Application Form
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4United States Liability Insurance Group
Property Managers
A P P L I C A T I O N
ALL QUESTIONS MUST BE ANSWERED AND APPLICATION MUST BE SIGNED BY APPLICANT.
1.
Name of Applicant: ______________________________________________________________________________________________
Address: ______________________________________________________________________________________________________
q
List complete addresses of all additional offices on a separate sheet; if none check here:
Web Site:______________________________________________________________________________________________________
Contact Name: __________________________________
Phone#: ______________________
Fax #:______________________
2.
Date Business was established: ______________
Years of Property Management Experience of Principal / Partner: ______________
q Corporation
q Partnership
q LLC
q Sole Proprietorship
q Individual
3.
Is Applicant applying for coverage as a:
4.
Please list all Applicant’s Professional Designations: ___________________________________________________________________
5.
Total number for each category (list each person only once, identifying their primary area of responsibility).
FULL TIME
PART TIME
Property Managers
______________
______________
Real Estate Agents
______________
______________
Appraisers
______________
______________
Clerical
______________
______________
Reserve Study Personnel
______________
______________
Other( ________________)
______________
______________
6.a. Income from Property management services or leasing in the last 12 months:
Amount of
Number of
Projected
Commission Income
Units/Square Footage
Commission Income
(A) Condo/Homeowner Association Management
______________
______________units
________________
(B) Apartment/Cooperatives
______________
______________units
________________
(C) Vacation Properties/Individual Home Management
______________
______________units
________________
(D) Office Buildings
______________
______________sq. feet
________________
(E) Shopping Centers/Malls
______________
______________sq. feet ________________
(F) Industrial/Manufacturing/Warehouses
______________
______________sq. feet
________________
(G) Other: ___________________________________
______________
______________
________________
TOTALS
______________
______________
________________
Only answer 6b and 6c if the Applicant derives more than 50% of the their income from residential management (A, B and C above)
6.b. What percentage of units managed is Applicant involved in placement of tenants? ___________________________________________
6.c. What is the average individual unit value of the property under management? _______________________________________________
7.
Has Applicant, Predecessor Firm or any affiliated company at any time in the past or present engaged in any business venture outside the
scope of a Property Management or Real Estate Organization, including but not limited to construction, property development or asset
q Yes
q No
management?
If Yes, please provide full details including the amount of income from these activities:
______________________________________________________________________________________________________________
8.
Does the applicant organize group investments, syndications, Real Estate Investment Trusts, or limited partnerships for the purpose of
q Yes
q No
investing in real estate?
If Yes, please provide full details on separate sheet.
q Yes
q No
9.
Do you have an ownership interest in any of the properties you manage?
If Yes, please provide a list,
on a separate sheet, of all the properties that applicant has an ownership interest in and the percentage of ownership they have in each.
10. Are any changes in the size of the applicant's operations, in excess of 25%, anticipated over the next 12 months?
q Yes
q No
If Yes, please provide details on a separate sheet.
q Yes
q No
11. Does your firm currently carry General Liability Insurance?
(Copy of the Declarations Page will be required prior to binding.)
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Parent category: Business