IOA Pros

Welcome To SmartSelect Pro by IOA Insurance Services

Apply Today for A&E Professional Liability Policy!

SmartSelect Pro enables your practice (on a “no obligation” basis) to tap into IOA Pros extensive marketplace knowledge* and 5,000+ client negotiation expertise.

* We have well-established relationships with over 50 leading insurers

Even if you don’t purchase coverage from IOA Pros, you’ll know if you’ll quickly know if your current policy (1) was the correct choice and (2) whether a fair premium applies.

We’re Different Because We’re Passionate About the Details

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THE INFORMATION BEING REQUESTED IS FOR A CLAIMS‐MADE POLICY. IF ISSUED, THE POLICY WILL APPLY ONLY TO CLAIMS FIRST MADE OR DEEMED MADE DURING THE POLICY PERIOD OR ANY APPLICABLE EXTENDED REPORTING PERIOD. THE LIMIT OF LIABILITY AVAILABLE TO PAY CLAIMS WILL BE REDUCED AND MAY BE EXHAUSTED BY THE AMOUNTS PAID AS DEFENSE EXPENSES. THE DEDUCTIBLE WILL APPLY TO DEFENSE EXPENSES.IMPORTANT NOTE – NEW YORK: DEFENSE EXPENSES WILL REDUCE UP TO 50% OF THE LIMIT OF LIABILITY, AND MAY BE APPLIED TO UP TO 50% OF THE DEDUCTIBLE.

Answer each question on behalf of all entities seeking insurance coverage, unless specifically requested otherwise.
An Additional Information section is provided at the end of this document for any information that exceeds the space provided.


Easiest Option: Just Send Us Your Most Recent Professional Liability Policy Application

Just attach your application and send it to us here!


2nd Option: Complete Our SmartSelect Pro Online Application

General Information

Proposed Name Insured:

Today's Date:

"Trade" or "Doing Business As" Name(s):

Mailing Address

Street:

City:

State:

Zip Code:

Physical Address (if different)

Street:

City:

State:

Zip Code:

Primary Contact Name and Title:

Telephone Number:

Email Address:

Web Address:

Type of Legal Entity
IndividualGeneral PartnershipLimited PartnershipCorporationLimited Liability CompanyOther

Proposed Effective Date (mm/dd/yyyy):

Date Business Started (mm/dd/yyyy):

APPLICANT INFORMATION

1. Indicate number of firm personnel:

 Number of Full-Time StaffNumber of Part-Time StaffNumber of Registered Architects, Landscape Architects, Land Surveyors, and Licensed EngineersNumber Who Attended Training or a Seminar on Professional Liability Risk Management in the Past 12 Months
Principals/Management
Employees

NEW FIRMS WITH NO HISTORICAL DATA SHOULD COMPLETE ALL QUESTIONS BASED UPON PROJECTIONS FOR THE FIRST YEAR IN BUSINESS

2. Indicate annual gross billings:

 Most Recently Completed Fiscal Yr:
MO/YR
to MO/YR
One Fiscal
Yr Prior:
MO/YR
to MO/YR
Two Fiscal
Yr Prior:
MO/YR
to MO/YR
Next 12 Months
Projected:
MO/YR
to MO/YR
Billings Passed to Sub consultants Carrying Their Own Professional
Liability Insurance
All Other Annual Billings
Total Annual Gross Billings

*Billings for non-professional services or expenses that are reimbursed under the terms of your client contract should not be included.

3. What percentage of annual gross billings from the most recently completed fiscal year were derived from contracts solely related to feasibility studies, master planning, reports, opinions, non-structural interior design, or forensic engineering?

4. Provide the percentage of annual gross billings for the most recently completed fiscal year attributable to the following disciplines, excluding billings to sub-consultants. For unlicensed construction and design consultants, such as acoustical consultants, please specify your discipline in “Other”.

Please provide percentage amount for at least one of the fields below.

Discipline% Of Annual Gross Billings
Agency Construction Manager
Architect
Civil Engineer
Electrical Engineer
Environmental Consultant*
Forensic Engineer
Geotechnical Engineer
Interior Designer
Landscape Architect
Land Surveyor
Mechanical Engineer
Process Engineer
Structural Engineer
Other (please specify):

*Complete the Environmental Additional Information Request

5. Provide the percentage of annual gross billings for the most recently completed fiscal year derived from each of the following project types. Please use whole numbers only.

Please provide percentage amount for at least one of the fields below.

Project Type% Of Annual Gross Billings
Airports
Amusement Parks/Zoos
Apartments (do not include condominiums or cooperatives)
Asbestos/Mold/Radon/Lead Abatement
Bridges (spans < 500 ft.)
Bridges (spans > 500 ft.)
Building Facade Restoration/Inspection
Civil/Site Development – Non-Residential
Civil/Site Development - Residential
Commercial/Office/Retail/Banks (> 15 stories)
Commercial/Office/Retail/Banks (< 15 stories)
Condominiums – Commercial
Condominiums – Residential
Cooperatives – Residential
Education/Schools
Harbors/Piers/Ports
Hospitals/Healthcare/Assisted Living Facilities
Hotels/Motels
Industrial/Manufacturing
Jails/Prisons/Detention Centers
Judicial Courts
Laboratories/Clean Rooms
Landfills
Military Facilities
Mines/Quarries
Museums/Libraries
Nuclear Facilities
Parking Garages
Parks/Playgrounds/Sports
Power Generation/Distribution
Public Safety/Police/Fire Stations
Refinery/Petrochemical
Religious Facilities
Roads/Highways
Single Family Homes
Stadiums/Arenas/Convention Centers
Swimming Pools
Telecommunications/Cabling
Townhouses
Toxic/Hazardous Waste Sites
Tunnels/Dams/Levees
Underground Storage Tanks
Water/Sewer Pipelines
Water/Wastewater Treatment Plants/Facilities - Industrial
Water/Wastewater Treatment Plants/Facilities – Municipal
Other (please specify):

6. Has the applicant firm, any subsidiary, or any predecessor rendered services in the past 3 years, or do they expect to render services in the next 12 months, for any project where all or a portion of the project is currently titled, or is expected to be sold, under a condominium or cooperative form of ownership? (Note: Do not include services provided for the owner of a single condominium or co-op unit)

YesNo

If yes, please provide the firm’s total gross annual billings derived from condominium and cooperative projects below. Include 100% of the billings for projects where all or a portion of the project is currently titled, or expected to be sold, under a condominium or cooperative form of ownership.

 Most Recently Completed Fiscal Year:
MO/YR
to MO/YR
One Fiscal
Yr Prior:
MO/YR
to MO/YR
Two Fiscal
Yr Prior:
MO/YR
to MO/YR
Next 12 Months
Projected:
MO/YR
to MO/YR
Condominium Projects
Cooperative Projects

7. For the five largest projects based on construction value over the past three years, provide:

Project NameLocationServices RenderedProject TypeConstruction ValueFees Billed

8. In the most recently completed fiscal year, what percentage of your annual gross billings were derived from the following clients:

Please provide percentage amount for at least one of the fields below.

Firm’s Client% Of Annual Gross Billings
Contractors
Design Professionals
Developers
Private Owners
State or Local Governments
Other (please specify):
Federal Government
Non-Profit Entities
Other (please specify):
Total100%

9. What percentage of annual gross billings from the most recently completed fiscal year were derived from repeat clients?

10. Is more than 50% of annual gross billings from the most recently completed fiscal year derived from one client?

YesNo

If yes, please provide details in the Additional Information section at the end of this application.

11. What percentage of annual gross billings from the most recently completed fiscal year were derived from projects located outside the U.S., its territories, or possessions ?

Provide the following for the three largest current or proposed foreign projects:

Project NameLocationServices RenderedProject TypeConstruction ValueFees Billed

12. Is the firm, or any parent, subsidiary, or other related organization domiciled outside of the U.S., its territories, or possessions?

YesNo

13. Does any partner, principal, member, officer, director, shareholder, or immediate family member have an ownership interest in any entity for whom professional services are rendered?

YesNo

If yes, please provide details in the Additional Information section at the end of this application.

14. Is the firm or any parent, subsidiary, or other related organization engaged in any of the following:

a. Actual construction, fabrication, installation, or erection?

YesNo

b. Real estate development?

YesNo

c. Designing, manufacturing, selling, leasing, or distributing any other product, process, or patented design?

YesNo

If yes, please provide details in the Additional Information section at the end of this application

15. Does the firm or any parent, subsidiary, or other related organization ever have single-point responsibility for both the design and construction of a project?

YesNo

If yes, please provide details in the Additional Information section at the end of this application

16. Has the firm or any subsidiary or predecessor firm ever filed for, or been in, receivership or bankruptcy?

YesNo

If yes, please provide details in the Additional Information section at the end of this application.

RISK MANAGEMENT

17. For all contracts used in the most recently completed fiscal year, provide the breakdown of contracts used by type:

Please provide percentage amount for at least one of the fields below.

Type Of Contract% All Contracts
Professional Association Contract
Client Drafted Contract
Purchase Order
Firm’s Drafted Contract
Letter of Agreement
Verbal Agreement
Other (please specify):
Total100%

18. Is a limitation of liability provision incorporated into contracts and agreements?

YesNo

If yes, what percentage of contracts contain a limitation of liability clause less than or equal to $250,000?

19. Provide the breakdown of design services based on annual gross billings from the most recently completed fiscal year:

a. Percentage with construction observation:

b. Percentage without construction observation:

20. Do you use a written contract with all subconsultants?

YesNo

If no, please explain:

21. What percentage of your accounts receivable are more than 90 days past due?

22. In the past three years has any suit been brought against any client to collect fees?

YesNo

If yes, please provide details in the Additional Information section at the end of this application.

PRIOR INSURANCE AND CLAIM HISTORY

23. Has any claim involving professional services been made against any of the following during the past five years (ten years if gross annual billings are greater than $5 million), or earlier if still pending:

a. You, your firm, or any member of your firm?

YesNo

b. Any predecessor firm?

YesNo

c. Any former member of your firm or a predecessor firm for professional services while a member of such firm?

YesNo

24. Do you or any person seeking coverage under this proposed policy have knowledge of any incident, act, error, or omission involving professional services that could reasonably be expected to be the basis of a claim?

YesNo

25. Complete the following chart for professional liability insurance coverage carried during the past five years: (Check here if none: None)

 Insurance Company NamePolicy PeriodPer Claim Limit Of LiabilityAggregate Limit of LiabilityDeductible AmountPremiumRetroactive Date
Current Year to
Prior Year 1 to
Prior Year 2 to
Prior Year 3 to
Prior Year 4 to

26. Provide the following for general liability insurance coverage currently in force (Check here if none: None):

Insurance Company NamePolicy Expiration DateLimits of Liability

27. Has any person or entity seeking professional liability insurance ever been declined or had such insurance nonrenewed or cancelled, including for nonpayment of premium? (Missouri applicants: Do not complete)

YesNo

If yes, please provide details in the Additional Information section at the end of this application.

COMPENSATION NOTICE

Important Notice Regarding Compensation Disclosure

For information about how Travelers compensates independent agents, brokers, or other insurance producers, visit this website:

http://www.travelers.com/w3c/legal/Producer_Compensation_Disclosure.html

If you prefer, you can call the following toll-free number: 1-866-904-8348. Or you can write to us at Travelers, Agency Compensation, One Tower Square, Hartford, CT 06183.


This application, including any material submitted in conjunction with this application or any renewal of any policy issued, does not amend the provisions or coverages of any insurance policy or bond issued by Travelers. It is not a representation that coverage does or does not exist for any particular claim or loss under any such policy or bond. Coverage depends on the facts and circumstances involved in the claim or loss, all applicable policy or bond provisions, and any applicable law. Availability of coverage referenced in this document can depend on underwriting qualifications and state regulations.

FRAUD WARNINGS

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ALABAMA, ARKANSAS, DISTRICT OF COLUMBIA, MARYLAND, NEW MEXICO, AND RHODE ISLAND: Any person who knowingly (or willfully in MD) presents a false or fraudulent claim for payment of a loss or benefit or who knowingly (or willfully in MD) presents false information in an application for insurance is guilty of a crime and may be subject to fines and confinement in prison.

COLORADO: It is unlawful to knowingly provide false, incomplete, or misleading facts or information to an insurance company for the purpose of defrauding or attempting to defraud the company. Penalties may include imprisonment, fines, denial of insurance, and civil damages. Any insurance company or agent of an insurance company who knowingly provides false, incomplete, or misleading facts or information to a policyholder or claimant for the purpose of defrauding or attempting to defraud the policyholder or claimant with regard to a settlement or award payable from insurance proceeds shall be reported to the Colorado Division of Insurance within the Department of Regulatory Agencies.

FLORIDA: Any person who knowingly and with intent to injure, defraud, or deceive any insurer files a statement of claim or an application containing any false, incomplete, or misleading information is guilty of a felony of the third degree.

KENTUCKY, NEW JERSEY, NEW YORK, OHIO, AND PENNSYLVANIA: 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 such person to criminal and civil penalties. (In New York, the civil penalty is not to exceed five thousand dollars ($5,000) and the stated value of the claim for each such violation.)

LOUISIANA, MAINE, TENNESSEE, VIRGINIA, AND WASHINGTON: It is a crime to knowingly provide false, incomplete, or misleading information to an insurance company for the purpose of defrauding the company. Penalties include imprisonment, fines, and denial of insurance benefits.

OREGON: Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or who knowingly presents false information in an application for insurance may be guilty of a crime and may be subject to fines and confinement in prison.

SIGNATURES

I declare that I have examined this application and accompanying supplements and materials, and to the best of my knowledge and belief, after reasonable inquiry, they are true, correct, and complete, and may be relied upon by Travelers. I understand that if any of this information changes prior to the issuance of the insurance applied for that I am obligated to notify Travelers of such changes and that Travelers may modify or withdraw any proposal for insurance. Travelers are authorized to make inquiry in connection with this application.

Authorized Representative Signature:* (Principal, Officer, or Shareholder)

Authorized Representative Name - Printed:

Today's Date:

* If you are electronically submitting this document, apply your electronic signature to this form by checking the Electronic Signature and Acceptance box below. By doing so, you agree that your use of a keypad, mouse, or other devices to check the Electronic Signature and Acceptance box constitutes your signature, acceptance, and agreement as if actually signed by you in writing and has the same force and effect as a signature affixed by hand.

Yes
Electronic Signature and Acceptance – Authorized Representative


ADDITIONAL INFORMATION

This area may be used to provide additional information to any question. Reference the question number.