Lawyer's Professional Liability Quote

Contact Name*

First Last

Firm Name*

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email*

Office Phone

Cell Phone

How may we contact you?

Email
Office phone
Cell phone

Date Firm Established

Number of Attorneys

Number of Support Staff

Number of "Of Counsel"

Number of hours per week for each OC

ATTORNEY EXPERIENCE

Please provide the number of attorneys for each number of years with the firm.

5+ Years

4 Years

3 Years

2 Years

1 Year

6 months or less

Estimated Gross Income

Is this a full-time, private practice of law?

Yes
No

Do you maintain a Docket Control System with at least two independent date controls?

Yes
No

Is a Conflict of Interest System maintained?

Yes
No

Are engagement and non-engagement letters used on a regular basis?

Yes
No

CURRENT INSURANCE

Carrier

Limits & Deductibles

Retroactive/Prior Acts Date

Policy Term

Date of first continuous claims-made coverage

CLAIM HISTORY

Are you aware of any claims against you or your firm or incidents that may result in a claim in the past 5 years?

Yes
No

Has any member of the firm been refused admission to practice, disbarred, suspended, reprimanded, sanctioned, or held in contempt by the court administrative agency or regulatory body?

Yes
No

AREA OF PRACTICE PERCENTAGES

Using the drop-down menus, select your Primary, Secondary, or Other areas of practice and include an approximate percentage of each area to reach 100%.

Primary Area of Practice

Percentage

e.g., 25%

Secondary Area of Practice

Percentage

e.g., 25%

Other Area of Practice

Percentage

e.g., 25%

*If selected *"BI/PI Plaintiff", is any of this work Class Action/Mass Tort?

Yes
No

Additional Comments

Lawyer’s Professional Liability Quote

ATTORNEY EXPERIENCE

CURRENT INSURANCE

CLAIM HISTORY

AREA OF PRACTICE PERCENTAGES