Step 1 of 4 25% Property Management ApplicationName of Company* Contact Name* Company Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone* E-mail* FEIN # Year Business Started Type Corp Partnership LLC Sole Proprietorship Employee Breakdown Full Time Part Time Gross Income Property ManagementCondo/Homeowner Association # Units Projected Next 12 Months Apartments # Units Projected Next 12 Months Residential Homes # Units Projected Next 12 Months Commercial Buildings # Buildings Projected Next 12 Months Gross Real Estate Sales IncomeResidential Sales # Homes Sold a Year Projected Income Next 12 Months Does the Applicant have ownership interest in any of the properties managed? Yes No If yes, please provide details here:*Describe your Contract usages Always Used Sometimes Used Never Used Does your contract contain both hold harmless and indemnification clauses? Yes No Does your contract clearly define the scope of services that are being performed? Yes No Current InsuranceErrors and OmissionsInsurance Co Limit of Liability Retro Date Deductible General LiabilityDoes it cover more than just things in your office? Yes No Insurance Co Limit of Liability Retro Date Deductible Tenant Discrimination AND/OR EPLI Employment Practices Liability InsuranceInsurance Co Limit of Liability Retro Date Deductible Cyber CoverageInsurance Co Limit of Liability Retro Date Deductible In the past 5 years, have you ever been Canceled or Refused renewal on any of your insurance? Yes No In the past 5 years, have you had any claimed, suits, complaints involving Errors and Omissions, Discrimination, Fair Housing Act Violations, Wrongful eviction, EPLI, or Wrongful Termination, been brought on you? Yes No General Liability / Property CoveragesIs the office located at one of the sites you manage? Yes No Do you own the building? Yes No Gross Sqft of office Business Personal Property Limit (contents) Does organization have coverage for Hired/Non-owned Autos? Yes No Do you require evidence of insurance from employees? Yes No Does organization require agents to carry a minimum of $100,000/$300,000/$50,000 Personal Auto Liability Yes No Δ
