Directors & Officers and Employment Practice Liability Insurance

by JB Woods | Aug 27, 2019 | 0 comments

Quote Request for D&O and EPLI Insurance

Your Name:

Business Name:

Phone

Address

Street Address Street Address Line 2 City State / Province / Region Postal / Zip Code

Please list all other business/dba names, including subsidiaries for which you are seeking coverage under this policy:

Please list any other entities and the relationship to the applicant requesting coverage under the policy:

Directors and Officers Shareholders:

Name

Percentage of Ownership

Shareholder:

Has the applicant raised capital through any offerings, private placements or other in the last 12 months, or anticipating within the next 12 months?

Total Number of Employees:

Does the Applicant have written employment agreements with all officers?

Does the Applicant have its employment policies/procedures reviewed by labor or employment counsel?

Have the Applicant’s managers and/or supervisors attended training and education programs/seminars on sexual harassment and other types of discrimination within the last 12 months?

Does the Applicant have a Human Resources or Personnel Department?

Does the Applicant have an employee handbook?

Does the Applicant have written procedures for handling employee complaints of discrimination and/or sexual harassment?

Do all employees receiving an employee handbook sign up for its receipt?

Does the Applicant maintain a personnel file for each employee?

Are all terminations of employees reviewed not only by human resources, but legal counsel?

During the past five years, has any insurer ever canceled or non-renewed similar insurance with any applicant, or has your insurance been canceled for nonpayment of premium by any insurance or finance company?

After inquiry with each person as appropriate, in the last five (5) years, have any Directors and Officers claims, or any wrongful termination, discrimination, sexual harassment or any other wrongful employment practices liability claim or suit, including third party claims, ever been made against the Firm or any predecessor firm or any current or former member of the Firm or predecessor firm?

After inquiry with each person as appropriate, do you, or any of your partners, officers, directors, or employees know of any circumstances, acts, errors, omissions, or any allegations or contentions of any incident that could result in a Directors and Officers claim, or any employment related claim, Including third party claims?

Note: This application for insurance is non-binding as we are not licensed in all states. Please visit our terms of use page for further information.