Employment Practices Liability (EPLI) Quote

  • Employment Practices Liability (EPLI) Quote

  • General Information

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  • Underwriting / Rating Information

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  • Including all salary and commissions, do 5% or more of the company’s employees earn over $100,000 annually or does any one employee earn over $250,000 annually (do not include the owner(s) when answering the question)?
  • Has the company laid-off (excluding seasonal layoffs) or terminated more than 30% of its workforce in the past 12 months?
  • Does the company anticipate any layoffs (excluding seasonal layoffs), downsizing or office or plant closings in the next 12 months?
  • Within past 3 years, has company had any lawsuits, threatened claims, or charges filed with the EEOC or state/local administrative agency involving a Wrongful Employment Act, or Third Party Wrongful Act?
  • [NEW APPLICANTS ONLY] Does any director, officer, owner, member, or partner of the company have knowledge of any fact, circumstance, or situation which may result in a Claim, such as would fall under the proposed insurance?
  • Does the company currently have AND regularly distribute the following written policies? (Check all that applies)
  • Does the company currently carry Employment Liability Insurance (EPLI) coverage?
  • Policy Expiration Date:
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  • Date of First Policy or Coverage:
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  • Should be Empty: