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Preliminary Questionnaire For Outside Adjusters/Investigators/Auto Damage Appraisers

* - Fields are required

* Date Completed:

* FEIN:

* D&B #:

* Company Name:
* Main Office Address:

* Contact Person:
* Title:
* Phone:		* E-Mail:
* Company Website:
* Number of Full Time Investigators/Adjusters:
* Number of Part Time Investigators/Adjusters:
* Does your Company use Independent Contractors?:
* E&O Coverage Amt:		* Insurance Co.:
* States in which your company is licensed:
* Locations of all offices:

Areas of Expertise:	Yes	No
AOE/COE (Workers’ Compensation)
Auto Damage Appraisals
Auto Liability
Municipal Claims
Educational Claims
Cause & Origin
Construction Claims
Property Claims Investigation
Property Claims Adjustments
Surveillance/SIU Investigation
E & O
Sexual Misconduct
Civil Rights Violations
Discrimination
Other (Explain)

Please identify any web based file management system used by your company.
Please identify any estimating software programs used by your company.
Please identify any industry organizations or associations to which your company belongs.
Does your company have a brochure and/or fee schedule? If so, please forward.
Please list several of your larger insurance company clients.
Does your company have a staff resume? If so, please forward.
Have there been any legal actions taken against your company by customers, government agencies or consumer groups within the past two years? If yes, explain.
Have there been any Error & Omissions claims in the past five years against your company? If yes, explain
Please provide any other information you believe would assist us in evaluating your company for placement on our panel.