Home Inspector Liability Program
Insurance Quote Inquiry

Pennsylvania Only
Company Name
      Type of Company:   if "Other", describe: 
Contact Name:
Address:
City:
    State:    Zip: 
Phone(s):
       Fax: 
E-Mail Address:

Year Business Was Established
Years Experience
 Number of Inspectors
Projected Annual Revenue Total Revenue from just Commercial Inspections

Brief description of your operation? 
 
Do you have Profession Liability Insurance now?
  If "YES", do you have "Full Prior Acts Coverage"?
  If "NO", what is the "Retroactive Date" (listed on your policy)? 
Yes /  No
Yes /  No
Are you a member of the National Association of Certified Home Inspectors (NACHI) or a member of the American Society of Home Inspectors (ASHI)?    NACHI        ASHI 
Yes /  No
Do you participate in a formal Risk Management or Continuing Education Program or maintain membership to another Professional Association offering risk management services?
Please indicate which association you belong: 
Yes /  No
Is a Pre-Inspection Agreement / Contract signed 100% of the time?
Yes /  No
In the past five (5) years, has any professional liability claim or lawsuit been made against you?
  If "YES", has more than $ 5,000 been paid?
  If "YES", please provide a brief description of the claim (s)
Yes /  No
Yes /  No

Requested Coverages
Liability Limit (per Claim / Aggregate Limit):  Deductible:

Please check the Optional Coverage you would like to include
Premises Liability
Wood Destroying Organism / Termite Inspection
Radon Inspections / Sample Collections
Sewer, Pool, and/or Spa

Prior Insurance Information
Insurance Company Policy Period Liability Limits Deductible Premium
to 
to 
to 

Insurance Losses in the last 3 years
Date of Loss Description of Loss Status Amount
Paid
Closed /  Open
$ 
Closed /  Open
$ 
Closed /  Open
$ 


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M c G R A T H   I N S U R A N C E   G R O U P

4170 William Penn Highway      Murrysville, PA. 15668-1890
(724) 327-8474           FAX: (724) 327-7911
Toll Free: 1-800-977-2999              Fax: 1-888-800-0034