Florida Professional Liability Insurance Online Quote

Professional Liability Insurance Online Quote - Florida

To obtain the most accurate quote,please complete all fields below.
Firm Name*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Contact Name*

First NameLast Name
Contact Phone*
Please enter a valid phone number.
Contact Email*
example@example.com
Website*
Does The Firm Have Any Additional Locations?*

YesNo
Please enter the addresses of all additional locations (1 per line please)
Firm Details

Please answer the following questions about your law firm
Year the firm was established*
How many years of experience in this industry?*
Projected Annual revenue (next 12 months)*
Applicant firm is*

Sole ProprietorshipPartnershipCorporationNon-ProfitLLCLLPTrustOther
Total number of owners (actively involved in business operations)*
Number of full-time employees: (Exclude officers, owners, partners, and independent contractors)*
Number of part-time employees: (Exclude independent contractors)*
Number of part-time employees: (Exclude independent contractors)*
Is the number of non-attorney staff higher than 5 times the number of attorneys at your firm?*

YesNo

Enter full-time and part-time attorneys’ details here. Part-time = fewer than 26 hours per week on average.Do not include “of counsel,” independent contractor or per diem.*

	Name	Part-Time or Full-Time	Hire Date	Prior Acts Date
1
2
3
4
5
6

Does any outside attorney provide services to your firm in any of the following capacities: Of Counsel, independent contractors, per diem attorneys?*

YesNo
Please advise total annual number of hours provided to the Applicant Firm: by of counsel, independent contractors and per diem attorneys. (if zero, indicate 0):
Areas of Practice
GROUP 1

Please indicate below the percentage of the Applicant Firm’s gross revenues in the most recent fiscal year derived from each area of practice:

	Percentage Firm’s Gross Revenues
Admiralty/Maritime
Administrative (Social Security Disability) Compensation
Agricultural
Alternative Dispute (Arbitration/Mediation)
Antitrust/Trade Regulation
Appellate – Criminal
Appellate – Civil
Aviation & Aerospace
Bankruptcy
Business/Commercial – General & Contracts
Civil Litigation –Defense other than Insurance
Civil Litigation – Insurance Defense
Civil Rights
Communications
Constitutional
Construction
Corporate General
Criminal
Education
Elder Law
Election & Campaign
ERISA/Employee Benefits/Executive Compensation
Employment
Family
Governmental (Non-Contracts, Non-Lobbying)
Governmental Contracts
Governmental Relations/Lobbying
Healthcare (Non-Malpractice)
Immigration
Indigent Legal Services
Insurance (Non-Defense)
International Trade
Labor – Management
Labor – Unions
Military
Municipal (other than Securities)
Probate/Trust/Wills/Estates
Tribal & Native Populations
Workers Compensation/Defense
Workers Compensation/Plaintiff

GROUP 1 SUB-TOTAL*
Total Percentage from all of Group 1 Categories Above
GROUP 2

Please indicate below the percentage of the Applicant Firm’s gross revenues in the most recent fiscal year derived from each area of practice:

	Percentage Firm’s Gross Revenues
Banking & Finance
Bonds
Civil Litigation – Legal Malpractice
Civil Litigation – Mass Tort/Class Action
Civil Litigation – Medical Malpractice
Civil Litigation – Not Otherwise Classified
Civil Litigation – Other Malpractice
Civil Litigation – Personal Injury
Civil Litigation – Products Liability
Corporate Formation (other than M&A)
Debtor & Creditor/Collections
Entertainment/Sports/Fine Art/Media/Public
Figures
Environmental
Intellectual Property
Investment Counseling
Mergers & Acquisitions
Natural Resources/Minerals/Oil & Gas/Energy
Real Estate – Residential
Real Estate – Commercial
Real Estate – Syndication/Development
Real Estate – Title WorkReal Estate – Condo Offering
Real Estate – Foreclosure/Loan Workout
Securities – Publicly Traded
Securities – Private Placement
Tax – Individuals
Tax – Opinions/Corporate

GROUP 2 SUB-TOTAL*
Total Percentage from all of Group 1 Categories Above
COMBINED TOTAL (Group 1 Sub-total + Group 2 Sub-total)*
(MUST = 100%)
In the past five (5) years, has the Applicant Firm provided legal services for a cannabis industry client?*

YesNo
In the past five (5) years, has the Applicant Firm provided legal services for a cryptocurrency or blockchain client?*

YesNo
Please respond to all following questions that apply to the Applicant Firm’s areas of practice above:
3. Plaintiff Civil Litigation:*

(check here if NA)
a. In the past 5 years, have there been more than two plaintiff cases with a value greater than $5 million?*

YesNo
b. For any legal or medical malpractice cases, is any of the work done in house (not referred to other firms)?*

YesNo
4. Real Estate:*

(check here if NA)
a. During the past 5 years, has the firm had more than two residential real estate or condo transactions greater than $10 million ?*

YesNo
b. During the past 5 years, has the firm had more than two commercial transactions greater than $50 million ?*

YesNo
c. Does your firm, or any attorney for whom coverage is sought, wholly own a title agency ?*

YesNo
d. During the past 5 years, of all commercial real estate transactions, was the percentage that involved more than 5 passive investors higher than 5% ?*

YesNo
5. Debtor/Creditor Collections:*

(check here if NA)
a. Has the firm received more than one allegation or notice of violation of the Fair Debt Collections Practices Act or any similar “fair debt collection” law?*

YesNo
6. Probate/Trust/Wills/Estates:*

(check here if NA)
a. Is discretionary investment authority either greater than $1 million or not limited in writing?*

YesNo
7. Banking & Finance:*

(check here if NA)
a. Has any past or present financial institution client of the firm ceased operations, gone insolvent or become controlled or operated by the FDIC, OCC, OTS, or any other government agency?*

YesNo
8. Please indicate which of the traits below apply to your firm (select all that apply):

i. Uses engagement letters on all new mattersii. Uses non-engagement and disengagement lettersiii. Has computerized system for identifying conflicts which includes cross check for former, current, andpotential clients, and predecessor merger and/or acquired firmsiv. Requires written waiver when actual or potential conflict existv. Has computerized docket/calendar systemvi. Has a non-computerized dual calendar systemvii. Currently complies with state continuing legal education requirements
a. Does any lawyer of the Applicant Firm practice in jurisdictions outside of the United States?*

YesNo
b. In the past 5 years, has any attorney currently working at the firm provided service as an Officer, Director, Regulatory or General Counsel?*

YesNo
c. In the past 5 years, has the firm filed three or more suits to collect unpaid client fees?*

YesNo
d. Has anyone at your firm:*

Been disbarred?Been the subject of reprimand, censure, sanction, or other disciplinary action?Been convicted or pled guilty to a crime?Been refused admission to the Bar?None of these Apply
e. In the past 5 years, has any attorney at your firm:*

Been the subject of a professional liability claim suit?Had knowledge of anything that could result in a professional liability claim that has not yetbeen reported to an insurance carrier?Had professional liability insurance cancelled or non-renewed for any reason other than theinsurance carrier exiting the market? (Missouri Applicants Need Not Reply)None of these Apply
9. Coverage Information
a. Does your firm currently have Professional Liability insurance?*

YesNo
What is the expiration date of your policy?

MonthDayYear
Date
b. Does your current policy have a retroactive or prior acts date listed on your firm?*

YesNo
What is the expiration date of your policy?

MonthDayYear
Date
c. Has the firm had continuous professional liability coverage from the retroactive or prior acts dateindicated above to present?*

YesNoN/A
d. When would you like your policy to start?*

MonthDayYear
Date
e. Limits Requested – Per Claim/Aggregate:

$100,000/$300,000$250,000/$500,000$500,000/$1,000,000$1,000,000/$1,000,000$1,000,000/$2,000,000$2,000,000/$2,000,000Claim ExpensesIncluded in the Limit of LiabilityPaid in addition to the Limit of LiabilityOther (please indicate below)
If "Other" was selected above, please elaborate:
f. Deductible Requested

$0$1,000$2,500$5,000$10,000$15,000Other (please indicate below)
If "Other" was selected above, please elaborate:
Deductible Type:*

Damages OnlyDamages & Claim ExpensesAggregate
Signature

Please read carefully and sign below where indicated.

The undersigned proprietor, partner, member or officer, acting on behalf of the Applicant Firm and all others to be insured, hereby,
1. Declares after diligently inquiry that the above statements and particulars are true and that no material facts have been omitted or misstated to the best of his or her knowledge;
2. Understands and agrees that the completion of the application does not bind the Company to issue no the Applicant Firm to purchase the insurance; and
3. Acknowledges that (1) this application will be the basis of the policy, if issued; (2) all written statements and material furnished to the company in conjunction with this application are hereby incorporated by reference in this application and made part hereof; and (3) if the Company issues a policy, the Company will have relied upon, as representations, the declarations and statements which are contained in or attached to orincorporated in this application.
Signature of Owner, Partner or Officer:*

Clear
Name:
Date*

MonthDayYear
Today's Date
NOTICE TO FLORIDA APPLICANTS: ANY PERSON WHO KNOWINGLY AND WITH INTENT TO INJURE, DEFRAUD, OR DECEIVE ANY INSURER FILES A STATEMENT OF CLAIM OR AN APPLICATION CONTAINING ANY FALSE, INCOMPLETE OR MISLEADING INFORMATION IS GUILTY OF A FELONY OF THE THIRD DEGREE.
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Professional Liability Insurance Online Quote - Florida

Firm Details

Areas of Practice