Application for Stateside APM Hazard & Liability insurance bulk billing program.ALL fields must be completed.BI App Bulk Billing Company name * Person responsible for payment * Email * Phone * Address * Address Address Address City City State/Province state Alabama Alaska Arkansas Arizona California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State/Province Zip/Postal Zip/PostalProperties to addFirst download our template, then add your properties to it. You must complete all of the property information fields. We won't be able to process your application if any are blank.Download template What is the name of your spreadsheet * copy and pate the file name, so it's accurate No of properties? * How many properties does your spreadsheet contain?Have any of the properties suffered a loss. * No Yes Upload you completed spreadsheet * Drop a file here or click to upload Choose File Maximum upload size: 52.43MBStateside APM terms & conditionsI/We agree & understand that I am contracting with Stateside APM to provide Administrative Property Management Services which include the option to add property I/We manage to Stateside APM’ master insurance policies. The costs of which will be itemized on each invoice.I/We have read, understand and accept the Building & Liability Insurance and/or Home Warranty policy terms & conditions & agree to hold harmless Stateside APM for any reason including with regard to the suitability of the policy for my purpose, the amount of cover I choose or howsoever claims may be adjusted.I further agree that it is solely my responsibility as the property manager of these properties to ensure that the owner is fully aware of the policy terms and conditions and agree to hold harmless Stateside APM should I fail to do so.I/We understand that Full Terms & Conditions are available online at statesideapm.com/iptc and agree to ensure that I will pass this on to the owner of every property that I add to this application.I/We understand that the coverage offered by the Stateside APM programs does not replace E&O or General Liability insurance that my business should carry. I/We further agree to hold harmless Stateside APM from any action arising out of our negligence as a property manager.I/We understand it is our responsibility to notify Stateside APM of any change in property management and any change in occupancy status within 48 hours and agree to hold harmless Stateside APM should I fail to do so.New properties may be added at any time, by notifying Stateside APM using its agreed procedures.Policies may be cancelled at any time by notifying Stateside APM using its agreed procedures and a prorated amount of any premium paid will be refunded.I/We understand that vacant properties must be inspected in accordance with the conditions of the program the property has been added to and secured in a manner suitable for the area they are situated, which may require the provision of additional security measures the cost of which shall be borne by the owner or property manager. Failure to do so may affect cover and invalidate any claim and agree to hold harmless Stateside APM should I fail to do so.Proof of value may be required for sums insured of $150,000 and above.I/We authorize Stateside APM to collect payment for the selected options monthly by ACH from our nominated account. I/We understand that payments by any other method may attract additional fees.I/We understand and agree that should my payment fail cover for the properties covered by that payment will cease from the date of the last cleared payment and no claims will be accepted. I/we agree to hold harmless Stateside APM should my payment fail, and a claim is refused or denied as a result.Stateside APM reserves the right not to accept payment if it is received after the due date of the invoice and whether to remove or add any properties.I/We understand there is a $25 one-time setup fee applied to each property, for each product selected.Applications take 48 hours to process. Expedited service may be requested for an additional fee but agree to hold harmless Stateside APM for any delay howsoever caused.Payments by credit or debit card attract a 3.75% convenience fee. Payments by wire transfer attract an additional $25 processing fee.If payment is not received by the date due, the service and coverage will be cancelled from the date of the last premium payment received. A $25 per property reinstatement fee may be applied for reinstatement.Where cover has been requested, we agree to pay all premiums, setup and admin fees for the period cover is required.I/We understand that Stateside APM’s master policies are monthly policies and if I pay for 12 months in advance it does not guarantee the premium will not change during that period. Should the premium change I understand I will have the option to continue and pay the additional cost, or cancel and receive a prorated refund of premiums paidAll policies will commence from the Start Date indicated on this form unless we are notified in writing 48 hours in advance.Start dates cannot be earlier than the application date.I/we understand that all notifications regarding the property, cover, amendments, claims etc. must be made in writing, instructions by telephone or given verbally are not accepted and are not binding.I/We agree and understand that Stateside APM cannot give and has not, given any advice as to the amount of insurance that I/we should purchase or to the suitability of the cover provided and agree that this is solely my/our responsibility. I/we further understand that Stateside APM is NOT an insurance agency does not act as one and that they cannot advise on or procure any individual insurance policy for me.Full details of the policy terms and conditions and claims procedures, together with any additional terms and conditions imposed by Stateside APM are available at statesideapm.com/iptcThese Terms and Conditions supersede all previous Terms and Conditions and are in addition to the policy terms & conditions. By submitting this application, I agree to be bound by the policy terms and conditions of Stateside APM and its insurance carriers. Completed & submitted by * Position * Email * Phone * Checkboxes * I accept the Terms & conditions Signature * Clear Date * Submit If you are human, leave this field blank.