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Property Management Information

Contact Name*

First Last

Email*

Title*

Phone*

Property Management Company Name*

DBA if Any

Website*

Entity Type (i.e. LLC, S Corp, Etc.)*

Physical Address*

Street Address Address Line 2 City State ZIP Code

How did you Hear about SureVestor?*

Please describe how you heard about SureVestor:*

How many Unique States do you Manage Property In?*

State 1*

State 2*

State 3*

State 4*

State 5*

Acknowledgement*

This product is only for professionally managed residential properties

Portfolio Overview

1. How many Doors/Units do you have in your portfolio?*

2. What % of your portfolio has lease terms shorter than 6 Months?*

Please note that Landlord Protection may not cover short term leases

3. Single Family Houses:*

4. Buildings with 2-20 Units:*

5. Buildings with 21+ Units:*

*NOTE: Locations with 21+ units in a building are not permitted at this time for general liability.

Product Bundle Selection

Select the services you're interested in below (your quote will display options for all services so you have the option to change what you offer at any time with no additional cost):*

Protection Plus (Landlord Protection & General Liability for the price of 1)

Landlord Protection Insurance

General Liability Insurance

Tenant Liability Insurance

Loss History

1. Has the insured had their insurance coverage cancelled or not renewed?*

YES

NO

1a. Describe any insurance that was cancelled or not renewed:*

1b. For what reason was the coverage cancelled?*

No Payment

Claims/Losses

Other

2. Have you had any General Liability claims in the past 3 years?*

YES

NO

2a. When did you have General Liability claims, what were the details on loss, and what was the claim total?*

3. Have you been enrolled in a Tenant Liability program before?*

YES

NO

3a. Can you provide the Loss history from the current provider?

3b. Number of Renter Liability losses in the past three years?*

3c. Type of Losses*

Landlord Protection (LP)

All items below must be checked and agreed to in order for an application to be approved.

Acknowledgement - 1*

You understand that if a tenant has not made payment on time (by the 5th of the month) and is behind on payment, coverage for Loss of Rent, Malicious Damage, and Eviction cost will not be covered until the tenant is up to date and paid 2 consecutive months on time (by the 5th of the month).

Acknowledgement - 2*

You will not add locations to this policy where you are aware of a situation that could lead to a claim.

Acknowledgement - 3*

You understand that this product must have a monthly rent amount of $1,000 or more. You also understand the maximum rental limit is $3,000 which means you can add locations with higher rent values, but the coverage will cap at $3,000.

Acknowledgement - 4*

You acknowledge that as a professional property management company you will continue to use best practices in screening and placing of tenants. This insurance does not replace your duty of care for screening tenants.

There are no known losses or claims that have not already been reported to a prior insurance carrier, or to any other source from which claims might be made; There is no knowledge of facts or circumstances that relate to an occurrence, wrongful act, or incident of any type, including those caused by incremental, continuous, or progressive damage; arising from any of the insured’s operations, employees, or affiliates acting on the insured’s behalf which could reasonably result in a claim, that have not been reported to a prior insurance carrier; There is no knowledge of any requests for information by anyone, including an attorney, which might result in a claim; and There is no knowledge of any prior insurance carrier refusing coverage for, or declining to accept a report of any occurrence, incident, threat of claim, letter of intent, adverse result notice, or attorney contact.

Signature*

Date

Initial the following, indicating you have had the opportunity to review:

1. I warrant that the information contained in this application is true, it becomes part of my insurance application, and is subject to the same warranties and conditions. This statement will form the basis of and be incorporated into the final policy, if issued. By initialing here, you are hereby agree to state specific guidelines listed above.*

2. I understand that this quote and policy if offered is offered by a non-admitted or surplus lines insurer rated currently rated A XV by A.M. Best. By initialing here, you are hereby agreeing to the state specific guidelines listed above.*

Protection Plus Example Policy

Tenant Liability Insurance Example Policy

Landlord Protection Insurance Example Policy

RPG Agreement

General Liability Insurance Example Policy

3. I agree to and understand the terms and conditions of the policy(s). Example policies for reference can be found above.*

4. I understand that by purchasing this insurance I am joining the Professional Industry Purchasing Group, an approved Risk Purchasing Group (RPG), and understand the terms and conditions of the Membership Agreement. By initialing here, I are hereby agree to the RPG Statement linked to above.*

FRAUD STATEMENT

ANY PERSON WHO KNOWINGLY AND WITH INTENT TO DEFRAUD ANY INSURANCE COMPANY OR OTHER PERSON FILES AN APPLICATION FOR INSURANCE OR STATEMENT OF CLAIM CONTAINING ANY MATERIALLY FALSE INFORMATION OR CONCEALS FOR THE PURPOSE OF MISLEADING, INFORMATION CONCERNING ANY FACT MATERIAL THERETO, COMMITS A FRAUDULENT INSURANCE ACT, WHICH IS A CRIME AND SUBJECTS THE PERSON TO CRIMINAL AND CIVIL PENALTIES.

I warrant that the information contained in this application is true, it becomes part of my insurance application, and is subject to the same warranties and conditions. This statement will form the basis of and be incorporated into the final policy, if issued.

THE UNDERSIGNED EXECUTIVE OFFICER, DIRECTOR, PARTNER, OR EQUIVALENT insured OR AUTHORIZED REPRESENTATIVE DECLARES THAT THE STATEMENTS SET FORTH HEREIN ARE TRUE. THE UNDERSIGNED AGREES THAT IF THE INFORMATION SUPPLIED ON THE APPLICATION CHANGES BETWEEN THE DATE OF THE APPLICATION AND THE EFFECTIVE DATE OF THE INSURANCE, HE/SHE (UNDERSIGNED) WILL IMMEDIATELY NOTIFY THE INSURER OF SUCH CHANGES, AND THE INSURER MAY WITHDRAW OR MODIFY ANY OUTSTANDING QUOTATIONS AND/OR AUTHORIZATION OR AGREEMENT TO BIND THE INSURANCE. SIGNING OF THIS APPLICATION DOES NOT BIND THE insured TO THE INSURER TO COMPLETE THE INSURANCE.

THE insured AGREES TO NOTIFY US OF ANY MATERIAL CHANGES IN THE ANSWERS TO THE QUESTIONS ON THIS QUESTIONNAIRE WHICH MAY ARISE PRIOR TO THE EFFECTIVE DATE OF ANY POLICY ISSUED PURSUANT TO THIS QUESTIONNAIRE AND THE insured UNDERSTANDS THAT ANY OUTSTANDING QUOTATIONS MAY BE MODIFIED OR WITHDRAWN BASED UPON SUCH CHANGES AT OUR SOLE DISCRETION. COMPLETION OF THIS FORM DOES NOT BIND COVERAGE. insured's ACCEPTANCE OF THE COMPANY'S QUOTATIONS IS REQUIRED PRIOR TO BINDING COVERAGE AND POLICY ISSUANCE. ALL WRITTEN STATEMENTS AND MATERIALS FURNISHED TO THE COMPANY IN CONJUNCTION WITH THIS APPLICATION ARE HEREBY INCORPORATED BY REFERENCE INTO THIS APPLICATION AND MADE A PART OF THIS APPLICATION.

Signature*

Date

SureVestor Application