I understand and agree this Application and any supplements may be made part of any policy issued, and that any such policy will be issued in reliance upon the representations made herein. Failure to provide true and accurate responses may, at the option of the Company, result in the voiding of insurance issued in reliance on this Application and/or denial of claims under any policy issued.
I authorize investigations of information bearing upon moral character, professional reputation, and fitness to engage in the activities of my business, and authorize any person or entity to release relevant documents, records, or information to the Company and to its underwriters.
Applicant and all owners, employees, and contractors are licensed or duly authorized in all states or jurisdictions where professional services are provided. Applicant warrants the truth of all answers above and has not withheld information calculated to influence the judgment of the insurer. Signing this form does not bind the company to complete the insurance.
