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Home > California Association of REALTORS® E&O Program > Realtor Errors & Omissions Liability Application

Realtor Errors & Omissions Liability Application

General Information
Legal Applicant Name:*
DBA:
Your Address:
Street Address City State ZIP Code
Business Phone:*
Email:*
1. Qualification Questions
1. During the past five years, none of the principals, directors, officers, partners, professional employees or independent contractors of the Applicant nor the Applicant itself, nor any of its predecessors in business, subsidiaries or affiliates:*
a. Have derived income from professional services other than 100% real estate sales.
b. Have been the subject of a disciplinary action as a result of professional activities, nor has had a claim against them.
- True
- False
2. The applicant's combined total gross revenues did not exceed $250,000 for the past one (1) year period (gross revenues are defined as all fees and commissions before expenses payable to employees and independent contractors).*
- True
- False
3. No principals, directors, officers, partners, professional employees or independent contractors of the Applicant:*
a. have provided services related to pre-foreclosed or bank-owned properties that included involvement in any eviction procedures, delivering or negotiating cash-for-keys offers or property rehabilitation.
b. have knowledge or information of any actual or alleged acts, errors, omissions, offenses or circumstances which might reasonably be expected to give rise to a claim against the Applicant or any proposed insured entity.
c. have had their Errors or Omissions Insurance or Professional Liability Insurance declined, cancelled or non-renewed.
d. have an exclusive listing arrangement with any builder/developer.
- True
- False
4. The Applicant is a member of the California Association of REALTORS®, and has no offices outside of California.*
- True
- False
5. All of the Applicant's services are provided under written contracts.*
- True
- False
6. All contract forms that the Applicant uses are approved by or obtained from the California Association of REALTORS®.*
- True
- False
If ALL True Section
Insurance Company Name (not agency):
If ANY False Section
2. Limits of Liability and Deductible
Limits of Liability Requested:
- $500,000 / $500,000
- $1,000,000 / $1,000,000
- $2,000,000 / $2,000,000
Limits of Liability Requested:
- $2,000
- $3,000
- $5,000
- $10,000
- $25,000
- $50,000
Effective Date Requested:
MM
DD
YYYY
Prior Acts Date Requested:
MM
DD
YYYY
Attach a copy of your current Declarations page showing the prior acts date.
3. Subsidiaries:
List all Subsidiaries for which coverage is desired. For purposes of completing this question, Subsidiary means any entity that is not formed as a joint venture of which the Applicant owns or has the right to vote more than 50% of the outstanding voting securities representing the present right to vote for election of directors, or the managers or members of the board of managers or equivalent executives of a limited liability company or partnership, on or before the inception date of the Policy. Please provide percentage ownership by Applicant:
Subsidiary Name Percentage of Ownership Acquisition or Formation Services Performed by the Subsidiary
4. Acquisition, Merger, Consolidation:
a. Is the Applicant owned, controlled or affiliated with any other entity?
- Yes
- No
b. Has the name of the Applicant ever been changed?
- Yes
- No
c. Has the Applicant ever been the subject of any merger, acquisition or consolidation?
- Yes
- No
d. Do you anticipate any material changes to the nature of the Applicant's business in the next 12 months, including but not limited to acquisitions or divestitures of subsidiaries by the Applicant, acquisition or divestiture of the Applicant by another entity, substantial increase in or reduction of staffing (net change of +/- 10% or more), any change in business strategy, structure or plan, or any other material change in business?
- Yes
- No
Since you answered YES to one of the questions, please explain.
5. Staff Count
Indicate the number of professional employees and/or staff by categories listed below (count each person only once):

Principals, Licensed Brokers/Agent and Other Professional Staff:
Less than 4 years of experience:
Full Time Part Time Total
At least 4 years, but less than 7 years of experience:
Full Time Part Time Total
At least 7 years, but less than 11 years of experience:
Full Time Part Time Total
At least 11 years, but less than 20 years of experience:
Full Time Part Time Total
20 or more years of experience:
Full Time Part Time Total
Do you carry Workers' Compensation Insurance?
- Yes
- No
Prior Acts Date
MM
DD
YYYY
Upload a copy of your current Declarations page showing the prior acts date.
6. Professional Services:
a. Please check all boxes below indicating the professional services performed by the Applicant for which coverage is desired and the applicable percentage of total revenue derived from each professional service provided. If the Applicant's professional services do not fit into one of the categories below, please indicate "Other" and provide a comprehensive description of the type(s) of professional service(s) performed attaching a separate sheet.
Professional Services Percentages
- Auctioneer
- Business Broker
- Construction Manager
- Escrow Agent
- Foreclosure Agent
- Home Inspector
- Investment Advisor
- Lease Broker
- Loan Servicer/Closing Services
- Mortgage Banker/Broker
- Property Manager
- Property Developer
- Real Estate Agent/Broker
- Real Estate Appraiser
- Other
Auctioneer %
Business Broker %
Construction Manager %
Escrow Agent %
Foreclosure Agent %
Home Inspector %
Investment Advisor %
Lease Broker %
Loan Servicer/Closing Services %
Mortgage Banker/Broker %
Property Manager %
Property Developer %
Real Estate Agent/Broker %
Real Estate Appraiser %
Other %
b. During the past five years has the Applicant been engaged in any business or professional services other than then professional services described in question 6a?
- Yes
- No
c. During the past five years, have any of the Subsidiaries listed in question 3 been engaged in any business or professional services other than those professional services listed in question 6a?
- Yes
- No
d. Is the applicant is involved in property management?
- Yes
- No
Is a budget prepared for each property managed?
- Yes
- No
Is a credit report obtained on each prospective tenant?
- Yes
- No
Do you use std. management & lease agreements?
- Yes
- No
Number of residential units managed?
Amt. of commercial/industrial square footage managed?
7. Financial & Business Information:
List the total revenues for all professional services indicated in question 6a.
Prior Fiscal Year
Revenues
Description Revenues Transactions
Current Fiscal Year
Revenues
Description Revenues Transactions
Projected Next Fiscal Year
Revenues
Description Revenues Transactions
a. Please indicate the average sales price of the company's prior year closed residential sales transactions:
b. What was the highest residential sales price?
c. Is the applicant a member of any national franchise, referral or relocation organization?
- Yes
- No
If "Yes" to Question 7c, please indicate names:
If "Yes" to Question 7c, do they require to be named as additional insured?
- Yes
- No
8. Contracts
a. What percentage of the Applicant's services is provided under written agreement?
Please enter a value between 0 and 100.
b. In those instances when written contracts are not used, please explain why.
c. What percentage of the Applicant's services is provided under modification of its standard contract?
Please enter a value between 0 and 100.
d. Are Applicant's contracts reviewed by your legal department or by an outside law firm that you hire?
- Yes
- No
If “No” to Question 8d, are all contract forms that the Applicant uses approved by or obtained from the California Association of REALTORS®?
- Yes
- No
e. Do such contracts or agreements contain:
Check all that apply.
- Specific description of the professional services Applicant is to provide;
- Clauses defining the responsibility of each party;
- Clauses limiting the applicant's liability;
- Provisions for liquidated damages.
9. Firm's internal procedures, practices and risk management:
a. Does the firm require continuing education for all professional employees?
- Yes
- No
b. Does the firm have an in-house procedures manual?
- Yes
- No
c. Does the firm have regular in-house training sessions?
- Yes
- No
d. Does the principal broker have a specific training program for new sales associates?
- Yes
- No
e. Does the firm use standard real estate trade association purchase/sale contracts on all transactions?
- Yes
- No
f. Does the firm require all agents to perform a physical inspection of the property?
- Yes
- No
g. Does the firm use ALL applicable state required disclosure forms?
- Yes
- No
h. Does the firm use industry standard file construction requirements?
- Yes
- No
10. Disaster Recovery Planning:
a. Does the Applicant have a Disaster Recovery Plan currently in place for catastrophic events?
- Yes
- No
b. Has the Applicant tested the Disaster Recovery Plan within the past 6 months?
- Yes
- No
c. Does the Applicant have a Disaster Recovery Team, with specific assignments for team members?
- Yes
- No
11. Prior Insurance:
Prior Insurance:
a. Please provide the following information for any Errors and Omissions or Professional Liability Insurance the Applicant carried during the last five years:
Company Limits of Liability Deductible Premium Policy Period Retro Date
b. Has any Errors or Omissions Insurance or Professional Liability Insurance issued to the Applicant ever been declined, cancelled or non-renewed?
- Yes
- No
If "Yes" to Question 11b, please explain:
12. Claims Experience:
Please attach Loss Runs for the past five years supplied by the Applicant's previous Insurance Carrier.
a. After inquiry, any principals, directors, officers, partners, professional employees or independent contractors of the Applicant have knowledge or information of any actual or alleged acts, errors, omissions, offenses or circumstances which might reasonably be expected to give rise to a claim against the Applicant or any proposed insured entity?
- Yes
- No
b. During the past five years, has the Applicant, or any of its predecessors in business, subsidiaries or affiliates, or any of the principals, directors, officers, partners, professional employees or independent contractors ever been the subject of a disciplinary action as a result of professional activities?
- Yes
- No
c. During the past five years, have any claims or suits been made against the Applicant, any predecessors in business, subsidiaries, affiliates or any principal, director, officer or professional employee?
- Yes
- No
d. Has the Applicant reported the matters listed in Question 12a-c to its current or former insurance carrier?
- Yes
- No
If "Yes" to any part of Question 12 a-c, please complete a Supplemental Claims Questionnaire for each claim, notice or circumstance.
NOTICE TO APPLICANTS. PLEASE READ CAREFULLY:

ANY PERSON WHO KNOWINGLY AND WITH INTENT TO DEFRAUD ANY INSURANCE COMPANY OR ANOTHER PERSON, FILES AN APPLICATION FOR INSURANCE OR STATEMENT OF CLAIM CONTAINING ANY MATERIALLY FALSE INFORMATION, OR CONCEALS INFORMATION FOR THE PURPOSE OF MISLEADING, COMMITS A FRAUDULENT INSURANCE ACT, WHICH IS A CRIME AND MAY SUBJECT SUCH PERSON TO CRIMINAL AND CIVIL PENALTIES.

BY SIGNING THIS APPLICATION, THE APPLICANT WARRANTS TO THE COMPANY THAT ALL STATEMENTS MADE IN THIS APPLICATION AND ATTACHMENTS HERETO ABOUT THE APPLICANT AND ITS OPERATIONS ARE TRUE AND COMPLETE AND THAT NO MATERIAL FACTS HAVE BEEN MISSTATED OR MISREPRESENTED IN THIS APPLICATION, SUPPRESSED OR CONCEALED. THE UNDERSIGNED AGREES THAT IF AFTER THE DATE OF THIS APPLICATION AND PRIOR TO THE EFFECTIVE DATE OF ANY POLICY BASED ON THIS APPLICATION, ANY OCCURRENCE, EVENT OR OTHER CIRCUMSTANCE SHOULD RENDER ANY OF THE INFORMATION CONTAINED IN THIS APPLICATION INACCURATE OR INCOMPLETE, THEN THE UNDERSIGNED SHALL NOTIFY THE COMPANY OF SUCH OCCURRENCE, EVENT OR CIRCUMSTANCE AND SHALL PROVIDE THE COMPANY WITH INFORMATION THAT WOULD COMPLETE UPDATE OR CORRECT SUCH INFORMATION. ANY OUTSTANDING QUOTATIONS MAY BE MODIFIED OR WITHDRAWN AT THE SOLE DISCRETION OF THE COMPANY.

COMPLETION OF THIS FORM DOES NOT BIND COVERAGE. THE APPLICANT'S ACCEPTANCE OF THE COMPANY'S QUOTATION IS REQUIRED BEFORE THE APPLICANT MAY BE BOUND AND A POLICY ISSUED. THE APPLICANT AGREES THAT THIS APPLICATION, IF THE INSURANCE COVERAGE APPLIED FOR IS WRITTEN, SHALL BE THE BASIS OF THE CONTRACT WITH THE INSURANCE COMPANY, AND BE DEEMED TO BE A PART OF THE POLICY TO BE ISSUED AS IF PHYSICALLY ATTACHED THERETO. THE APPLICANT HEREBY AUTHORIZES THE RELEASE OF CLAIMS INFORMATION FROM ANY PRIOR INSURERS TO THE COMPANY.
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August 29th, 2013 by RealCare Insurance Marketing, Inc.

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RealCare Insurance Marketing, Inc. Provides E&O, Auto, Home, Personal, Business, Life, and Health Insurance to Members of the California Association of REALTORS® (C.A.R.). CA License: 0B23546

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