Get Started – Alta Pro Lawyers Risk Purchasing Group

Email your questions or concerns to: dramos@altaproinsurance.com.

LPL Estimate Form:

What are your firm's Areas of Practice?

Select all that apply.

q3.5

Firm Basics

Name of Applicant Firm:

Date Established:

Address:

Street Address Address Line 2 City State ZIP Code

Website:

Phone:

Fax:

Contact Name:

Contact Email:

No. Lawyers in Firm:

No. Support Staff:

Do you have other office locations?

Yes

If yes, how many?

Please provide a list showing each location and the number of attorneys at each location

Location (Address)

Number of attorneys

Firm Insurance

1. Requested Effective Date:

2. a. Current Limits:

Deductible:

Retroactive: Date

b. Optional coverages you are requesting (check all that apply):

First Dollar Defense

Aggregate Deductible

Claim Expense Outside Limits

3. a. Is the firm currently insured for professional liability?

Yes

If yes, you will be asked to provide a copy of your current policy declarations including the retroactive date as evidence of current coverage.

If you have a copy of your policy declarations, upload it now:

Drop files here or

Max. file size: 10 MB.

b. Does your current policy have any type of endorsements that exclude or modify coverage?

Yes

If yes, you will be asked to provide a copy of each such endorsement.

4. List the names of all predecessor firms of the applicant firm.

Name only those firms where the applicant is a majority successor to the predecessor firm’s assets and liabilities.

Name of Predecessor Firm

Date Dissolved

Number of Lawyers

5. a. In the last 12 months, how many attorneys have left your firm?

b. Joined the firm?

c. How many attorneys does the firm plan to add during the next 12 months?

d. In the last 12 months, how many non-lawyer employees have left your firm?

e. Joined the firm?

6. Has any professional liability insurance for the applicant, or any member of the applicant firm ever been declined or canceled, refused to be renewed, or accepted only on special terms?

Yes

If yes, please provide a detailed narrative in the space provided:

7. Please identify your legal professional liability insurance for the past five years.

Company

Policy Period

Limits

Deductible

Premium

# of Attorneys

Firm Clients and Members

8. Does any client or group of related clients make up 25% or more of the firm’s gross receipts?

Yes

9. Please complete the information below for your five largest clients:

Client Name or Industry

Date Services Began

Percent of Revenues

Description of Legal Services Provided

10. Does your firm use any attorneys not listed on this application to provide legal services for the firm?

Yes

If yes, please list all such lawyers in the space below or separate attachment and describe their relationship to the firm.

Lawyer

Relationship to the firm

Does any firm member:

11. a. Does any firm member share cases or co-counsel with other attorneys or law firms?

Yes

b. Share letterhead or office space with other attorneys or law firms?

Yes

c. Refer clients to other firms and maintain an economic interest?

Yes

d. Work as an independent contractor for other law firms?

Yes

e. Handle cases or transactions for clients in other states?

Yes

f. Handle cases or transactions for clients in other countries?

Yes

If "yes", please attach a list of all such lawyers or firms, how many cases, and a description of the cases.

Lawyer or Firm

How Many Cases

Description of the Cases

Because you answered "yes" to a, b or c above, you will be asked to provide proof of insurance for all such lawyers.

Outside Interests and Claims

12. In the last two years, has any lawyer listed on the application been an officer, director, member, owner, trustee, manager or exercised fiduciary control over an entity other than the applicant firm?

Yes

If yes, please provide a complete Outside Interest Supplement. We provide you with a blank Outside Interest Supplement after you complete this form.

13. Is any lawyer listed on the application an employee of an entity other than the applicant firm?

Yes

If yes, please explain in the space provided below

14. Has any member of the firm provided legal services involving publicly traded securities or securities that are not exempt from registration?

Yes

If yes, please explain in the space provided below

15. Has any member of the firm been involved in class action or mass tort litigation?

Yes

If yes, please explain in the space provided below

16. Does any firm member provide services to or sit on the board of directors of a financial institution?

Yes

If yes, a complete Financial Institution Supplement must be provided. We provide you with a blank Financial Institution Supplement after you complete this form.

17. Is any firm member aware of any incident, facts, circumstances, acts or omissions that could reasonably be expected to result in a professional liability claim against the firm or predecessor firm or against any current or former firm member while affiliated with the firm or predecessor firm?

Yes

If yes, a complete Claim Supplement form must be provided for each incident. We provide you with a blank Claim Supplement form after you complete this form.

18. In the last five (5) years, has any member of the firm been the subject of any investigation, including but not limited to a disciplinary investigation, disciplinary reprimand or other disciplinary action, or been refused admission to the bar or any bar association, court or administrative agency?

Yes

If yes, explain in detail in the space provided below.

19. a. In the last five (5) years, has any professional liability claim been made or suit brought against the firm or predecessor firm or any member of the firm or predecessor firm?

Yes

If yes, a complete Claim Supplement form must be provided for each incident. We provide you with a blank Claim Supplement form after you complete this form.

b. Number of Claim Supplements completed for this application:

Practice Profile

21. a. Total firm revenues last fiscal year:

b. Current fiscal year revenues:

22. Complete the following based upon your gross revenue or billable hours for each category. Total must equal 100%.

This Practice Profile is based on:

Gross Revenue

Billable Hours

Your selection in Areas of Practice determined the following AOP fields:

Area of Practice: Admiralty

Percentage:

Plaintiff %:

Defense %:

Other %:

Area of Practice: Antitrust

Percentage:

Plaintiff %:

Defense %:

Other %:

Area of Practice: Appellate

Percentage:

Plaintiff %:

Defense %:

Other %:

Area of Practice: Arbitration, Mediation

Percentage:

Area of Practice: Aviation

Percentage:

Area of Practice: Bankruptcy

Percentage:

Creditor Rep %:

Debtor Rep %:

Trustee Rep %:

Area of Practice: Business Formation/Alteration Merger&Acquisition

Percentage:

Form/Alt %:

Merge/Ac%:

Area of Practice: Business Secured Transactions - UCC - Commercial

Percentage:

Public Corp %:

Private %:

Area of Practice: Business Admin, Records

Percentage:

Area of Practice: Civil Rights/Discrimination

Percentage:

Defense%:

Plaintiff %:

Area of Practice: Collections

Percentage:

Creditor %:

Debtor %:

Area of Practice: Commercial Litigation

Percentage:

Defense Lit%:

Plaintiff Lit%:

Area of Practice: Construction Law

Percentage:

Contracts%:

Litigation%:

Area of Practice: Consumer Claims

Percentage:

Defense%:

Plaintiff %:

Area of Practice: Criminal Defense

Percentage:

Area of Practice: Elder Law

Percentage:

Area of Practice: Employee Benefits

Percentage:

Area of Practice: Entertainment/Agency/ /Sports Agency

Percentage:

Management %:

Other %:

Area of Practice: Environmental

Percentage:

Plaintiff %:

Defense %:

Other %:

Area of Practice: Estate, Probate, Trust

Percentage:

Est. Planning %:

Probate %:

Trust Admin %:

Area of Practice: Family Law

Percentage:

Adoption %:

Divorce %:

Juvenile %:

Area of Practice: FCC/Communications

Percentage:

Area of Practice: Financial Institutions

Percentage:

Area of Practice: General Civil Litigation

Percentage:

Plaintiff %:

Defense %:

Other %:

Area of Practice: Government Contracts

Percentage:

Area of Practice: Guardian Ad Litem

Percentage:

Area of Practice: Health Care

Percentage:

Compliance %:

Litigation %:

Area of Practice: Immigration

Percentage:

Area of Practice: Insurance Defense

Percentage:

Coverage %:

Litigation%:

Other %:

Area of Practice: Intellectual Property

Percentage:

Patent %:

Trademark %:

Litigation%:

Area of Practice: International Law

Percentage:

Area of Practice: Labor & Employment

Percentage:

Management %:

Union/Labor%:

Other %:

Area of Practice: Municipal Law

Percentage:

Defense %:

Zoning %:

Finance %:

Area of Practice: Natural Resources, Oil & Gas

Percentage:

Leasing %:

Compliance %:

Other %:

Area of Practice: Plaintiff Personal Injury - Legal Malpractice

Percentage:

Plaintiff %:

Area of Practice: Plaintiff Personal Injury - Medical Malpractice

Percentage:

Plaintiff %:

Area of Practice: Plaintiff Personal Injury - MDL, Mass Tort, Class Action

Percentage:

Plaintiff %:

Area of Practice: Plaintiff Personal Injury - Products Liability

Percentage:

Plaintiff %:

Area of Practice: Plaintiff Personal Injury - Auto,BI/PD

Percentage:

Plaintiff %:

Area of Practice: Real Estate - Commercial

Percentage:

Area of Practice: Real Estate - Development

Percentage:

Area of Practice: Real Estate - Foreclosure

Percentage:

Area of Practice: Real Estate - Escrow

Percentage:

Area of Practice: Real Estate - Residential

Percentage:

Area of Practice: Real Estate - Title

Percentage:

Area of Practice: Real Estate - Securities

Percentage:

Public Offering%:

Corp. Bonds %:

Private Placemt:

Other %:

Area of Practice: Real Estate - Social Security

Percentage:

Soc Sec%:

Area of Practice: Real Estate - Tax, Tax Opinions

Percentage:

Personal %:

Corporate %:

Other %:

Area of Practice: Real Estate - Workers Compensation

Percentage:

Plaintiff %:

Defense%:

Area of Practice: Real Estate - Other

Percentage:

Please describe

(1) Family Law. In the last 24 months, please indicate the following:

Average value of property settlement handled:

Highest value of property settlement handled:

Does any firm member provide any of the following services? (select all that apply)

Surrogacy contracts

Ovum or sperm donation contracts

Embryo donation agreements

Firm Profile

22. Please complete the Firm Profile below for each attorney associated with your firm.

P = Partner/Owner/Member, A = Associate/Employee, OC = Of Counsel, I = Independent Contractor

Attorney Name

Position P, A, OC, I

Hire Date

Date First Admitted

States Admitted

Ave. Hours/ Week

Areas of Practice

23. If you are a sole practitioner, who handles your cases in the event of your incapacitation or vacation?

Note: If a policy is issued in reliance upon this application, it shall not apply to the attorney below:

24. Does your firm accept any form of compensation other than legal fees?

Yes

If yes, please provide an explanation in the space provided

25. a. Does your firm have a system for detecting and avoiding conflicts of interest?

Yes

If yes, check all that apply:

b. Does your firm require written disclosure of potential conflicts to all clients?

Yes

c. Does your firm require written consent from all parties to a potential conflict prior to representation?

Yes

Has any firm member:

26. a. Engaged in a business venture with a client?

Yes

b. Introduced clients to one another for investment purposes?

Yes

c. Represented adverse but friendly parties in the same matter?

Yes

If yes to 26. a, b, or c, please provide an explanation in the space provided

27. Please indicate which of the following the firm uses to manage its docket and scheduling demands:

Describe

28. Does the firm use law practice management software?

Yes

If yes, name of software:

Check all that apply:

Describe

With respect to cyber security, does the firm:

29. a. With respect to cyber security, does the firm use computer system security products to detect viruses and other malware?

Yes

b. Use firewalls and intrusion detection systems?

Yes

c. Purchase cyber liability insurance?

Yes

d. Require verification of all wire transfer instructions by phone call only to known parties?

Yes

e. Require all wire transfer instructions to be sent by encrypted email or fax?

Yes

For all clients and potential clients, does the firm use:

30. a. For all clients and potential clients, does the firm use Engagement letters/Fee Agreements:

Yes

b. Declination of Representation Letters:

Yes

c. Termination of Services Letters:

Yes

d. Regular File Status Updates:

Yes

If no to any, please explain in the space provided

Wrap Up

31. Are any of the firm’s Accounts Receivable more than 90 days past due?

Yes

If yes, approximately what percentage of Accounts Receivable are past due:

32. a. How many suits for fees were filed against clients in the last two years?

b. Are fee suits filed only after the statute of limitations for legal malpractice has passed?

Yes

c. If no to 32.b, are files reviewed for possible negligence claims before suit is filed?

Yes

Describe the firm’s Risk Management activities:

32. a. Does the firm have a formal procedures manual?

Yes

b. Does the firm outline its billing policy and procedures in writing to clients?

Yes

c. Does the firm have a formal process for responding to client complaints?

Yes

d. Does the firm have a formal document retention policy?

Yes

e. Are all employees trained regarding firm policies and procedures?

Yes

f. Are new attorneys supervised by a more senior attorney?

Yes

g. Are all cases brought in by new attorneys from prior firms reviewed by at least one senior partner or officer of the firm for potential conflicts of interest?

Yes

h. Is support personnel work reviewed by an attorney prior to release to the client?

Yes

i. Are all new matters reviewed prior to acceptance by firm management?

Yes

j. Does firm management regularly review all ongoing matters?

Yes

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What are your firm's Areas of Practice?

Firm Basics

Firm Insurance

Firm Clients and Members

Outside Interests and Claims

Practice Profile

Firm Profile

Wrap Up

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