of Firm:
Street Address:
City:   State:   Zip:

General Information:
Approximate Annual Revenues:
Residential Sales: (Including farms, ranches and raw land) $
Non-residential Sales: $
Non-owned property management/leasing: $
Other Income: $

Total Income: $
_____________________

Sales Force:
  Number of Full Time Agents:
  Number of Part Time Agents:
Do 80% or more of your sales involve the use of Standard Contracts?
 Yes  No
What percent of homes are sold with a Home Warranty?
Do 80% or more of  your sales involve the use of Disclosure Forms?
 Yes  No
Coverage:
How many years have you been purchasing Errors and Omissions Insurance?
Policy Period:
  Effective:   Expiration:
Limits of Liability:
Deductible Options:
Has your firm experienced any claims in the last five years? Yes  No

Whom should we contact with the Indication?
Name (Owner or Broker):
Email Address:
Comments:
 

Note: If a claim has been experienced in the last five years a quote will be generated from a completed application.

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