UW - APU - LPL Form

Lawyers E&O Premium Indication Form

Please complete the form below, and a member of our team will get in touch with you soon.

Insured Name *

Street Address (no PO box) *

City, State, County, Zip *

Insurance Broker/Agent Name

Email Address*

Effective Date *

Retroactive Date (expiring) *

Limits *

Deductible *

Expiring Premium *

# of Full-time Attorneys *

# of Part-time Attorneys *

# of Support Staff *

Areas of Practice - Please enter percentages. Should total 100% across various areas.

Administrative Law

Admiralty/Maritime

Anti-Trust/Trade Regulation

Appellate

Bankruptcy

Collections

Civil Rights/Discrimination - Defense

Civil Rights/Discrimination - Plaintiff

Class Action/Mass Tort - Defense

Class Action/Mass Tort - Plaintiff

Commercial Litigation - Defense

Commercial Litigation - Plaintiff

Commercial Transactions

Construction

Corporate Formation/Alteration

Criminal Law

Domestic Relations/Divorce <$1M

Domestic Relations/Divorce $1M-$5M

Domestic Relations/Divorce > $5M

Entertainment/Sports/Celebrity

Environmental

Estate/Trust/Probate/Wills <$5M

Estate/Trust/Probate/Wills $5M - $10M

Estate/Trust/Probate/Wills > $10M

ERISA

Financial Institutions

Government/Municipal (not Bonds)

Immigration/Naturalization

Insurance Defense

International Law

IP - Copyright/Trademark Licensing

IP - Copyright/Trademark Registration

IP - Litigation

IP - Patent

Juvenile/Guardianship

Labor - Labor Representation

Labor - Management Representation

Medical Malpractice - Defense

Medical Malpractice - Plaintiff

Mergers & Acquisitions

Oil/Gas/Mining

Pensions/Employee Benefits

Personal BI/PD - Defense

Personal BI/PD - Plaintiff <$100k

Personal BI/PD - Plaintiff $100k - $500k

Personal BI/PD - Plaintiff $500k - $1M

Personal BI/PD - Plaintiff > $1M

Product Liability - Defense

Product Liability - Plaintiff

Real Estate - Commercial

Real Estate - Foreclosure

Real Estate - HOA/COA/POA

Real Estate - Land Use/Zoning

Real Estate - Loan Modification

Real Estate - Residential

SEC/Securities

Tax - Opinions

Tax - Preparation (Corporate)

Tax - Preparation (Individual)

Title Agency/Examination

Tribal

Water Law

Workers Comp - Defense

Workers Comp - Plaintiff

Other

# of Claims Within the Last 5 Years *

# of Fee Suits Within the Last 5 Years *

# of Disciplinary Matters Within the Last 5 Years *

Total Aggregate Claims, Losses and Expenses Incurred Within the Last 5 Years *