Request an Estimate

Basic Information
Firm Name*
Street Address*
City/Town*
County*
State*
Zip Code*
Phone*
Email Address*
Date of Establishment*
MM slash DD slash YYYY
Contact Name*

Insurance History
Current Carrier
Current Expiration Date
MM slash DD slash YYYY
Retroactive Date
MM slash DD slash YYYY
Current Limits
Current Deductible
Current Premium
# Expiring Attorneys
Claim Expenses Outside Limit:*
- Yes
- No
Per Claim Deductible First Dollar Defense Deductible Aggregate Deductible
- Per Claim Deductible
- First Dollar Defense Deductible
- Aggregate Deductible

Attorney Information
Number of attorneys in the firm for 6+ years
Bar Admit Date (For multiple, separate by a comma)
Number of attorneys in the firm for 5 years
Bar Admit Date (For multiple, separate by a comma)
Number of attorneys in the firm for 4 years
Bar Admit Date (For multiple, separate by a comma)
Number of attorneys in the firm for 3 years
Bar Admit Date (For multiple, separate by a comma)
Number of attorneys in the firm for 2 years
Bar Admit Date (For multiple, separate by a comma)
Number of attorneys in the firm for 1 year
Bar Admit Date (For multiple, separate by a comma)
Number of attorneys in the firm for < 1 year
Bar Admit Date (For multiple, separate by a comma)
Total number of attorneys in the firm*
Total Number of Attorneys Must be Great than Zero!

Area of Practice Information
Administrative Law
Financial Institutions/Banking*
Admiralty Law
Government Contracts and Claims
Adoption Law
Guardianship/Juvenile
Antitrust/Trade Regulation
Immigration and Naturalization
Arbitration/ Mediation
Insurance Defense
Bankruptcy
I. P. Copyrights & Trademarks*
Business Transactions & Contracts
I.P. Patents*
Civil Rights and Discrimination
International Law
Class Actions/Mass Tort*
Local Government (not bonds)
Collection/ Repossession – Commercial
Oil & Gas
Collection/ Repossession – Consumer
Personal Injury – Defense
Commercial Litigation – Defense
Personal Injury – Plaintiff
Commercial Litigation – Plaintiff
Real Estate – Commercial
Construction/ Building Contracts
Real Estate – Foreclosure
Consumer Claims
Real Estate – Land Use & Zoning
Corporate & Business Formation
Real Estate – Residential
Corporate Mergers and Acquisitions
Real Estate –Title
Criminal
Securities or Bonds*
Divorce – w/ Assets < $1M
Social Security
Divorce – w/ Assets $1M - $5M
Taxation
Divorce – w/ Assets > $5M
Wills, Trusts & Estates < $1M
Value of largest divorce case in 2 years
Wills, Trusts & Estates $1M - $5M
Eminent Domain
Wills, Trusts & Estates > $5M
Employment Law – Employee /Union
Value of largest WTE case in 2 years
Employment Law – Employer /Management
Workers Compensation – Defense
Entertainment
Workers Compensation – Plaintiff
Environmental Law
Other (Please Elaborate)
Specify "Other" Area of Law*
ERISA/Employee Benefits
BOTH COLUMNS MUST TOTAL 100%
Total Areas Must Equal 100%!

Fee Suit and Claim History Information:
How many suites for fees have you filed against your clients in the last two (2) years?
Any professional liability claims or incidents reported against any of the attorneys listed, prior partners or associates in the last 5 years? * If yes, please provide loss runs.**
- Yes
- No
Provide Loss Runs Below*
Have any of the firm’s attorneys been the subject of any disciplinary action, for any reason other than non-payment of dues, within the last ten (10) years?**
- Yes
- No
* = We may need additional information to provide an estimate. The information collected herein will be used for our underwriting purposes and will be shared with an LPP Preferred Agent appointed to write business with us in your domicile state. Insurance coverage and/or claims can not be bound, amended, or canceled through this contact form.

Basic Information

Insurance History

Attorney Information

Area of Practice Information

Fee Suit and Claim History Information: