Real Estate Professional E&O Application

NOTICE

Real estate E&O policies are generally written on a claims-made basis: only claims first made during the policy period (and reported as the policy requires) are covered. This application is not a binder.

Prefer paper? Download the printable PDF · Questions? Call (469) 777-3025 or email contactus@proiexp.com.

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Step 1 of 5 - Applicant & Coverage

20%

Please type directly into the fields. Answer every question that applies to your firm; items marked "if yes", "optional" or "complete only if checked" only need an answer when they fit. Real estate E&O policies are generally written on a claims-made basis: only claims first made during the policy period (and reported as the policy requires) are covered. This application is not a binder.

1. Applicant & Contact Information

Applicant legal name*

DBA(s) / trade names

Website

Principal street address*

Address City State Zip Code

County

Mailing address (if different)

Address City State Zip Code

Phone*

Email*

Contact name*

Contact title

Entity type

Corporation

LLC

Partnership / LLP

Sole Proprietor

Independent Contractor

Other

Date established

Year current owner took over management

Please enter a number greater than or equal to 0.

FEIN (optional)

Years owner licensed as agent

Please enter a number greater than or equal to 0.

Years owner licensed as broker

Please enter a number greater than or equal to 0.

Years owner licensed as appraiser

Please enter a number greater than or equal to 0.

Leave blank if none

States where licensed

Broker of record

Broker license #

Is the applicant a member of the National Association of REALTORS (NAR)?

Yes

Is the applicant part of a real estate franchise?

Yes

Franchise name

Is the applicant owned by, associated with or controlled by any other business, investment group or syndication?

Yes

Name of the entity(ies) and the relationship

2. Coverage Requested & Insurance History

Real estate E&O is always quoted. General Liability, Property and Cyber are optional.

Desired effective date

Deductible requested ($)

Please enter a number greater than or equal to 0.

E&O limits (per claim / aggregate)

$250K/$500K

$500K/$1M

$1M/$1M

$1M/$2M

$2M/$2M

Other

Other limits requested

Deductible applies to

Loss only

Loss and claim expenses

No preference

Also quote (optional)

General Liability

Property

Cyber

Does the applicant have a real estate E&O policy in force now? (New firms: answer No.)

Yes

Does the current policy provide full prior acts (retroactive) coverage?

Yes

N/A

Current and prior E&O policies (last 5 years)

Insurer

Policy period (from - to)

Limits

Deductible ($)

Premium ($)

Retro date

Current policy first. Add one row per policy year; leave out years without coverage.

In the past 5 years, has any insurer declined, cancelled or non-renewed similar insurance for the applicant or anyone to be covered (other than an insurer leaving the market)?

Yes

Has the applicant ever purchased an extended reporting period (tail) endorsement?

Yes

Please give the date, insurer and reason

3. Firm Profile & Staff

Staff: enter counts. Part time = $25,000 or less in annual commission income. Include independent contractors.

Owners / principals / partners / officers - # full time

Please enter a number greater than or equal to 0.

Owners / principals / partners / officers - # part time

Please enter a number greater than or equal to 0.

Owners / principals / partners / officers - # independent contractors

Please enter a number greater than or equal to 0.

Licensed brokers - # full time

Please enter a number greater than or equal to 0.

Licensed brokers - # part time

Please enter a number greater than or equal to 0.

Licensed brokers - # independent contractors

Please enter a number greater than or equal to 0.

Licensed agents / salespersons - # full time

Please enter a number greater than or equal to 0.

Licensed agents / salespersons - # part time

Please enter a number greater than or equal to 0.

Licensed agents / salespersons - # independent contractors

Please enter a number greater than or equal to 0.

Appraisers - # full time

Please enter a number greater than or equal to 0.

Appraisers - # part time

Please enter a number greater than or equal to 0.

Appraisers - # independent contractors

Please enter a number greater than or equal to 0.

Property managers - # full time

Please enter a number greater than or equal to 0.

Property managers - # part time

Please enter a number greater than or equal to 0.

Property managers - # independent contractors

Please enter a number greater than or equal to 0.

Consultants / auctioneers / other - # full time

Please enter a number greater than or equal to 0.

Consultants / auctioneers / other - # part time

Please enter a number greater than or equal to 0.

Consultants / auctioneers / other - # independent contractors

Please enter a number greater than or equal to 0.

Support staff (unlicensed) - # full time

Please enter a number greater than or equal to 0.

Support staff (unlicensed) - # part time

Please enter a number greater than or equal to 0.

Support staff (unlicensed) - # independent contractors

Please enter a number greater than or equal to 0.

Are independent-contractor agents required to carry their own E&O insurance?

Yes

N/A

Does the applicant have a written agreement with every independent-contractor agent?

Yes

N/A

Do at least 15% of all professionals hold a professional designation (e.g. GRI, CRS, CRE, ABR, MAI, SRA)?

Yes

Does the applicant have a formal training program for all professionals and staff?

Yes

Number of professionals who completed accredited continuing education in the past 2 years

Please enter a number greater than or equal to 0.

In the past 5 years, has the applicant had a change in operations, including any merger or acquisition?

Yes

In the past 5 years, has any principal, partner, director, officer or professional performed professional services for another business in which the applicant has an ownership or management interest?

Yes

If yes to either, please explain

4. Revenue & Services

Other services the firm performs (check each that applies)

Appraisal (6A)

Auctioneering (6B)

Property management (6C)

Mortgage brokering (6D)

Sales of properties built by a related entity (6E)

Consulting / counseling (6F)

Business brokerage (6G)

Other real estate services (6H)

Each service you check opens its own short section later in this form.

Last fiscal year ended

Gross revenue (all fees and commissions before expenses; if newly established, estimate the current year). Totals calculate automatically.

Residential - sales & leasing - Last FY ($)

Please enter a number greater than or equal to 0.

Residential - sales & leasing - # transactions last FY

Please enter a number greater than or equal to 0.

Residential - sales & leasing - Prior FY ($)

Please enter a number greater than or equal to 0.

Residential - sales & leasing - Next 12 months ($)

Please enter a number greater than or equal to 0.

Residential - agent/broker-owned sales - Last FY ($)

Please enter a number greater than or equal to 0.

Residential - agent/broker-owned sales - # transactions last FY

Please enter a number greater than or equal to 0.

Residential - agent/broker-owned sales - Prior FY ($)

Please enter a number greater than or equal to 0.

Residential - agent/broker-owned sales - Next 12 months ($)

Please enter a number greater than or equal to 0.

Residential - land & lots - Last FY ($)

Please enter a number greater than or equal to 0.

Residential - land & lots - # transactions last FY

Please enter a number greater than or equal to 0.

Residential - land & lots - Prior FY ($)

Please enter a number greater than or equal to 0.

Residential - land & lots - Next 12 months ($)

Please enter a number greater than or equal to 0.

Broker price opinions (BPOs) - Last FY ($)

Please enter a number greater than or equal to 0.

Broker price opinions (BPOs) - # transactions last FY

Please enter a number greater than or equal to 0.

Broker price opinions (BPOs) - Prior FY ($)

Please enter a number greater than or equal to 0.

Broker price opinions (BPOs) - Next 12 months ($)

Please enter a number greater than or equal to 0.

Commercial - sales & leasing - Last FY ($)

Please enter a number greater than or equal to 0.

Commercial - sales & leasing - # transactions last FY

Please enter a number greater than or equal to 0.

Commercial - sales & leasing - Prior FY ($)

Please enter a number greater than or equal to 0.

Commercial - sales & leasing - Next 12 months ($)

Please enter a number greater than or equal to 0.

Commercial - agent/broker-owned sales - Last FY ($)

Please enter a number greater than or equal to 0.

Commercial - agent/broker-owned sales - # transactions last FY

Please enter a number greater than or equal to 0.

Commercial - agent/broker-owned sales - Prior FY ($)

Please enter a number greater than or equal to 0.

Commercial - agent/broker-owned sales - Next 12 months ($)

Please enter a number greater than or equal to 0.

Commercial - land & lots - Last FY ($)

Please enter a number greater than or equal to 0.

Commercial - land & lots - # transactions last FY

Please enter a number greater than or equal to 0.

Commercial - land & lots - Prior FY ($)

Please enter a number greater than or equal to 0.

Commercial - land & lots - Next 12 months ($)

Please enter a number greater than or equal to 0.

Farm land / ranch sales - Last FY ($)

Please enter a number greater than or equal to 0.

Farm land / ranch sales - # transactions last FY

Please enter a number greater than or equal to 0.

Farm land / ranch sales - Prior FY ($)

Please enter a number greater than or equal to 0.

Farm land / ranch sales - Next 12 months ($)

Please enter a number greater than or equal to 0.

Appraisals - Last FY ($)

Please enter a number greater than or equal to 0.

Appraisals - # transactions last FY

Please enter a number greater than or equal to 0.

Appraisals - Prior FY ($)

Please enter a number greater than or equal to 0.

Appraisals - Next 12 months ($)

Please enter a number greater than or equal to 0.

Property management - Last FY ($)

Please enter a number greater than or equal to 0.

Property management - # transactions last FY

Please enter a number greater than or equal to 0.

Property management - Prior FY ($)

Please enter a number greater than or equal to 0.

Property management - Next 12 months ($)

Please enter a number greater than or equal to 0.

Business brokerage - Last FY ($)

Please enter a number greater than or equal to 0.

Business brokerage - # transactions last FY

Please enter a number greater than or equal to 0.

Business brokerage - Prior FY ($)

Please enter a number greater than or equal to 0.

Business brokerage - Next 12 months ($)

Please enter a number greater than or equal to 0.

Auctioneering - Last FY ($)

Please enter a number greater than or equal to 0.

Auctioneering - # transactions last FY

Please enter a number greater than or equal to 0.

Auctioneering - Prior FY ($)

Please enter a number greater than or equal to 0.

Auctioneering - Next 12 months ($)

Please enter a number greater than or equal to 0.

Mortgage brokering - Last FY ($)

Please enter a number greater than or equal to 0.

Mortgage brokering - # transactions last FY

Please enter a number greater than or equal to 0.

Mortgage brokering - Prior FY ($)

Please enter a number greater than or equal to 0.

Mortgage brokering - Next 12 months ($)

Please enter a number greater than or equal to 0.

Construction / development - Last FY ($)

Please enter a number greater than or equal to 0.

Construction / development - # transactions last FY

Please enter a number greater than or equal to 0.

Construction / development - Prior FY ($)

Please enter a number greater than or equal to 0.

Construction / development - Next 12 months ($)

Please enter a number greater than or equal to 0.

Consulting / counseling - Last FY ($)

Please enter a number greater than or equal to 0.

Consulting / counseling - # transactions last FY

Please enter a number greater than or equal to 0.

Consulting / counseling - Prior FY ($)

Please enter a number greater than or equal to 0.

Consulting / counseling - Next 12 months ($)

Please enter a number greater than or equal to 0.

Other real estate services - Last FY ($)

Please enter a number greater than or equal to 0.

Other real estate services - # transactions last FY

Please enter a number greater than or equal to 0.

Other real estate services - Prior FY ($)

Please enter a number greater than or equal to 0.

Other real estate services - Next 12 months ($)

Please enter a number greater than or equal to 0.

Other real estate services - describe

TOTAL - Last FY ($)

Calculated

TOTAL - # transactions last FY

Calculated

TOTAL - Prior FY ($)

Calculated

TOTAL - Next 12 months ($)

Calculated

Average sale price of residential properties sold in the past year ($)

Please enter a number greater than or equal to 0.

Largest sale in the past 3 years ($)

Please enter a number greater than or equal to 0.

2nd-largest sale ($)

Please enter a number greater than or equal to 0.

3rd-largest sale ($)

Please enter a number greater than or equal to 0.

% of total revenue from the largest single client

Please enter a number from 0 to 100.

Does the applicant do business in more than one state or outside the United States?

Yes

List each state / country and its % of gross revenue

Has the applicant performed, or does it intend to perform, services for Real Estate Investment Trusts (REITs) or property syndications?

Yes

% of gross commission income from REIT / syndication services

Please enter a number from 0 to 100.

5. Real Estate Risk Management

Does the applicant use board of REALTORS or state association standard forms for all listings and sales?

Yes

N/A

Does the applicant have documented procedures for handling complaints and for complying with federal, state and local laws?

Yes

Does the applicant have a written Fair Housing policy and train all agents on it?

Yes

% of transactions as dual agent

Please enter a number from 0 to 100.

% as intermediary

Please enter a number from 0 to 100.

% as transaction broker

Please enter a number from 0 to 100.

Is a written agency disclosure statement used in every transaction and given to the client?

Yes

N/A

% of residential sales with signed seller disclosure

Please enter a number from 0 to 100.

% with home warranty

Please enter a number from 0 to 100.

% with inspection / waiver

Please enter a number from 0 to 100.

Does the applicant have an exclusive listing agreement with a builder or developer?

Yes

Does the applicant sell, lease or manage hotels, motels, or mobile home / RV parks?

Yes

% of gross commission income from hotels / motels

Please enter a number from 0 to 100.

% from mobile home / RV parks

Please enter a number from 0 to 100.

When representing a buyer of a bank-owned property, do you advise the buyer in writing to have it inspected by a licensed, insured home inspector?

Yes

N/A

In the past 3 years, has anyone in the firm:

Personally acquired properties or deeds of financially distressed homeowners, including sale-leasebacks?

Yes

Provided asset or property preservation services, including incidental repairs, on bank-owned properties?

Yes

Provided property rehabilitation services on bank-owned properties?

Yes

Was all such repair work done by a licensed contractor?

Yes

N/A

Provided eviction services on pre-foreclosure or bank-owned properties?

Yes

Did an attorney prepare, file and serve the eviction complaint and obtain the judgment?

Yes

N/A

Please explain

Explain a "No" to the standard-forms question or any "Yes" to the 3-year questions.

6. Other Services

6A. Appraisal services

Owners and appraisers

Name

Year licensed / certified

Designations / certifications

Years with firm

Employee / contractor / subcontractor / trainee

Does the applicant use a written agreement that sets out the scope of each assignment, the appraiser's duties and the fee?

Yes

Does the applicant always use standard appraisal forms that comply with USPAP?

Yes

Highest-value appraisal, past 3 years ($)

Please enter a number greater than or equal to 0.

2nd-highest ($)

Please enter a number greater than or equal to 0.

3rd-highest ($)

Please enter a number greater than or equal to 0.

% of appraisal revenue by type, last fiscal year (should total 100%)

Appraisal - Single-family dwellings (%)

Please enter a number from 0 to 100.

Appraisal - Commercial / industrial property (%)

Please enter a number from 0 to 100.

Appraisal - Multi-family dwellings (%)

Please enter a number from 0 to 100.

Appraisal - Shopping center / retail store (%)

Please enter a number from 0 to 100.

Appraisal - Residential lots (%)

Please enter a number from 0 to 100.

Appraisal - Land development / subdivisions (%)

Please enter a number from 0 to 100.

Appraisal - Review appraisals (%)

Please enter a number from 0 to 100.

Appraisal - Agriculture / farm / ranch (%)

Please enter a number from 0 to 100.

Appraisal - Flood zone certifications (%)

Please enter a number from 0 to 100.

Appraisal - Construction phase inspections (%)

Please enter a number from 0 to 100.

Appraisal - Estate or tax purposes (%)

Please enter a number from 0 to 100.

Appraisal - Condemnation / eminent domain (%)

Please enter a number from 0 to 100.

Appraisal - Right-of-way (%)

Please enter a number from 0 to 100.

Other appraisal type (describe)

Other appraisal type (%)

Please enter a number from 0 to 100.

6B. Auctioneering services

Years of auctioneering experience

Please enter a number greater than or equal to 0.

Year auction license obtained (if required)

Please enter a number greater than or equal to 0.

Does your state require a license to auction real estate?

Yes

Does the applicant give any written guarantee about the condition of properties being auctioned?

Yes

Does the applicant always make properties available for inspection before the auction?

Yes

6C. Property management services

Does the applicant have a written contract with each property owner?

Yes

Is a budget prepared for each property managed?

Yes

Does the applicant obtain a credit report and background check for each prospective tenant?

Yes

Are standard management and lease agreements used for all properties?

Yes

Does the applicant hire contractors to provide services at managed properties?

Yes

Does the applicant require a certificate of insurance from each contractor?

Yes

N/A

Does the applicant require liability insurance to be in place on every property managed?

Yes

Average spending authority for repairs / capital improvements ($)

Please enter a number greater than or equal to 0.

Years of property management experience

Please enter a number greater than or equal to 0.

Properties managed

Property type

# Units or sq. ft.

Gross PM income last FY ($)

% owned by applicant / agents

One row per type: 1-4 family residential; Apartments / condominiums; Homeowners associations; Shopping centers / warehouses; Office buildings / commercial; Other.

6D. Mortgage brokering services

Years of mortgage brokering experience

Please enter a number greater than or equal to 0.

States licensed for mortgage brokering

% of loans - residential

Please enter a number from 0 to 100.

% of loans - commercial

Please enter a number from 0 to 100.

% of loans - other

Please enter a number from 0 to 100.

Other loans - specify

% related to loan modifications for distressed homeowners

Please enter a number from 0 to 100.

Largest loan, past 12 months ($)

Please enter a number greater than or equal to 0.

When the applicant is both the real estate agent/broker and the mortgage broker, is the client told in writing they need not use the applicant's mortgage services?

Yes

N/A

Does the applicant have any discretionary loan-making or loan-underwriting authority?

Yes

Please explain the discretionary authority

6E. Sales of properties built or developed by a related entity

Has the applicant or any agent sold or listed a property developed or built by a separate business owned by the firm, an agent, or an agent's or owner's spouse / domestic partner?

Yes

Related entity name

% owned by firm / agent

Please enter a number from 0 to 100.

% owned by spouse / partner

Please enter a number from 0 to 100.

Years entity in business

Please enter a number greater than or equal to 0.

Years in same area

Please enter a number greater than or equal to 0.

Years key personnel experience

Please enter a number greater than or equal to 0.

Entity builds / develops

Residential

Commercial

GCI from these sales, past 12 months - residential ($)

Please enter a number greater than or equal to 0.

GCI from these sales, past 12 months - commercial ($)

Please enter a number greater than or equal to 0.

Any claims against the applicant or its agents involving this entity?

Yes

Any known act or omission involving this entity that could lead to a claim?

Yes

Please give details

6F. Consulting / counseling services

Describe the real estate consulting or counseling provided in the past year

6G. Business brokerage services

Agents or brokers who sell business opportunities

Name

Years of business brokerage experience

Is the applicant, or the agent handling the sale, involved in valuing the business being sold?

Yes

Does the applicant tell the buyer in writing that no future business value or income is assured? (Please attach the disclosure.)

Yes

Does the applicant recommend in writing that each party use an attorney and an accountant for due diligence?

Yes

Does the applicant have a written policy prohibiting staff from recommending specific attorneys or accountants?

Yes

Describe the number and types of business opportunities arranged, negotiated or sold in the past 3 years

6H. Other real estate services

Describe any other real estate related services provided in the past year

7. Funds Transfer, Cyber & Employment Practices

Does the applicant hold client funds or send / receive wire transfers for clients?

Yes

Controls in place (check all that apply)

Callback to verify transfer requests / bank changes

Dual authorization for fund transfers

Multi-factor authentication on email

Annual staff phishing / wire-fraud training

In the past 3 years, has the applicant had a wire-fraud loss, data breach or ransomware attack?

Yes

Please describe the incident and what was done

Would you like Employment Practices Liability (EPL) quoted? (Not available in every state.)

Yes

In the past 3 years, has any employment-related proceeding (including EEOC) been brought against the applicant or its people with $10,000 or more paid or expected?

Yes

N/A

Current EPLI policy (if any)

Insurer

Policy period

Limits / deductible

Premium ($)

Retro date

8. Claims & Disciplinary History

In the past 6 years, has any claim been made against the applicant, a predecessor firm or anyone in the firm (including Fair Housing or licensing-board complaints)?

Yes

Is anyone aware of any act, error, omission or circumstance that might reasonably be expected to lead to a claim?

Yes

Has anyone in the firm ever had a real estate license revoked or suspended?

Yes

In the past 6 years, has anyone faced a complaint, investigation or disciplinary action by a regulator?

Yes

Have there been any changes to claims reported on a previous application?

Yes

N/A

Claim / incident details

Date

Claimant

Allegation / what happened

Status (open / closed / suit)

Paid / reserved ($)

One row per claim or incident. You can also attach loss runs on the next page.

Disclosing a claim does not mean it is covered. Circumstances that could lead to a claim must also be reported to your current insurer before its reporting period ends.

9. Attachments & Comments

Please attach, if available: 5 years of loss runs; the current E&O declarations page; and, if you do business brokerage, your standard disclosure form.

Attachments (optional)

Drop files here or

Accepted file types: pdf, jpg, jpeg, png, doc, docx, xls, xlsx, Max. file size: 10 MB, Max. files: 10.

Additional comments or details for any "Yes" answer

Applicant Statement & Signature

The undersigned, an authorized owner or officer of the applicant, declares that the statements in this application and any attachments are true and complete to the best of his or her knowledge after reasonable inquiry. If any information changes before the policy effective date, the applicant will promptly notify us, and any quote or binder may be changed or withdrawn. Signing this application does not bind the applicant or any insurer to complete the insurance, but if a policy is issued, the insurer will rely on this application and it will become part of the policy. Nothing in this application is notice of a claim or potential claim under any policy. The applicant authorizes this information to be shared with insurance companies for the purpose of obtaining quotes.

FRAUD WARNING: Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance containing any materially false, incomplete or misleading information, or conceals for the purpose of misleading any fact material thereto, commits a fraudulent insurance act, which is a crime and may subject the person to criminal and civil penalties, including fines, imprisonment and denial of benefits. Additional state-specific fraud notices may apply and will be provided by the insurer where required.

Applicant statement*

I have read and agree to the Applicant Statement and Fraud Warning above.

Signature*

Your Name
Your Name
Your Name

Date*

Printed name*

Title

How did you hear about us?

Real Estate Professional E&O Application

NOTICE

1. Applicant & Contact Information

2. Coverage Requested & Insurance History

3. Firm Profile & Staff

4. Revenue & Services

5. Real Estate Risk Management

6. Other Services

6A. Appraisal services

6B. Auctioneering services

6C. Property management services

6D. Mortgage brokering services

6E. Sales of properties built or developed by a related entity

6F. Consulting / counseling services

6G. Business brokerage services

6H. Other real estate services

7. Funds Transfer, Cyber & Employment Practices

8. Claims & Disciplinary History

9. Attachments & Comments

Applicant Statement & Signature

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