SPMGA Southern Preferred MGA, Inc.
13465 Midway Road, Suite 202
Dallas, TX 75244
214-703-9900 - Fax 214-703-9624
  1. Applicant's name
  2. Business name
  3. Physical Address
    City  State  Zip 
  4. Phone  Fax  Email 

  5. Licensed Inspectors TREC License # or File ID # % of ownership years licensed
  6. Y   N Is applicant engaged in any other business other than Home Inspection?
    If yes, explain
  7. Y   N Is there an E & O policy currently in force?
    Expiration Date    Retroactive Date   Company 
  8. Y   N Has the applicant ever had an E & O policy declined, renewal refused, or canceled?
    If yes, explain
  9. What was the total gross revenue in the last 12 months from inspections?   $
  10. What was the total number of inspections performed in the last 12 months? 
  11. How many years do you maintain your files? 
  12. If accepted by the insurer, what is the requested effective date? 
  13. Requested Errors & Omissions limits $ per claim, $ Aggregate
  14. Requested Errors & Omissions deductible $
    (We currently offer $1,000, $1,500, $2,500, or $5,000 deductibles)
  15. Requested General Liability limits $ per claim, $ Aggregate
    (The deductible for General Liability coverage is always $500)
  16. Y  N Has the applicant or any listed inspector been subject to disciplinary action by any State Agency?
  17. Y  N Have any claims or suits been made against the applicant or any listed inspector in the last five years?
  18. Y  N Is the applicant or any listed inspector aware of any issues, circumstances, errors, omissions, or offenses which may result in a claim being made against the applicant, any listed inspector, or the business?
  19. If the answer to 14, 15, or 16 is YES, please explain


    I certify that I have read the questions above, and have answered each truthfully and completely to the best of my knowledge

    I further herein certify that I understand and agree as follows:

    1. This is a CLAIMS MADE policy form, and any claim or suspected claim must be reported during the policy period for coverage to be in effect.
    2. Each and every loss shall be subject to the DEDUCTIBLE stated in the policy declarations.
    3. Coverage is only in effect for the TYPE OF BUSINESS stated in the declarations.
    4. Any material misrepresentations, failure to disclose material facts, or failure to disclose any pre-existing condition or incident may result in denial of coverage and/or rescission of the policy by the company.
    5. The policy contains EXCLUSIONS for situations not intended for coverage by the company, and it is the responsibility of the applicant to read the policy.
    By placing the initials of the applicant in the box below, the applicant acknowledges acceptance of the above, and understands that the initials carry the effect of a signature.

    Initials Date Name of applicant Title