1 (877) 272-4653

42 West Allendale Ave
Allendale, NJ 07401

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We typically respond within one business day. Please fill out the following form. This information will be used solely to provide the insurance proposal you are requesting.
To contact us by phone, call (877) 272-4653 during normal business hours.


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Firm Details




 

RISK MANAGEMENT DETAILS

Are engagement letters or retainer agreements, that establish the scope of your firm’s representation, required to be sent to all new clients?

Have you ever sued a client (past or present) for uncollected fees?
 Yes No

Has any member of your firm handled class action or mass tort litigation in the past 5 years?
 Yes No

Has any member of your firm been disbarred or been the subject of a disciplinary proceeding?
 Yes No

STAFF LIST

Designations: O=Owner, P=Partner, A=Associate, IC=Independent Contractor, OC=Of Counsel, PA=Patent Agent

Name Hire Date Designation
 O P A IC OC PA
 O P A IC OC PA
 O P A IC OC PA
 O P A IC OC PA
 O P A IC OC PA

AREA OF PRACTICE (Total must equal 100%)






INSURANCE HISTORY

Does your firm currently have professional liability insurance?
 Yes No

If currently insured, please complete the following:

Who is your Insurer?

What are your expiring limits of liability?

What is the deductible?

What is the annual premium?

What is the Retroactive Date (if applicable)?

Current policy expires

CLAIMS HISTORY (if applicable)

Date of Claim or Incident Reported Amount Paid (incl. Expenses) Claim Status
Claim #1  Open Closed
Claim #2  Open Closed
Claim #3  Open Closed