4.
Is the Applicant Firm controlled, owned, or associated with any other firm corporation or company?
Yes
No
If Yes, please provide details here:
5.
Number of Years in Business:
Less than 1 year
Equal to or Greater than 1 year and Less than 3 years
Equal to or Greater than 3 years and Less than 10 years
Equal to or Greater than 10 years and Less than 20 years
Equal to or Greater than 20 years
Unknown
6.
Average number of years of related professional experience for all Partners, Principals and Key Employees :
Unknown
Less than 3 years
Equal to or Greater than 3 year and Less than 7 years
Equal to or Greater than 7 year and Less than 10 years
Equal to or Greater than 10 years and Less than 20 years
Equal to or Greater than 20 years
7.
What percentage of services are rendered under a written contract?
100%
75-99%
50-74%
25-49%
1-24%
0%
Unknown
8.
Have any claim(s) been made against any proposed insured(s) during the past three years?
Yes
No
If Yes, please provide details here:
9.
Have any Partners, Principals or Key Employees ever been the subject of disciplinary action by authorities as a result of their professional services?
Yes
No
If Yes, please provide details here:
10.
Does any person or entity proposed for insurance have knowledge or information of any act, error or omission which might reasonably be expected to give rise to a claim under the proposed policy?
Yes
No
If Yes, please provide details here:
11.
Has any similar insurance ever been declined or cancelled?
Yes
No
If Yes, please provide details here:
12.
Is similar insurance currently in force?
Yes
No
If Yes, please provide:
Name of Carrier.
Select
AIG
Ace
CNA
Chubb/ERMA
E Risk
Firemans Fund
Hartford
Kemper
Other
Royal
St.Paul
Unknown
Zurich
If Other.
Expiration Date
Limit
$
Deductible
$
Premium
$
Retroactive Date
13.
Please provide the number of years of continuous coverage
None
Equal to or Less than 1 year
Greater than 1 and Equal to or Less than 2 years
Greater than 2 and Equal to or Less than 3 years
Greater than 3 years
It is agreed with respect to Questions #8, 9, and 10 above, that if such knowledge or information exists any claim or action arising therefrom is excluded from this proposed coverage.