LAWYERS' PROFESSIONAL LIABILITY PRELIMINARY PREMIUM INDICATION
State:*
LAWYERS' PROFESSIONAL LIABILITY PRELIMINARY PREMIUM INDICATION
No. of hours per week for each OC:*
No. of attorneys (excl. OCs) - 5+ years with Applicant:
No. of attorneys (excl. OCs) - 4 years with Applicant:
No. of attorneys (excl. OCs) - 3 years with Applicant:
No. of attorneys (excl. OCs) - 2 years with Applicant:
No. of attorneys (excl. OCs) - 1 year with Applicant:
No. of attorneys (excl. OCs) - less than 6 months with Applicant:
Is this a full-time, private practice of law?*
Estimated annual gross income?*
LAWYERS' PROFESSIONAL LIABILITY PRELIMINARY PREMIUM INDICATION
Do you maintain a Docket Control System with at least two independent date controls?
Is a Conflict of Interest System maintained?*
Are engagement and non-engagement letters used on a regular basis?*
LAWYERS' PROFESSIONAL LIABILITY PRELIMINARY PREMIUM INDICATION
Retro/Prior Acts Date (mm/dd/yyyy):
Date of first continuous claims-made coverage*
LAWYERS' PROFESSIONAL LIABILITY PRELIMINARY PREMIUM INDICATION
Are you aware of any claims against you or your firm or any incidents that could result in a claim against you or your firm within the past five years?*
If "Yes", how many? Please provide specific details of each, including a description of the allegations, current reserve and/or indemnity paid, expenses paid, etc.
Has any member of the applicant firm been refused admission to practice, disbarred, suspended, reprimanded, sanctioned, or held in contempt by the court administrative agency or regulatory body?*
If "Yes", please provide details.
LAWYERS' PROFESSIONAL LIABILITY PRELIMINARY PREMIUM INDICATION
Area of Practice Percentages (percentages must total 100%)
Antitrust/Trade Regulation:
Banking/Financial Institutions:
Civil Rights/Discrimination:
Domestic Relations/Family:
Estates/Probate/Wills/Trusts:
Social Security/Elder Law:
LAWYERS' PROFESSIONAL LIABILITY PRELIMINARY PREMIUM INDICATION
* Is any of this work Class Action/Mass Tort?*
If "Yes", please provide details.