Phone: (972) 235-3030
Toll-Free: (866) 900-RISK

Your Specialist

AJ Cobb
EXT 150
cobb@riskpro.us



About 15 mins to complete application.
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PLEASE NOTE, in order for us to provide an accurate quote, ALL QUESTIONS must be answered. If you are unsure, please answer to the best of your knowledge.

Applicant / Company Name (include all company names, trading names or DBA’s under which applicant operates):
Individual
Partnership/ Joint Venture
LLC
Corporation
Other:

Contact Person:
Title:

Street:
City
State
Zip
Telphone
E-Mail

Please provide list of any additional physical address or branch locations below or email to cobb@riskpro.us.


  1. Year established:
  2. List all Officers and Owners and their titles:
    1) Name:

    Title:

    Ownership Percentage:%

    Active in daily business?
    Yes
    No


    2) Name:

    Title:

    Ownership Percentage:%

    Active in daily business?
    Yes
    No


    3) Name:

    Title:

    Ownership Percentage:%

    Active in daily business?
    Yes
    No


  3. Please list all additional principals, partners, directors or officers.

  4. Total number of employees:
  5. Please provide the total number of employees who have less than three (3) years of real estate or title industry related work experience.
    Title Agent
    Escrow Agent
    Abstractor /Searcher
    Clerical / Support Staff
  6. Are all professional employees with less than three (3) years experience supervised by senior staff / officer?
    Yes
    No
  7. Does Applicant have bond coverage currently in force? (check all that apply) :
    Fidelity (Crime, Employee Dishonesty)
    Surety (Performance Bond)
  8. Does Applicant have errors and omissions liability insurance currently in force?
    Yes
    No

    If yes, Insurer:
    Policy Period:
    Limits:
    Retroactive/Prior Acts Date:
    Deductible:
  9. Please check the Applicant’s desired Limit of Liability and Deductible (choose all that apply):
    Limits of Liability Requested:
    $250,000/$250,000
    $500,000/$500,000

    $1,000,000/$1,000,000
    Other:
  10. Deductible Requested:
    $2,500
    $5,000
    $10,000
    Other:
  11. Total Annual Revenue:
    Last 12 Months:
    Next 12 Months:
  12. Breakdown of services performed by Applicant (click service to expand and provide details)
    Title Agent
    % of Total Revenue:

    Average # of Monthly
    Transactions:

    # of Owners Performing Service:

    # of Employees Performing Service:
    % of Service Performed by
    Subcontractor:
    % of Service Performed by
    Title Underwriter:
    Escrow Agent / Closer
    % of Total Revenue:

    Average # of Monthly
    Transactions:

    # of Owners Performing Service:

    # of Employees Performing Service:
    % of Service Performed by
    Subcontractor:
    % of Service Performed by
    Title Underwriter:
    Abstractor / Searcher
    % of Total Revenue:

    Average # of Monthly
    Transactions:

    # of Owners Performing Service:

    # of Employees Performing Service:
    % of Service Performed by
    Subcontractor:
    % of Service Performed by
    Title Underwriter:
    Witness Closer / Signing Agent
    % of Total Revenue:

    Average # of Monthly
    Transactions:

    # of Owners Performing Service:

    # of Employees Performing Service:
    % of Service Performed by
    Subcontractor:
    % of Service Performed by
    Title Underwriter:
    Other (describe):

    % of Total Revenue:

    Average # of Monthly
    Transactions:

    # of Owners Performing Service:

    # of Employees Performing Service:
    % of Service Performed by
    Subcontractor:
    % of Service Performed by
    Title Underwriter:
  13. Are all independent subcontractors required to carry their own errors and omissions insurance?
    Yes
    No
    N/A
  14. If “No” in question 12, What percentage of independent subcontractors DO NOT carry their own errors and omissions liability insurance?%
    Would you like to insure them on your policy?
    Yes
    No
    N/A
  15. Does 25% or more of Applicant's total revenues come from one client or source?
    Yes
    No

    If “Yes”, please list the largest source and describe the nature of the business:
  16. What percent of Applicant’s total revenue is:
    Residential %
    Commercial %
    Agricultural %
    Raw Land (Vacant Lots) %
    and/or Oil, Gas, or Minerals
    %
  17. During the last five (5) years, has the name or structure of the Applicant ever changed, or has there been an acquisition, consolidation, merger, dissolution, reconstruction or any other change?
    Yes
    No

    If “Yes”, provide details:
  18. Is the Applicant affiliated with any legal, real estate development, mortgage or construction company through common ownership, operation or control including any controlled business arrangements?
    Yes
    No

    If “Yes”, provide details:
  19. When performing title searches, does the Applicant:
    • Verify legal description?
      Yes
      No
    • If “Yes”, please state the source used to verify:
    • Document and verify all requirements are met prior to issuing policy?
      Yes
      No
      N/A
    • Use an attorney to provide a title opinion prior to issuing title commitment?
      Yes
      No
      N/A
  20. List the Title Underwriters Applicant issues title policies for and the percentage of the
    1: Title Underwriter
    % of Applicant’s Total Revenue
    2: Title Underwriter
    % of Applicant’s Total Revenue
    3: Title Underwriter
    % of Applicant’s Total Revenue
    4: Title Underwriter
    % of Applicant’s Total Revenue
    5: Title Underwriter
    % of Applicant’s Total Revenue
  21. COMPLETE QUESTION 20 ONLY IF APPLICANT FIRM PERFORMS THE CLOSING OR ESCROW SERVICE
  22. When providing escrow/closing/settlement services, does the Applicant:
    • Use software for all escrow, closing or settlement activities?
      Yes
      No
    • Require written approval or funding number on all settlement or most current HUD-1 statement sprior to closing?
      Yes
      No
    • Obtain a “gap” or “date shown” search on the chain of title and any liens on the property 24 hours prior to closing?
      Yes
      No
    • Perform a “post closing” title search and/or obtain filed documents to assure filing was made?
      Yes
      No
    • Document and obtain signatures from all parties on any change/deviation to Escrow or Purchase Contracts?
      Yes
      No
    • Follow lender instructions or, if not provided, have standard written procedures for closings and escrows?
      Yes
      No
    • Conduct all closings with title insurance, title commitment, title opinion in hand -OR- use a written disclaimeror hold harmless as to the condition of the title?
      Yes
      No
    • Have you ever been convicted, found guilty, pleaded nolo contendere, or received probation without verdict as to any felony or misdemeanor, including any drug law violations or any criminal charges pending and unresolved in any state or jurisdiction other than a minor traffic violation?
      Yes
      No
    • Have you ever had a complaint filed against you by a customer with any state or federal government authority?
      Yes
      No
    • Have you ever had any professional license or permit investigated (even if dismissed), suspended, revoked,restricted or placed under probation?
      Yes
      No
    • Have you ever been denied any professional license or certification by a specialty board?
      Yes
      No
    • Have you ever had professional liability insurance policy declined, canceled or been non-renewed?
      (This question is not applicable to Missouri residents.)
      Yes
      No
    • Have any professional liability claims or suites been brought against you in the past 5 years?
      Yes
      No
    • Have you become aware of any fact or circumstance which resulted in or which could reasonably be expected to result in a professional liability claim, incident or suit?
      Yes
      No

  23. HOW DID YOU HEAR ABOUT US?
    Google Adwords
    Search Engine
    Referred
    Direct Mail
    Other:


    Are there any questions, comments or additional coverage required?


    I/We hereby declare that the above statements and declarations are true and that I/We have not suppressed or misstated any material facts. I/We agree that any misrepresentation or misstatement of material facts may void coverage under this insurance. I/We agree that this application shall be the basis of the contract with the company and that coverage, if written, will be provided on a claims made basis. It is understood and agreed that completion of this application does not bind the company to provide coverage or the applicant to purchase the insurance.

    Check here to agree to the above statement:


    Name:
    Title:
    Date:

    All information provided is confidential and will be used soley to obtain an indication for coverage. Coverage cannot be bound from this information sheet.




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