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The Fox Point Team

PROFESSIONAL BAIL AGENTS
OF THE UNITED STATES–
BAIL AGENT PROFESSIONAL
LIABILITY INSURANCE APPLICATION

  NOTICE: THE POLICY FOR WHICH YOU ARE APPLYING IS WRITTEN ON A CLAIMS-MADE AND REPORTED BASIS. ONLY CLAIMS FIRST MADE AGAINST THE INSURED AND REPORTED TO THE COMPANY DURING THE POLICY PERIOD ARE COVERED SUBJECT TO THE POLICY PROVISIONS. THE LIMITS OF LIABILITY STATED IN THE POLICY ARE REDUCED, AND MAY BE EXHAUSTED, BY CLAIMS EXPENSES. CLAIMS EXPENSES ARE ALSO APPLIED AGAINST YOUR DEDUCTIBLE, IF APPLICABLE.  

RATES SHOWN BELOW ARE FOR APPLICANTS GENERATING GROSS REVENUES OF $300,000 OR LESS ANNUALLY AND POSSESSING THE FOLLOWING RISK CHARACTERISTICS:
  • Does not provide Fugitive Recovery or Skip Tracer-related services for others
  • Is a member of the Professional Bail Agents of the United States (PBUS) Association
  • Has had no claims activity over the past 3 years
 
STEP 1 DETERMINE LIABILITY LIMIT AND RETENTION REQUIRED:
 
Limit of Liability Bodily Injury/Property
Damage Sub-Limit
Deductible
ANNUAL REVENUE
$150,000 or less $150,001 to $300,000
Premium Premium
$250,000/$250,000 $100,000 $5,000                              
$500,000/$500,000 $250,000 $5,000                              
$1,000,000/$1,000,000 $250,000 $5,000                              
 
STEP 2 SELECT OPTIONAL COVERAGE:
 
SELECT COVERAGE Description Premium Charge
Independent
Contractors
Expands coverage to include up to 3 independent contractors working under Applicant's direction. Independent Contractor supplemental application must be completed. $200.00
 
STEP 3 CALCULATE FINAL PREMIUM DUE:
 
SELECTED COVERAGE
FROM STEP 1
SELECTED OPTION
FROM STEP 2
POLICY TAXES AND
FEES (REQUIRED)
TOTAL
AMOUNT DUE
$0.00 + $0.00 + $250.00 = $0.00
             
 
GENERAL INFORMATION
 
A. Name of Applicant: 
Applicant Address: 
City:  State:  Zipcode: 
Telephone:  Fax: 
Email:   
B. Date Business Established:    Federal ID Number:  License Number: 
C. Is the Applicant a member of PBUS?
  NOTE: Rates shown above are exclusively for PBUS members.  Applicants not belonging to this organization should contact Rockwood Programs.
D. Prior Acts coverage required? If "Yes", please specify retro-date:   
  NOTE: An additional premium may be assessed for Prior Acts coverage.  Proof of previous insurance may be required.
 
FINANCIAL AND BUSINESS INFORMATION
 
A. Provide gross annual revenues.  Amounts shown in the Gross Commission column should reflect the amount retained by the Applicant after payment of premium to Insurance Carrier and after payment to Build Up Fund, but before payment of any claims.
    Gross Annual Commissions

  Other Revenues

  Total Annual Revenues

Prior Year:  $   $   $
Current Year:  $   $   $
Projected Next Year:  $   $   $
B. What background do the principals have in the Law Enforcement/Bail Industry?
 
Type of agent: 
Certified CBA: 
Please indicate breakdown of employees:  
    Bail Agents Sub Agents Recovery Agents Clerical Employees Other Employees
Do you use independent contractors? Do they carry their own insurance?
Annual gross receipts (not bond premium, your office sales) $
Annual number of bail bonds written:  Average dollar amount of a bail bond written:  $
Annual number of defendants apprehended by:
  Your Firm  Recovery Agents  You For Others 
Are weapons used? 
Do you write any other types of bond (ie: civil bonds, notary publics, investigator bonds, etc)?       
Previous professional liability insurer:  Expiration date:   
Have you incurred any professional liability, property damage, or bodily injury losses over the past 3 years?
Training: (please provide the no, of hours of training for each category)
  On–the-job training: 
  Classroom training: 
  Other (describe):  
Pre-Employment Screening:
Fingerprints:  Honesty Testing:  Prior Employer: 
Drug Testing:  Psychological Testing:  Personal Interview: 

 

THE APPLICANT WARRANTS THAT THE STATEMENTS AND RESPONSES TO THE QUESTIONS ON THIS APPLICATION ARE TRUE AND COMPLETE.  THIS APPLICATION DOES NOT BIND THE APPLICANT OR THE COMPANY, NOR DOES IT OBLIGATE THE COMPANY TO ISSUE A POLICY. SUCH POLICY MAY BE CANCELLED BY THE COMPANY FROM INCEPTION UPON DISCOVERY THAT THE POLICY WAS OBTAINED THROUGH A FRAUDULENT STATEMENT, OMISSION, OR CONCEALMENT OF THE FACTS MATERIAL TO THE ACCEPTANCE OF THE RISK OR HAZARD ASSUMED.

  I Agree