LAWYERS PROFESSIONAL LIABILITY ONLINE QUOTE REQUEST

To obtain the most accurate quote possible,
please complete the following form, answering all relevant
questions and sections before Submitting.

With the ever increasing rate of malpractice action against attorneys, a well planned and integrated professional liability program is essential to the stability and longevity of your firm.; At BAER our experienced and knowledgeable staff has thorough understanding expertise in professional liability coverages, specifically lawyers malpractice.

We have relationships with several highly rated insurers and can find the best carrier for your firm as a competitive price.; We have market for firms with wide and unique areas of practice, and can customize a program for your firm through various deductible, coverage limits and defense cost coverage options.

Subject to underwriting approval, programs include:

• Innocent partner Coverage
• Unlimited Prior Acts Coverage
• First dollar defense options
• Defendant reimbursement expense
• Predecessor firm coverage

By submitting this completed form you understand there is no coverage in force until an application is approved and premium is received by the insurance company.; You certify that the statements made on this quote request are accurate to the best of your knowledge.; This Web site should not be construed as a solicitation of any sort in any jurisdictions other than those in which the agency holds a license and is authorized to transact business.; A list of licensing state(s) can be viewed at the bottom of our homepage.

General Information

Full Name: E-mail Address: Firm Name: Year Firm Established: Mailing Address: City: State: Zip: Phone Number: Fax Number:

Underwriting Information

Form Of Business: Select one... C-Corporation S-Corporation Sole Proprietor Partnership L.L.P. L.L.C. # of Full-time Attorneys: Combined years of experience: Number of suits for fees in the last
2 years: Gross Annual Fees:

Breakdown of Gross Fees in Percentage of Billable Hours:

Please Note: When completing this portion of the form, all fields which do not have a value of "1" or more must contain a "0" for the auto-calculation function to work properly.

General Categories

Admiralty/Marine - Defense (%): Admiralty/Marine - Plaintiff (%): Anti-Trust Trade Regulation (%): Arbitrator/Mediator (%): Banking/Financial Institutions (%): Bankruptcy (%): Civil Rights/Discrimination (%): Collections (%): Construction (Building Contracts) (%): Consumer Claims (not class action) (%): Criminal (%): Entertainment (%): Environmental Law (%): ERISA/Pension/Employee Benefits (%): Government Contracts/Claims (%): Healthcare - Regulatory Compliance (%): Immigration/Naturalization (%): Intellectual Property (%): International Law (%): Labor/Employment - Management (%): Labor/Employment - Employee (%): Labor/Employment - Union (%): Lobbying (%): Local Govt/Municipal (not bonds) (%): Natural Resources/Oil & Gas (%): Securities (SEC, Blue Sky, Bonds) (%):

Business Transactions/Corporate Law

Administrative (%): Formation of Entities (%): General Contract Negotiation (%): Mergers & Acquisitions (%): Secured Transactions (%):

Family Law

Adoption (%): Divorce - marital assets < $1,000,000 (%): Divorce - marital assets > $1,000,000 (%): Elder Law (%): Guardianship/Juvenile (%): Social Security (%):

Litigation

Class Action/Mass tort - Defense (%): Class Action/Mass Tort - Plaintiff (%): General Commercial - Defense (%): General Commercial - Plaintiff (%): Insurance Defense (%): Personal Injury/Prop Damage
- Defense (%): Personal Injury/Prop Damage
- Plaintiff (%): Workers' Compensation - Defense (%): Workers' Compensation - Plaintiff (%):

Real Estate

Abstracting/Title Commercial (%): Abstracting/Title Residential (%): Conveyance - Commercial (%): Conveyance - Residential (%): Foreclosures and Loan Workouts (%): Landlord/Tenant (%): Syndications/Limited Partnerships (%): Planning & Zoning (%):

Taxation

Business (%): Individual (%): Tax Litigation (%): Opinions (%):

Wills, Estate Trust, Probate & Planning

For assets < $1,000,000 (%): For assets > $1,000,000 (%):

Other Type(s)

Other (describe): Other Percentage: %
Total (%):

Following calculation, if your percentages do not equal 100%, please scroll-up and adjust your figures. Then return to this section and Click again to re-calculate.

Current Professional Liability Coverage

Current Insurer: Renewal Date: (mm/dd/yy): Coverage in force since (year): Number of years of continuous
coverage: Current Policy Expiration Date
(mm/dd/yy): Annual Premium: Current Deductible: Select one... $1,000 $2,500 $5,000 $10,000 Other... Current Other Deductible: Current Limit: Select one... $100,000/$300,000 $250,000/$500,000 $500,000/$1,000,000 $1,000,000/$2,000,000 Other... Other Current Limit: What is the Retro Date of your current Claims Made Policy (mm/dd/yy):

General Questions

Have any Professional liability claims been made against your firm within the last 5 years?

Yes No

Does any attorney in your firm serve as a director, officer, or employee, or have any equity interest, in any client of the firm?

Yes No

Does your firm use Engagement Letters and Fee Agreements?

Yes No

Does the firm have at least two independently maintained calendars, cross checked at least bi-weekly by separate individuals?

Yes No

Do you have written procedures in place to identify and disclose conflicts of interest?

Yes No

Have at least half of the attorneys in your firm had some type of continuing legal education within the last year?

Yes No

Have any of the firm's attorneys been the subject of any disciplinary proceedings, for any reason other than non-payment of dues, within the last five years?

Yes No

Optional Coverages (check all that apply):

Title CEOL First Dollar Per Claim Deductible

Additional Comments

Please leave any comments or additional entries here.

Click "Submit Request" to send your completed quote request.