LIO Insurance
Homeowners Association Application
Complete all required fields • Fields marked ● are required
🏘️ Homeowner Association

How to complete and submit this application

  1. Fill out all required fields in the form below.
  2. Click Save as PDF at the bottom of the application. When the print dialog opens, save the file as a PDF to your computer.
  3. Email the saved PDF to the LIO underwriter you are working with, or to a LIO Regional Executive if it is a new application.

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1. Producer & Submission Info
2. Named Insured
Mailing Address
3. Risk Location
Enter the primary location of the association. If the association covers multiple developments, enter the principal address. If same as mailing, check below.
4. Business Class & Coverage Requested
Business Class
Select the HOA business class that matches the applicant. This drives the available classification codes and the premium basis (Number of Members vs. Units).
Lines of Coverage
General Liability Limits
Optional Coverages
Select all optional coverages requested. Limits are fixed at LIO's offered values for HOA.
5. Ineligible Exposures & Declaration
The operations and exposures listed below are ineligible for LIO's Homeowner Association product. Review carefully, then complete the declaration at the bottom of this section.
  • Affordable Housing
  • Glass Buildings
  • Polybutylene Piping
  • Aluminum Wiring / Zinsco / Stab-Lok / Federal Pacific
  • Golf Course on Premises Not Insured Elsewhere / Separately
  • Pools with Diving Boards / Slides / Lazy Rivers
  • Bridges Over $100,000 in Property Value
  • Historical Buildings
  • Rental Communities — Less than 70% Owner-Occupied
  • Buildings Built on Piers
  • Hunting and Shooting
  • Restaurant / Bars
  • Buildings Greater than 4 Stories
  • Ice Fishing
  • Skate Park
  • Commercial Properties
  • Ice Skating
  • Spa / Beauty Salons
  • Condo Associations
  • Individual Owners (HO-3 Policies)
  • Student Housing
  • Dams
  • Jet Skiing / Snow Skiing / Waterskiing
  • Vacation / Resort Properties
  • Docks
  • Lake / Pond / River (Over 100 Acres)
  • Wood Shake Roofing / Siding (CA Only)
  • Equestrian Exposure
  • Zip-Lines
  •  
6. Liability Exposure – Classification Details
Required. Add one row per classification. The primary HOA class (68500 or 62003) is typically the lead exposure; common areas and amenities (pools, playgrounds, etc.) should each be added as separate rows. Premium basis defaults to Units for Single Family/PUDs/Townhouse and Number of Members for Master Associations.
Classification * Premium Basis Exposure * Remove
Units Breakdown (Single Family / PUD / Townhouse)
Premium basis is auto-set per the Business Class selected in Section 4. Master Association → Number of Members. Single Family / PUD / Townhouse / HOA → Units. Common-area classes such as Swimming Pools (48925), Parks (46671), and Streets/Roads (48727) use class-specific bases (Area, Square Feet, etc.) per ISO; describe to the underwriter in the brokerage submission email.
7. Underwriting Supplemental – Homeowner Association
Questions are bucketed by topic. Line-specific subsections (General Liability, Property, Inland Marine, Excess, Accident) appear automatically based on the lines of coverage selected in Section 4. Class-conditional questions (e.g., pools) appear only when those classes are added in Section 5.
A. General
Applicant is a new entity with no prior insurance coverage
Applicant has experienced a loss in the last 5 years for a coverage being requested
Applicant has been involved in bankruptcy, criminal or civil proceedings
Applicant has had insurance denied, cancelled, or non-renewed by an insurance company in the last 5 years for a coverage being requested
This is a mid-term quote or coverage is currently lapsed
Applicant is currently insured by a surplus lines carrier
B. General Liability – HOA Underwriting Questions
Does the applicant own any residential buildings?
Is the association a 55+ community?
Does the applicant conduct routine inspections of the premises with established procedures to address necessary repairs / maintenance issues identified during inspections?
Does the association employ armed security guards?
Do employees or volunteers operate power equipment or machinery (e.g., excavators, backhoes, chainsaws, chippers)?
Are independent contractors utilized?
8. Fraud Warning & Declaration
⚠ NOTICE TO POLICYHOLDERS — FRAUD NOTICE (NTC FR01 10/21)

NOTICE TO APPLICANTS: Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any materially false information, or conceals, for the purpose of misleading, information concerning any fact material thereto, commits a fraudulent act, which is a crime, and may subject such person to criminal and civil penalties.

NOTICE TO ALABAMA APPLICANTS: Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or who knowingly presents false information in an application for insurance is guilty of a crime and may be subject to restitution, fines, or confinement in prison, or any combination thereof.

NOTICE TO ARKANSAS, LOUISIANA, RHODE ISLAND, AND WEST VIRGINIA APPLICANTS: Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or knowingly presents false information in an application for insurance is guilty of a crime and may be subject to fines and confinement in prison.

NOTICE TO CALIFORNIA APPLICANTS: For your protection California law requires the following to appear on this form: Any person who knowingly presents false or fraudulent information to obtain or amend insurance coverage or to make a claim for the payment of a loss is guilty of a crime and may be subject to fines and confinement in state prison.

NOTICE TO COLORADO APPLICANTS: It is unlawful to knowingly provide false, incomplete, or misleading facts or information to an insurance company for the purpose of defrauding or attempting to defraud the company. Penalties may include imprisonment, fines, denial of insurance, and civil damages. Any insurance company or agent of an insurance company who knowingly provides false, incomplete, or misleading facts or information to a policyholder or claimant for the purpose of defrauding or attempting to defraud the policyholder or claimant with regard to a settlement or award payable from insurance proceeds shall be reported to the Colorado Division of Insurance within the Department of Regulatory Agencies.

NOTICE TO DISTRICT OF COLUMBIA APPLICANTS: Warning: It is a crime to provide false or misleading information to an insurer for the purpose of defrauding the insurer or any other person. Penalties include imprisonment and/or fines. In addition, an insurer may deny insurance benefits if false information materially related to a claim was provided by the applicant.

NOTICE TO FLORIDA APPLICANTS: Any person who knowingly and with intent to injure, defraud, or deceive any insurer files a statement of claim or an application containing any false, incomplete or misleading information is guilty of a felony of the third degree.

NOTICE TO KANSAS APPLICANTS: Any person who knowingly and with intent to defraud, presents, causes to be presented or prepares with knowledge or belief that it will be presented to or by an insurer, purported insurer, broker or any agent thereof, any written, electronic, electronic impulse, facsimile, magnetic, oral, or telephonic communication or statement as part of, or in support of, an application for the issuance of, or the rating of an insurance policy for personal or commercial insurance, or a claim for payment or other benefit pursuant to an insurance policy for commercial or personal insurance that such person knows to contain materially false information concerning any fact material thereto; or conceals, for the purpose of misleading, information concerning any fact material thereto commits a fraudulent insurance act.

NOTICE TO KENTUCKY APPLICANTS: Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance containing any materially false information or conceals, for the purpose of misleading, information concerning any fact material thereto commits a fraudulent insurance act, which is a crime.

NOTICE TO MAINE APPLICANTS: It is a crime to knowingly provide false, incomplete or misleading information to an insurance company for the purpose of defrauding the company. Penalties may include imprisonment, fines or a denial of insurance benefits.

NOTICE TO MARYLAND APPLICANTS: Any person who knowingly or willfully presents a false or fraudulent claim for payment of a loss or benefit or who knowingly or willfully presents false information in an application for insurance is guilty of a crime and may be subject to fines and confinement in prison.

NOTICE TO MINNESOTA APPLICANTS: A person who files a claim with intent to defraud or helps commit a fraud against an insurer is guilty of a crime.

NOTICE TO NEW JERSEY APPLICANTS: Any person who includes any false or misleading information on an application for an insurance policy is subject to criminal and civil penalties.

NOTICE TO NEW MEXICO APPLICANTS: Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or knowingly presents false information in an application for insurance is guilty of a crime and may be subject to civil fines and criminal penalties.

NOTICE TO NEW YORK APPLICANTS: Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any materially false information, or conceals for the purpose of misleading, information concerning any fact material thereto, commits a fraudulent insurance act, which is a crime, and shall also be subject to a civil penalty not to exceed five thousand dollars and the stated value of the claim for each such violation.

FIRE: Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance containing any false information, or conceals for the purpose of misleading, information concerning any fact material thereto, commits a fraudulent insurance act, which is a crime.

NOTICE TO OHIO APPLICANTS: Any person who, with intent to defraud or knowing that he is facilitating a fraud against an insurer, submits an application or files a claim containing a false or deceptive statement is guilty of insurance fraud.

NOTICE TO OKLAHOMA APPLICANTS: Warning: Any person who knowingly, and with intent to injure, defraud or deceive any insurer, makes any claim for the proceeds of an insurance policy containing any false, incomplete or misleading information is guilty of a felony.

NOTICE TO OREGON APPLICANTS: Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any materially false information or conceals, for the purpose of misleading, information concerning any fact material thereto, may be guilty of a fraudulent act, which may be a crime, and may subject such person to criminal and civil penalties.

NOTICE TO PENNSYLVANIA APPLICANTS: Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any materially false information or conceals for the purpose of misleading, information concerning any fact material thereto commits a fraudulent insurance act, which is a crime and subjects such person to criminal and civil penalties.

NOTICE TO TENNESSEE, VIRGINIA AND WASHINGTON APPLICANTS: It is a crime to knowingly provide false, incomplete or misleading information to an insurance company for the purpose of defrauding the company. Penalties include imprisonment, fines and denial of insurance benefits.

NOTICE TO VERMONT APPLICANTS: Any person who knowingly presents a false statement in an application for insurance may be guilty of a criminal offense and subject to penalties under state law.
I DECLARE THAT THE STATEMENTS MADE IN THIS APPLICATION ARE COMPLETE AND TRUE. The undersigned authorized representative of the Association affirms that all information provided is accurate and complete to the best of their knowledge. I understand that coverage is not bound until confirmed in writing by LIO Insurance.
9. Signatures
Applicant / Authorized Representative
Signature
Producer / Broker
Signature
This form is designed to align with the LIO General Liability digital underwriting experience • Business Class: Homeowner Association • Field mapping per exported offer rules 04/21/2026
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