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COLONY INSURANCE COMPANY COLONY SPECIALTY INSURANCE COMPANY PELEUS (Strickland Insurance Brokers)

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  • 58 check-boxes
  • 29 other fields

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C‐APP032‐0815 Page1of4
COLONY INSURANCE COMPANY – COLONY SPECIALTY INSURANCE COMPANY
PELEUS INSURANCE COMPANY
CONTRACT DIVISION - REAL ESTATE PROPERTY MANAGERS - SUPPLEMENTAL APPLICATION
ACORD Application also required - Check all applicable checkboxes below
General Agent:
Date:
Insured:
Insured Mailing Address:
Insured’s Web Address:
Insured Contact Name:
Phone Number:
PROHIBITED (check all that apply to your operations)
Adult Foster Care - Assisted Living
Building exposures that include any of the following:
Construction that is not at least Masonry-NC or better when heights are 6 to 10 stories
Elevator maintenance contract not in place
Heights that exceed 10 stories
Life safety standards not met based on building codes
Halfway Houses – Homeless Shelters – Rehabilitation Centers
Home Inspections
Insureds who are contractually responsible for security services
Mortgage services
New-ground-up multi-family-habitational property development and/or construction (i.e. apartments, condos, co-
ops, townhomes, tract homes)
Real Estate Investment Trusts
Swimming Pool exposures lacking any of the following controls: depths marked, fencing with self-latching gates,
life safety equipment in the pool area, rules including hours posted.
Meets Federal swimming pool/spa drain cover standards found in the Virginia Graeme Baker Pool and Spa
Safety Act
Diving Boards Water Slides If either of these exposures are present submit is required.
Some properties are seasonal occupancy or vacant and have a swimming pool exposure
Syndications / Partnerships
YEARS IN BUSINESS / EXPERIENCE
_____ Years in business as the ‘Named Insured’ indicated on this application
_____ Years’ experience in the operations indicated on this application - Attach resumes if available
Has applicant had an insurance policy cancelled or non-renewed in past 3 years? If yes, explain.
(Missouri Applicants - Do not answer this question)
Applicant in receivership
Bankruptcy (Chapter 7, 11 or 13) has been filed in past 5 years
C‐APP032‐0815 Page2of4
REAL ESTATE PROPERTY MANAGERS - SUPPLEMENTAL APPLICATION
CONTRACTS
Written contracts are always used with third parties. If not, explain:
LOSS HISTORY / EVICTIONS / VIOLATIONS
Three years of loss history information on ACORD application or attached to this application
Fair Housing Act violation alleging discrimination made in the past 5 years. If “yes” provide details:
Professional Liability claim(s) have been made in the past 5 years. If “yes provide details:
No known act, circumstance, fact or omission is known at this time which might reasonably be expected to be the
basis of a claim or suit against the applicant or anyone for whom this insurance will apply
EXPOSURES / OPERATIONS / CONTROLS
Customers carry primary GL insurance at least equal to applicant’s GL limits. (The CGL coverage grant
automatically contemplates coverage for “real estate managers” in Section II at (1) (b), (1)(c0, and (2)(b). Given
this real estate managers do not need to seek out additional insured status on customers’ policies.
Disclosures regarding asbestos, lead paint, mold, underground storage tanks and any other required disclosures
at the subject location(s) are addressed formally where legally required
Home Warranty Plans – Applicant owns subsidiary(s) that offer home warranty plans
Insurance placement and maintenance on properties managed is the responsibility of the applicant.
Professional Liability Insurance is in place (and required) if this exposure exists
Life Safety – Applicant is contractually responsible for maintaining compliance with life safety regulations. If so, all
properties subject to this contractual agreement are actually in compliance with all life safety regulations.
Memberships – Insured belongs to a Professional Trade Association and/or holds special designations or licenses
related to property management
Moving services provided. If “yes” provide details:
Professional Trade Association
Real Estate Agent Sales Personal exposures exist. If “yes” they are:
Employees Independent Contractors
Independent Contractors maintain their own GL and E&O coverage with limits
equal or greater than applicant’s, and name applicant A.I. on their policies
Remodeling, alteration services provided to property owners by applicant. If “yes” describe and indicate annual
costs related to this:
C‐APP032‐0815 Page3of4
REAL ESTATE PROPERTY MANAGERS - SUPPLEMENTAL APPLICATION
SUBCONTRACTORS
Insured is using a licensed general contractor that is insured elsewhere and provides additional insured status to
applicant. Uninsured subcontractors are not acceptable.
Describe type of work performed by subcontractors:
Risk Transfer – Subcontractors:
Additional Insured – Status granted to you on the subcontractor’s policy
Certificates of Insurance - Always obtained from a subcontractor prior to any work being done for you
Hold Harmless and Indemnification Agreements – Required from subcontractors
Limits of Liability - Subcontractors are required to carry limits equal or above your own
Workers Compensation (if applicable) – Subcontractors required to have their own WC
EMPLOYEES
Total Number of Employees (include leased employees): __________
RECEIPTS
Property Management:
Annual Receipts Last 12 Months: $ ________________
Annual Receipts Anticipated in Coming Policy Term: $ _______________
Property management fees are what percentage of total fees for Commercial: _____ %
Property management fees are what percentage of total fees for Commercial: _____ %
If there is commercial property management, what type(s) of occupancies? ____________________________
________________________________________________________________________________________
Insured has an ownership interest in property(s) they manage. If “yes” the properties must be properly
classified and rated. Attach a list of all such properties and indicate the insured’s percentage of ownership in
each.
Real Estate Sales:
Annual Receipts Last 12 Months: $ ________________
Annual Receipts Anticipated in Coming Policy Term: $ _______________
(Submit required if real estate sales exceed 15% of total annual receipts for all operations)
COVERAGE OPTIONS - LIABILITY (check if you would like a quote on any of the following)
Employee Benefit Liability – U058
Employment Practices Liability Insurance – U817 (Not available in AR, LA, MT, NM, NY, VT)
High Limits General Liability
Identity Recovery – i.e. Identity Theft – U651
Medical Expense Limit of $10,000 rather than $5,000
Stop Gap Liability – U066
COVERAGE OPTIONS - PROPERTY (check if you would like a quote on any of the following)
Building Ordinance or Law (Increased Cost of Construction) – U750
Equipment Breakdown – U522 and U523
Property Coverage Enhancement:
Bronze – U777C Silver – U777B or Gold-U777A
Signs (Outdoor) 0 Co1449
Water Back Up and Sump Overflow – U548
C‐APP032‐0815 Page4of4
REAL ESTATE PROPERTY MANAGERS - SUPPLEMENTAL APPLICATION
GENERAL FRAUD STATEMENT (Not applicable in all states.)
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, may be committing a fraudulent insurance act, and may be subject to
a civil penalty or fine.
The undersigned is an authorized representative of the applicant and certifies that reasonable inquiry has been made to
questions on this application. He/She certifies:
The answers are true, correct and complete to the best of his/her knowledge.
They agree to the Privacy and Fraud provisions found in the ACORD-125 (Commercial Insurance Application)
and understand those provisions also apply to this supplemental application.
SIGN AND DATE
PRODUCER’S SIGNATURE DATE
APPLICANT’S PRINTED NAME DATE
APPLICANT’S SIGNATURE DATE
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COLONY INSURANCE COMPANY COLONY SPECIALTY INSURANCE COMPANY PELEUS (Strickland Insurance Brokers)

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Completed 17 July 2021

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