Home Staging Professionals Program Application

* Required

Company Information:

Name of Entity: * 🛈

Years in Operation * 🛈

Legal Entity Type: *

If Other, Describe Here

Are their other Entities with Insurable Interest? *

If Yes, please list all of the entities along with a description of their interest.

Questions? Call Deb Prein or Mike Brown at (610) 696-6081

Contact Information:

First Name: *

Last Name: *

Title: *

Phone Number: *

Email: *

Professional Designations:

Street: *

City: *

State: *

Zip: *

Private Residence? *

Year built: * 🛈

Sprinkler System? *

Central Station Monitored Fire Alarm? *

Central Station Monitored Burglar System? *

Questions? Call Deb Prein or Mike Brown at (610) 696-6081

Mailing Address (if different than above):

Street:

City:

State:

Zip:

Current Insurance Information:

Current Coverage? *

Current Carrier:

Premium

Expiration Date of Current Policy(ies): +

Upload Current Policy if Available: 🛈

Have you had any claims in the past? *

If Yes, please describe:

Questions? Call Deb Prein or Mike Brown at (610) 696-6081

Business Information:

Website (if applicable):

Do you have any Professional Certifications? *

How many Staging engagements do you perform in a given year? *

Have you filed for bankruptcy, foreclosure, repossession, or had any liens filed against you in the past 5 years? *

If Yes, provide details:

# of employees including yourself? *

Annual Employee Wages *

Annual Revenues: *

Questions? Call Deb Prein or Mike Brown at (610) 696-6081

Liability Information:

Do you or your organization perform any of the following: (If so, provide a brief explanation)

Construction or Renovation (including any electrical, plumbing, etc. *

Construction Description

Remodeling (including painting, wallpapering, etc. *

Remodeling Description

Real Estate services (including listing properties, buyer representation, etc. *

Real Estate Services Description

Moving or Storage *

Moving and Storage Description

Do you hire subcontractors directly (in lieu of homeowner) to perform any of the above services? *

Description of subcontractor relationship and whether there is written agreement and with whom.

IMPORTANT: We require the homeowner hire contractors directly. If your company hires the contractors you could be found liable for claims arising out of their work. Many Carriers specifically exclude coverage for work done on your behalf by Sub-Contractors.

Questions? Call Deb Prein or Mike Brown at (610) 696-6081

Staging Property Information:

Do you have inventory you own and use in your staging business? *

If so; what is the total value of inventory you own:

How much inventory do you sell in a given year? *

Do you store your customer's furniture / fixtures? (We recommend your customer's arrange for the storage of their assets themselves due to potential insurance complications) *

If so; what is the total value of inventory your store for others?:

Questions? Call Deb Prein or Mike Brown at (610) 696-6081

Building Information:

If you store inventory at any OTHER LOCATION THAN ABOVE please answer the following:

Street:

City:

State:

Zip:

Year built:

Year of roof update:

Year of wiring update:

Year of plumbing update:

Year of heating/cooling update:

What type of construction?

Description of Other:

Sprinkler System?

Central Station Monitored Fire Alarm?

Central Station Monitored Burglar System?

If you use a public storage facility, is your unit climate controlled?

Questions? Call Deb Prein or Mike Brown at (610) 696-6081

Automobile Information:

Does your company own any automobiles? *

Do any of your employees use their own auto when performing their duties? *

If so; please describe the usage:

Questions? Call Deb Prein or Mike Brown at (610) 696-6081

Thank you for utilizing this system. You should receive confirmation of your request via email. A KMRD representative will reach out to you with questions if we have them. If you do not hear from us, feel free to call at 610-696-6081 or contactus@kmrdpartners.com

This form is for communication purposes only. This form does not bind coverage