Application | Language Protect

Interpreter and Translator Application

Section 1: Insured Details

Insured Name*

First Last

Legal Business Name: (if applicable)

Applicant is:*

Physical Address:*

Street Address City State Zip Code

Mailing Address: (if different than the physical address)

Street Address City State Zip Code

Contact Name:*

Full Name of Primary Contact

Email Address:*

Phone Number:*

Desired Effective Date:*

Estimated Annual Revenue:*

Section 2: Underwriting Questions

1. How many years of experience do you have in interpreting/translating?

2. Are you an ASL Interpreter?

Yes

3. Are you an interpreter/translator other than ASL?

Yes

3b. What languages do you interpret/translate?

4. Are you a member of RID?

Yes

5. Are you certified or licensed where your business operates?*

Yes

6. Do you offer services other than interpreting/translating?

Yes

6b. If yes, please describe the service(s) provided, along with the revenue generated by those services.

7. Please provide a list of all relevant Certifications / Accreditations

7. Please provide a break-down of revenue generated by the following segments.

Business / Community %*

Local & Federal Government %*

Emergency Services %*

(Fire, Police, Paramedics)

Medical Professionals %*

Legal Professionals / Court Services %*

Includes translation/interpretation of legal documents and/or court proceedings.

Education %*

Total:

Total must equal 100%

8. Have you been subject to any professional discipline, claims, or lawsuits, within the past five(5) years?

Yes

8b. If yes, please provide details below, including date(s) and any dollar amounts.*

9. What agencies do you provide service for?

Truthfulness Attestation for Liability Insurance Application

I hearby attest to the truthfulness and accuracy of the information provided in my liability insurance application submitted to Language Protect administered by Fortress Intermediaries, LLC DBA Citadel Insurance.

I certify that all details furnished in the application pertaining to my business operations, assets, liabilities, and any other relevant information are true and complete to the best of my knowledge. I understand that the accuracy of this information is crucial for assessing the risks associated with my business.

I acknowledge that any misrepresentation or omission of material facts could lead to the denial of coverage or limitations on the benefits provided by the insurance policy.

I further understand that it is my responsibility to promptly inform Language Protect administered by Fortress Intermediaries, LLC DBA Citadel Insurance of any changes to the information provided in the application, including but not limited to changes in business activities, ownership structure, or legal status.

Insured Signature:*

Date:*

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