Law Firm Professional Liability Renewal Application










    Total Gross Billings for 12 months ending:



    Areas of Practice


    Attorneys and Predecessor Firms



    Roster of lawyers (include all lawyers affiliated with the firm, including "Of Counsels" and independent contractors)

    *Status = O - Owner, E - Employee, OC - Of Counsel, IC - Independent Contractor

    Lawyer Name

    Status*

    Hours Worked per Week

    Approximate Month/Year of Hire



    File Opening and Client Management



    How often does the firm use:


    %


    %


    %


    %

    If the letters above are not used or not used in all circumstances please explain how the firm documents the commencement and discontinuation of services with a client.

    If you are a sole practitioner, please identify the lawyer with whom you have a written emergency coverage agreement and the expiration date of the agreement.





    Loss Information

    Within the past five years, has any firm member been the subject of any of the following disciplinary actions or investigations/proceedings?








    General Information






    Annual Payroll for:



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