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Home > Professional Liability Insurance > Lawyers Professional Liability Quotes
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Lawyers Professional Liability Quotes


Fill out the following form as completely as possible. Once you have completed the form, click the Submit button to send your information. Your request will be handled promptly.

Firm Name *
Year Est. *
Street *
City *
State / Province *
ZIP / Postal Code *
Contact Person
First Name *
Last Name *
E-Mail Address *
Primary Phone Number *
Fax # *
County *
Current Coverage
Name of Agent/Broker
Current Insurer - If No Current Coverage - Enter None *
Current Policy End Date
/ /
Current Limits
Current Deductible
Current Retro Date
/ /
Expiring Premium
1. Has the firm or any attorney at the firm had any Claims, Suits or Incidents in the Past 5 Years *

If Yes, How Many?
(If Yes, complete the Claim Information Section near the bottom)
2. Does the firm do any Class Action, Mass Tort or Toxic Tort Class action? *

If yes, need details.
3. Is the firm aware of any circumstance(s) or act(s) which may give rise to a claim? *
4. Have 50% of the firm’s attorneys attended CLE in the last 12 months? *
5. Number of Docket Control Systems? *
Is at least one Computerized? *

6. Do you have a Computerized Conflict of Interest control System? *

7. Has any attorney with the firm ever been disciplined or denied the right to practice? *
If yes, need details.
8. CHECK any used by firm



9. Gross Fees for next 12 months *
Percentage of Income Derived from the Following Areas of Practice
Administrative Law
Admiralty/Maritime
Admiralty Defense
Adoptions
Antitrust/Trade Regulation - Defense
Antitrust/Trade Regulation - Plaintiff
Appellate
Arbitration/Mediation
Aviation
Bankruptcy *
Banking
BI/PD Defense
Bond
Business Transactions
Cannabis Law *
Civil/General Litigation
Civil Rights
Collections *
Class Action/Mass Tort – Defense *
Class Action/Mass Tort – Plaintiff *
Commercial Defense
Commercial Law
Commercial Litigation
Construction Law
Consumer Claims
Contracts
Copyright/Trademark
Corporate – Business Formation/Alteration
Corporate – Business Transactions/Advice
Corporate General Counsel/Litigation
Criminal Law
Disability/Social Security
Divorce
Elder Law
Employment Law
Entertainment *
Environmental *
ERISA
Estate Planning
Estates/Trust/Probate *
Family Law (Non Divorce)
Family Law (Divorce)
Fiduciary
Financial Institutions *
Foreclosures
Foreign Law
Guardianships
Healthcare
Immigration/Naturalization
Insurance Defense Litigation
Insurance Other
International Law
Investment Counseling/Money Management
Juvenile
Lobbying
Labor/Management
Labor/Employee
Labor – Union Related Work
Landlord Tenant Leases
Medical Malpractice - Defendant
Medical Malpractice – Plaintiff *
Mergers & Acquisitions
Municipal Law/Federal/State/Local
Oil/Gas
Patent
Personal Injury - Defendant
Personal Injury – Plaintiff *
Plaintiff BI/PI (Non Product Liability)
Product Liability
Public Utilities
Real Estate – Commercial *
Real Estate – Residential *
Securities Law
Secured Transaction
Taxation Preparation
Taxation Representation/Opinions
Traffic
Tax Shelters
Wills
Workers’ Compensation – Defendant
Workers’ Compensation - Plaintiff
Other (Describe)
This Form is For Estimate Purposes Only!
Lawyers Detail Addendum
Firm Name *
Upload additional sheets if necessary
Name of Lawyer (State the full name of each lawyer) *
D/C (Designated Codes, seen below) *
Date Admitted to Bar MM/YY *
Date of Hire by Applicant MM/DD/YY *
Number of Hours Worked per Week on behalf of the Applicant *
Total Number of CLE Hours Taken During the Past Year *
Name of Lawyer (State the full name of each lawyer)
D/C (Designated Codes, seen below)
Date Admitted to Bar MM/YY
Date of Hire by Applicant MM/DD/YY
Number of Hours Worked per Week on behalf of the Applicant
Total Number of CLE Hours Taken During the Past Year
Name of Lawyer (State the full name of each lawyer)
D/C (Designated Codes, seen below)
Date Admitted to Bar MM/YY
Date of Hire by Applicant MM/DD/YY
Number of Hours Worked per Week on behalf of the Applicant
Total Number of CLE Hours Taken During the Past Year
Name of Lawyer (State the full name of each lawyer)
D/C (Designated Codes, seen below)
Date Admitted to Bar MM/YY
Date of Hire by Applicant MM/DD/YY
Number of Hours Worked per Week on behalf of the Applicant
Total Number of CLE Hours Taken During the Past Year
Name of Lawyer (State the full name of each lawyer)
D/C (Designated Codes, seen below)
Date Admitted to Bar MM/YY
Date of Hire by Applicant MM/DD/YY
Number of Hours Worked per Week on behalf of the Applicant
Total Number of CLE Hours Taken During the Past Year
Name of Lawyer (State the full name of each lawyer)
D/C (Designated Codes, seen below)
Date Admitted to Bar MM/YY
Date of Hire by Applicant MM/DD/YY
Number of Hours Worked per Week on behalf of the Applicant
Total Number of CLE Hours Taken During the Past Year
Name of Lawyer (State the full name of each lawyer)
D/C (Designated Codes, seen below)
Date Admitted to Bar MM/YY
Date of Hire by Applicant MM/DD/YY
Number of Hours Worked per Week on behalf of the Applicant
Total Number of CLE Hours Taken During the Past Year
Name of Lawyer (State the full name of each lawyer)
D/C (Designated Codes, seen below)
Date Admitted to Bar MM/YY
Date of Hire by Applicant MM/DD/YY
Number of Hours Worked per Week on behalf of the Applicant
Total Number of CLE Hours Taken During the Past Year
Designated Codes
O = Officer/Director/Shareholder
P = Partner
S = Sole Proprietor
E = Employed Lawyer
RP = Retired Partner of Applicant
OC = Of Counsel Lawyer
IC = Independent Contractor
Claims Information
Date Claim Made
Date of Alleged Error
Current Status/Date settled
Claim, Suit or Incident
Claimant(s)/Plaintiff(s)
Additional Defendant(s) (if any)
Nature of Claim and Allegations
Date Reported to Insurance Company and Name of Insurance Company
Amount Reserved (Loss/ Expense)
Amount Paid (Loss/Expense)
Date Claim Made
Date of Alleged Error
Current Status/Date settled
Claim, Suit or Incident
Claimant(s)/Plaintiff(s)
Additional Defendant(s) (if any)
Nature of Claim and Allegations
Date Reported to Insurance Company and Name of Insurance Company
Amount Reserved (Loss/ Expense)
Amount Paid (Loss/Expense)
If available, please upload loss runs.
Submission Validation
Required

Important Notice
Any submissions or payments made via this website do not constitute a binding agreement to your policy or coverages. Changes and payments to policies are not effective or binding until you, or any party involved, receive official notice from either your insurance agent, or your insurance company. If you have any questions, please feel free to contact us.

Per the terms of our online privacy policy we will not resell your information to any third-party.
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