NSPS Insurance Program

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NSPS Insurance Program

Thank you for the opportunity to present the NSPS Insurance Program.

Assurance

Risk Managers,

Inc. dba: ARM Multi Insurance Services

(ARM) was founded in 1998. We are an independent

insurance agency with offices in Aurora, Colorado and Woodland, California.

We specialize in risk management and insurance services; offering property, casualty, professional

liability coverage, surety, and personal lines insurance. With strong roots in the land surveying

industry, Lisa Isom, President of Assurance Risk Managers began working with land surveyors before

its formation. Those relationships led to our becoming the endorsed insurance agency for the state

association, the Professional Land Surveyors of Colorado (PLSC). Over time, Assurance Risk

Managers has acquired not only numerous other state endorsements but also the support of the Western

Federation of Professional Surveyors (WFPS) and also the National Society of Professional Surveyors

(NSPS) endorsement.

This recognition comes from our relationships which are based on our honesty, integrity and superior

level of service. Over these two decades we have developed exclusive coverages for the design

professional, principally the land surveyor. The NSPS Insurance Program offers members

and

organizations a comprehensive package to secure their insurable interests, while offering an exclusive,

competitive pricing structure and full protection to meet the specific needs of this industry.

Enclosed is the necessary information we need completed in order to provide a prompt and accurate

quotation. The Professional Liability application will need to be completed in the sections that pertain

to your operations, and will require a signature by an authorized person. We will also need verification

of membership within NSPS in order to provide the discounts applicable to the coverage included in

the Insurance Program.

After reviewing this application, contact us at (888) 454-9562 with any questions you may have.

Please return the completed application and associated material to Assurance Risk Managers, Inc. dba:

ARM Multi Insurance Services (CA #0C73841) at 10651 E. Bethany Drive, Suite 300, Aurora, CO

80014, or by fax at (303) 454-9564 or email.

Thank you again for your interest. My staff and I certainly look forward to working with you and your

organization in the future.

Sincerely,

Lisa Isom

Lisa Isom, President

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Company Name: NSPS #

Entity Type: Corporation LLC Sole Proprietorship Other

Contact Name:

Phone # Fax#

E-mail Website

Mailing Address: Physical Address #1:

What type of work does your company engage in?

Land Surveying % Civil Engineering % Other* %

* If “other” please be specific

Year Business was established Years of experience in this field

GENERAL LIABILITY

Existing Coverage

Carrier Expiration Date Premium $

Desired Limits: $1,000,000/$2,000,000 $2,000,000/$4,000,000

Have you had any claims in the past 3 years? No Yes (please provide details)

Do you have an umbrella requirement? No Yes; If Yes, what limit

$1,000,000 $2,000,000 $3,000,000 $4,000,000 $5,000,000 Other:

PROPERTY

Building Information

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PROPERTY (continued)

The following building questions are required as basic information about the structure where the property is stored is necessary.

Building Construction Frame Metal

Joisted Masonry Masonry Non-Combustible

Year Built

Year Updated Wiring Plumbing

Roofing Heating

Total square footage of building Square footage you occupy

Number of stories Basement Yes No Sprinklers Yes No

Replacement value of business property (i.e. furniture)

Replacement value of in-house (stationary) computer equipment

Replacement value of computerized surveying equipment (i.e. GPS, Total Station) Replacement value of non-computerized surveying equipment (i.e. tripod, shovel)

Please attach a schedule of surveying equipment valued over $500 (Year, Make, Model, S/N #, Cost New)

Have you had any claims in the past 3 years? No Yes (please provide details) Additional Locations (physical address):

AUTOMOBILE LIABILITY (Owned Autos)

Is your current auto policy a Personal or Business? Personal Business/Commercial

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AUTOMOBILE LIABILITY (continued)

Driver’s Name Date of Birth State Licensed License #

Comp/Collision Requested Yes No Deductible $500 $1,000

Have you had any claims in the past 3 years? No Yes (please provide details)

WORKERS’ COMPENSATION

Federal Tax ID Number (FEIN) Number of Employees FT PT

Estimated Annual Payroll

Surveyors $ Other $

Engineers $ Other $

Clerical/Drafting

(Office Only) $ Other $

Officers

Name Title Include / Exclude

Experience Modification Rate (if applicable)

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Does the business use an ATV or snowmobile in its operations? If so, replacement value: If so please provide information below.

Does the business use a boat in its operations? If so, replacement value:

If so please provide information below including length in feet, HIH (Hull identification #), type of motor (inboard, outboard or inboard/outboard) and horsepower of motor.

Field Equipment Schedule

Year Make Model Serial Number Cost New

_Description

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NSPS Insurance Program