What are your firm's Areas of Practice? Select all that apply.
q3 q3.5
Firm Basics Date Established: Address: Do you have other office locations? Please provide a list showing each location and the number of attorneys at each location
Firm Insurance 1. Requested Effective Date: Retroactive: Date b. Optional coverages you are requesting (check all that apply): 3. a. Is the firm currently insured for professional liability? 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:
b. Does your current policy have any type of endorsements that exclude or modify coverage? 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.
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? If yes, please provide a detailed narrative in the space provided:
7. Please identify your legal professional liability insurance for the past five years.
Firm Clients and Members 8. Does any client or group of related clients make up 25% or more of the firm’s gross receipts? 9. Please complete the information below for your five largest clients: 10. Does your firm use any attorneys not listed on this application to provide legal services for the firm? If yes, please list all such lawyers in the space below or separate attachment and describe their 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? b. Share letterhead or office space with other attorneys or law firms? c. Refer clients to other firms and maintain an economic interest? d. Work as an independent contractor for other law firms? e. Handle cases or transactions for clients in other states? f. Handle cases or transactions for clients in other countries? If "yes", please attach a list of all such lawyers or firms, how many cases, and a 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? 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? 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? 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? 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? 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? 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? 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? 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.
Practice Profile 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: Your selection in Areas of Practice determined the following AOP fields:
Area of Practice: Admiralty
Percentage:
Area of Practice: Antitrust
Percentage:
Area of Practice: Appellate
Percentage:
Area of Practice: Arbitration, Mediation
Percentage:
Area of Practice: Aviation
Percentage:
Area of Practice: Bankruptcy
Percentage:
Area of Practice: Business Formation/Alteration Merger&Acquisition
Percentage:
Area of Practice: Business Secured Transactions - UCC - Commercial
Percentage:
Area of Practice: Business Admin, Records
Percentage:
Area of Practice: Civil Rights/Discrimination
Percentage:
Area of Practice: Collections
Percentage:
Area of Practice: Commercial Litigation
Percentage:
Area of Practice: Construction Law
Percentage:
Area of Practice: Consumer Claims
Percentage:
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:
Area of Practice: Environmental
Percentage:
Area of Practice: Estate, Probate, Trust
Percentage:
Area of Practice: Family Law
Percentage:
Area of Practice: FCC/Communications
Percentage:
Area of Practice: Financial Institutions
Percentage:
Area of Practice: General Civil Litigation
Percentage:
Area of Practice: Government Contracts
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Area of Practice: Guardian Ad Litem
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Area of Practice: Health Care
Percentage:
Area of Practice: Immigration
Percentage:
Area of Practice: Insurance Defense
Percentage:
Area of Practice: Intellectual Property
Percentage:
Area of Practice: International Law
Percentage:
Area of Practice: Labor & Employment
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Area of Practice: Municipal Law
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Area of Practice: Natural Resources, Oil & Gas
Percentage:
Area of Practice: Plaintiff Personal Injury - Legal Malpractice
Percentage:
Area of Practice: Plaintiff Personal Injury - Medical Malpractice
Percentage:
Area of Practice: Plaintiff Personal Injury - MDL, Mass Tort, Class Action
Percentage:
Area of Practice: Plaintiff Personal Injury - Products Liability
Percentage:
Area of Practice: Plaintiff Personal Injury - Auto,BI/PD
Percentage:
Area of Practice: Real Estate - Commercial
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Area of Practice: Real Estate - Development
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Area of Practice: Real Estate - Foreclosure
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Area of Practice: Real Estate - Escrow
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Area of Practice: Real Estate - Residential
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Area of Practice: Real Estate - Title
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Area of Practice: Real Estate - Securities
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Area of Practice: Real Estate - Social Security
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Area of Practice: Real Estate - Tax, Tax Opinions
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Area of Practice: Real Estate - Workers Compensation
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Area of Practice: Real Estate - Other
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(1) Family Law. In the last 24 months, please indicate the following:
Does any firm member provide any of the following services? (select all that apply)
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
24. Does your firm accept any form of compensation other than legal fees? 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? If yes, check all that apply: b. Does your firm require written disclosure of potential conflicts to all clients? c. Does your firm require written consent from all parties to a potential conflict prior to representation? Has any firm member:
26. a. Engaged in a business venture with a client? b. Introduced clients to one another for investment purposes? c. Represented adverse but friendly parties in the same matter? 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: 28. Does the firm use law practice management software? Check all that apply: 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? b. Use firewalls and intrusion detection systems? c. Purchase cyber liability insurance? d. Require verification of all wire transfer instructions by phone call only to known parties? e. Require all wire transfer instructions to be sent by encrypted email or fax? 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: b. Declination of Representation Letters: c. Termination of Services Letters: d. Regular File Status Updates: 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? b. Are fee suits filed only after the statute of limitations for legal malpractice has passed? c. If no to 32.b, are files reviewed for possible negligence claims before suit is filed? Describe the firm’s Risk Management activities:
33. a. Does the firm have a formal procedures manual? b. Does the firm outline its billing policy and procedures in writing to clients? c. Does the firm have a formal process for responding to client complaints? d. Does the firm have a formal document retention policy? e. Are all employees trained regarding firm policies and procedures? f. Are new attorneys supervised by a more senior attorney? 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? h. Is support personnel work reviewed by an attorney prior to release to the client? i. Are all new matters reviewed prior to acceptance by firm management? j. Does firm management regularly review all ongoing matters? 
