Any person who knowlingly presents a false or fraudulent claim for payment of a loss or benefit or knowingly presents false information in an application for insurance is guilty of a crime and may be subject to fines and confinement in prison.
I (the Applicant) understand and agree that the Home Inspector General Liability/Professional Liability application (the Application) and any and all supplements attached hereto will be made part of any policy issued in reliance upon the representations made therein to the insurance company (the Company). I further understand and agree that failure to provide a true and accurate response to the Application questions may, at the option of the Company, result in the voiding of insurance issued in reliance on the Application or the denial of claims submitted under the policy.
I authorize and consent to investigations of information bearing upon moral character, professional reputation and fitness to engage in the activities of my business including authorization to every person or entity, public or private, to release to the Company providing insurance coverage and its affiliates and its affiliated partners and their employees any documents, records or other information bearing upon the foregoing.
I understand and agree these investigations will not be confined to information submitted in the Application, but may include other sources of information deemed relevant by the Company as may be authorized by law.
Applicant and all owners, employees, and contractors are licensed or duly authorized in all states or jurisdictions where professional services are provided. Applicant warrants the truth of all answers to the questions contained in the Application, and that applicant has not intentionally withheld any information that might influence the judgment of the Company in considering the Application.
Applicant understands and acknowleges that signing the Application (whether by hand or electronically) does not bind the Company to complete the insurance.
APPLICANT UNDERSTANDS AND AGREES THAT THE PREMIUM FOR THIS INSURANCE PRODUCT, ONCE COVERAGE IS BOUND, IS 100% EARNED PREMIUM AND IS NON-REFUNDABLE IN ANY AMOUNT TO APPLICANT. APPLICANT ACKNOWLEDGES AND WARRANTS THAT, SHOULD APPLICANT ELECT TO CANCEL COVERAGE DURING THE COVERAGE PERIOD, THAT THE COMPANY AND JD KUTTER INSURANCE ASSOCIATES WILL NOT BE RESPONSIBLE FOR ANY RETURN PREMIUM TO APPLICANT.
APPLICANT FURTHER ACKNOWLEDGES THAT THE ENTIRE PREMIUM PAYMENT IS DUE WHEN COVERAGE IS BOUND. COMPANY AND JD KUTTER INSURANCE ASSOCIATES DO NOT OFFER INSTALLMENT PAYMENT OPTIONS FOR THIS PROGRAM.