COVER-PRO
SM
APPLICATION
INTERIOR DESIGNER / DECORATOR SUPPLEMENT
1. Full name of the Applicant Firm:
2. What percentage of the Applicant’s gross annual revenue comes from the following activities?
% Residential
% Hospitals
% Restaurants
%
Hotels
% Retail
% Government
% Other: (specify)
% Other: (specify)
% Other: (specify)
% Other: (specify)
100
% TOTAL MUST EQUAL 100%
3.
Has the Applicant passed the Natio
nal Council of Interior Design Qualification exa
mination? Yes No
4. Does the Applicant provide any services
other than those services listed ab
ove in question 2? Yes No
If yes, provide details
5. Are any of the Applicant’s owners / employees a
rchitects or professional engineers
(PE)? Yes No
6. Are clients notified in writing that the Applicant can
not guarantee cost estima
tes and other contractor
performance? Yes No
7. Is the Applicant involved in the construc
tion or installation aspects of a project?
Yes No
8. Does the Applicant belong to any professional associations
such as the American
Society of Interior
Designers? Yes No If yes, please list:
9. Are all oral communications and commitments (such as changes in instructions and decision
s) approved in
writing by the client? Yes No
I understand that the information submitted herein becomes a part of my Philadelphia Insurance
Companies Cover-Pro
sm
application and is subject to the same conditions as stated on the application.
Name (Please Print) Title (Must be Principal, Partner or Officer)
___________
_______________________________
Signature Date
PI-PLSP-IDSUPP 08/10
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