STG Request for Approval to Issue Overlimits (Large) Policy or Extra Hazardous Coverage [Revised 11-10-21]

Date:

Name of Person Requesting Approval:

Telephone #:

Email Address:

Agency Name:

Stewart/ALTA ID:

Agency Address:

File Number:

City:

State:

ZIP:

Subject Property Address: (If an address is not available, please include City, or County, State and ZIP)

City:

State:

ZIP:

Anticipated Closing Date:

Project Name/Project Reference (“Re:”), if applicable:

1.  List the Policy Form(s), Type, Insured and Stewart’s Policy Amount
THIS SECTION IS REQUIRED. Please do not leave it blank. If a Policy Form is not identified, the form will be the 2021 ALTA Policy. Attach a copy of Commitment(s), Preliminary Report(s) and any Pro Forma(s).

2.   Description of the Property (e.g., undeveloped, apartments, offices, etc.):

3.   Describe: (a) transaction and (b) purpose of financing (briefly, but in detail):

4.   Title was searched and examined from ____________ to ____________.

5.   Starter, if any. Please specify and include a copy:  Yes     No

6.   If this property was the subject of a prior Over Limits Approval, please insert the prior approval #:
_____________________

7.   Describe grantor/mortgagor (e.g., person, entity) and authority (e.g., power of attorney, corporate resolution, etc.):

8.  Please select any of the following that apply to this transaction (anything left unchecked will represent “does not apply”):

   A construction loan

   Broken-priority (e.g., early start) or no-priority. If YES, please describe in a supplement.

   Recent construction performed or completed within the lien period. If YES, please describe in a supplement.

   Request for Mechanic’s Lien Coverage? NOTE: If this transaction is a construction loan and if the total project cost (i.e. the loan amount plus other contributions) is equal to or greater than $40,000,000, please also complete STG High Liability (Over $40 Million) Mechanic’s Lien Coverage Approval Request

   Tidelands, filled land, submerged land, navigable waters or riparian issues

   Insuring title to railroad property

   Title based upon judicial proceedings (e.g., tax foreclosure, condemnation, bankruptcy)

   Title based upon foreclosure or deed in lieu of foreclosure

    Mineral coverage on commercial property in area of mineral development

    Title derived from foreclosure or deed in lieu of foreclosure regarding a construction loan deed of trust, within the last three years

(continued selections from #8 on page 1)

    Easement independent of real property (e.g., an easement in gross)

    Insured Option

    Native American (Indian) lands

   Insuring Water Rights

   Sheriff’s Sale, Tax Sale or Receivership Sale in last 10 years (other than mortgage foreclosure)

   Insuring a lease and/or a mortgage encumbering a lease. If YES, please attach a copy of the lease and describe consents/estoppels in a supplement.

   Assignment or partial assignment or mortgage of a lease, easement, or other interest. If YES, describe consents/approvals to be obtained in a supplement.

   Any purchase contract(s) or option(s) outstanding including right of first refusal, right of first offer, other than the purchase contract in favor of the proposed insured

   Other extra hazardous risks, such as those shown in VU Underwriting Manual Section 5.36

   Current, recent or impending litigation that might affect the subject property

   A transaction that, to your knowledge, has been turned down by another Underwriter

   An energy project (e.g., wind, solar, geothermal, hydro, etc., including conventional) and/or any energy endorsement(s)
    Other unusual risks, issues and/or affirmative coverages, if any. If YES, please describe in a supplement.
    Co-insurance? If YES, please list the co-insurers and their liability amounts/percentages
If “YES” to any of the above, please describe below or in a supplement.

9.  This policy will be issued by (MUST be completed):

    an issuing agent authorized in the state, in compliance with state law; or
    direct issue/home office, in compliance with state law

Signature

Date

Endorsements and/or affirmative/express insurance requested. / Please use this area if you need additional space.

CPL Date:

CPL Limit: $

Email:

Addressee/Covered Party: (a CPL will be issued for each type of party selected below. Buyer/Borrower is required if Lender Addressee)

Lender

Buyer

Seller

Buyer/Borrower/Lessee

Seller

Name:

Address:

City, State, Zip:

Primary Lender

Secondary Lender

Name:

Include “Its Successors and/or Assigns” Language

Yes        No

Yes        No

Address:

City, State, Zip:

Loan Number:

Lender Attention To:

Closing/Settlement Office: (enter ONLY if this office needs to appear on the CPL and is different from the Agency referenced on page 1)

Name:

Stewart/ALTA ID:

Address:

File Number:

City:

State:

ZIP: