NESHTA Online Application

Thank you very much for applying for General/Professional Liability through your association as a NESHTA member benefit .
NESHTA LOGO

Please note all members may not be eligible for this coverage. 

Once your application has been completed and returned it will be submitted to an underwriter for review. Please take a moment to review the following description of operations listed hereunder which are used in determining primary eligibility for this program. If you have questions concerning whether your business practices meet these requirements please contact David Vaughan Jr. at (918) 779-7884 or 
dlvjr@higginbotham.net.

Regulatory Compliance Consulting: Environmental Health, Safety, Education, Rescue Training and Education, Office & Shop Training and Education, First Aid Training and Education, Permitting, Monitoring, Site Investigation and Occupational Health. Environmental Safety and Health Regulations Training and Education. All Consulting Professional Services provided are required to comply with all laws and regulations at a local, state and federal government level in accordance with any and all Federal Regulatory Compliance requirements.

Please Be Advised There Is NO COVERAGE For Bodily Injury or Property Damage to Participants/Students Participating in Physical Training Techniques.

If it is determined that your work is outside the acceptable criteria for this program, please be assured that we will make every effort to obtain the very best coverage at the most affordable price with an alternate insurance provider. Please note that subcontractors are not covered under this policy

Once your application has been approved by the company you will be notified via email from Vaughan Insurance Group. Attached to this notification will be an invoice for the annual premium. As soon as payment has been received, you will be provided a policy binder for 60 days indicating your coverage has been bound pending receipt of your policy from the insurance company. Also, any certificate of insurance requests will be sent at this time.

To apply for General/Professional Liability please complete and submit the form below.

Coverage not available under this particular program in the following states, however, we can look at alternative coverage options for you.
  • AK
  • AL
  • DE
  • IL
  • IN
  • MS
  • TX
  • VA
  • VT
  • WI

NESHTA: National Environmental, Safety, and Health Training Association

FOR MEMBERS applying for General/Professional Liability as a NESHTA member benefit through THEIR association.


*Please note that "Prior Acts" coverage is only available when your expiring policy is written on on a "claims made" form directly prior to purchasing this coverage. Coverage for "Prior Acts" will be provided for a (2) year term for a one time premium charge of 25% of the annual premium

Applicant Information Section
















For "Other" please specify above.









Definition: You are at one jobsite or facility the majority of the time and oversee the adherence to, and implementation of compliance regulations for all workers.

Definition: You inspect the jobsite records of multiple customers periodically and report the compliance with regulations. You do NO implementation of Compliance Regulations

ADDITIONAL INFORMATION








LOSS HISTORY




Claim Date Claim Description Amount Paid
Claim 1
Claim 2
Claim 3
Claim 4
Claim 5

Claim Date Claim Description Amount Paid
Claim 1
Claim 2
Claim 3
Claim 4
Claim 5

CURRENT COVERAGES


Insurance Company Effective Coverage Date Policy#
Commercial General Liability Policy Info

Insurance Company Effective Coverage Date Policy#
Commercial Auto Policy Info

Insurance Company Effective Coverage Date Policy#
Workers Comp Policy Info

Insurance Company Effective Coverage Date Policy#
Excess /Umbrella Policy Info

PRICING AND PREMIUM DETERMINATION






If "Yes" coverage will not be bound
Financing options are available upon request.

Thank you for allowing us to service your insurance needs. It has been a pleasure serving you. Should you have any additional questions, please contact David Vaughan Jr. at (918) 779-7884 or dlvjr@higginbotham.net.

* INFORMATION CONTAINED HEREIN TO THE BEST OF MY KNOWLEDGE IS ACCURATE AND COMPLETE




Contact Information