Home Inspector Liability Program
Quote Inquiry

Pennsylvania Only
Company Name
      Type of Company: 
Contact Name:
Address:
City:
    State:    Zip: 
Phone:
       Fax: 
E-Mail Address:
Number of Years in Business
Years Experience
License Number
Do you have at least 5 years in business, or have at least 5 years work experience as a Home Inspector? Yes /  No
Do you have training or experience in residential constuction or real estate appraisal? Yes /  No
Do you belong to any professional Societies?  AHSI  Other 
Describe membership qualification guidelines and code of ethics: 
Do you always use a letter of engagement or standard contract? Yes /  No
Do you perform work on behalf of real estate agencies, where your fee is paid by the agency and not by the buyer or seller of the property? Yes /  No
Percentage of your gross receipts generated by any combination of the following specialty inspections, such as termite inspections, radon testing, well flow testing and septic system testing?
%
Do you ever do any handy man or repair work to deficient items found during inspection? Yes /  No
Please provide your payroll.  Include $5,200 for each proprietor or partner, and actual payroll of all employees:
$  Annual Payroll    Number of Inspectors: 
 
Current Residential Inspection Income Current Commercial Inspection Income
Projected Gross Income for all Inspection Services for Next Year
Are you providing services on properties in any state or country where you do not maintain an office? Yes /  No

Based on gross revenue for the past 12 months, please provide the following breakdowns.   If newly established, provide best estimate.

Types of Inspections
Air %
Lead %
Termites/Other Pests %
Asbestos %
Mechanical %
Assessment or Survey %
Environmental Site %
Radon %
Structural %
Types of Properties Inspected
1 & 2 family dwellings %
Commercial & Industrial %
3 & 4 family dwellings %
Farms & Ranches %
Sources of Business
Sellers %
Prospective Buyers %
Financial Institutions %
Real Estate/Relocation Companies %

Additional Insured

Type: 
Name
Address:
City:
    State:    Zipcode: 

Prior Insurance Information
Insurance Company:
Expiring Policy #:
Expiration Date:

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) 327-7911
Toll Free: 1-800-977-2999              Fax: 1-888-800-0034