Employment Practices Liability Insurance Quote

Employment Practices Liability Quote

Employment Practices Liability Insurance can be complicated, use this simple request so we can provide you with a quote.

"*" indicates required fields

Step 1 of 3

Name*

First Last

Business Entity is*

Full Legal Business Name or DBA*

Email*

Phone Number*

Alt Phone Number (cell, home)

Mailing Address*

Street Address Address Line 2 City State ZIP Code

Website

Date Business First Started*

Briefly describe the nature of your business.*

Office, Medical Facility, Service, Contractor, Retail Store, Restaurant, School.....

What best describes your business classification?*

Start Typing to narrow fields

Location Address*

If different from mailing address

Street Address Address Line 2 City State ZIP Code

Is this a publicly-held or a public reporting company under the Securities Exchange Act of 1934*

Have you been involved with, negotiated, attempted or transacted any merger, acquisition, asset sale or divestment in the past eighteen (18) months where such merger, acquisition, asset sale or divestment involved more than twenty five percent (25%) of the total assets or securities of the Applicant?*

If so, please provide details*

Are you contemplating transacting any merger, acquisition, asset sale or divestment in the next twelve (12) months where such merger, acquisition, asset sale or divestment would involve more than fifty percent (50%) of the total assets or securities of the Applicant?*

If so, please provide details*

Within the last three (3) years, has the Applicant or any person proposed for this insurance in his or her capacity as an employee, officer, or director of the Applicant or another entity been the subject of or involved in any of the following:*

Litigation, civil, arbitration, administrative or criminal proceeding, civil or criminal charge or hearing, or a written demand seeking monetary or non-monetary damages?

formal or informal investigation, proceeding or inquiry by any federal, state or local governmental agency or regulatory body, including without limitation, the U.S. Department of Justice, the U.S. Department of Labor, or any federal or state office of the Attorney General

notice of charges or other proceeding from the Equal Employment Opportunity Commission or any similar state or local agency or regulatory body?

None of the above

Within the last three (3) years, have you had any commercial crime losses?*

State of incorporation*

US Based Full Time Employees*

Enter 0 if zero

US Based Part Time Employees*

Enter 0 if zero

Foreign Full Time Employees*

Enter 0 if zero

Foreign Part Time Employees*

Enter 0 if zero

Number of employees in CA*

Enter 0 if zero

Number of employees in FL*

Enter 0 if zero

Number of employees in NJ*

Enter 0 if zero

Number of employees in NY*

Enter 0 if zero

Number of employees in TX*

Enter 0 if zero

Total number of current employees with annual compensation greater than $100,000*

Enter 0 if zero

How many employees have been terminated in the past 12 months?

Voluntary*

Enter 0 if zero

Involuntary*

Enter 0 if zero

Laid off*

Enter 0 if zero

If any reduction of employees or change of status is anticipated or being contemplated in the next year, enter the estimated number of each.

Voluntary*

Enter 0 if zero

Involuntary*

Enter 0 if zero

Laid off*

Enter 0 if zero

Do you anticipate any plant, facility, branch, office, or department closing, consideration, reorganization or layoff within the next twenty-four (24) months?*

Yes

Please Select ALL of the Human Resource Policies and Procedures that are in place.*

None of These

have a standard employment application for all applicants?

have an employment handbook?

have an "At Will" provision in the employment application?

have a written policy with respect to sexual harassment?

have a written policy with respect to discrimination?

have written annual evaluations for employees?

Have you had any discriminatory practice violations or litigations*

Yes

Have you had any disciplinary action by any regulatory agency or association, including the EEOC?*

Yes

Have you been given notice of claims, specific facts or circumstances which might give rise to a claim under any prior policies providing similar insurance?*

Yes

If so, please provide details*

Employment Practices Liability Insurance Quote – EPLI

Employment Practices Liability Quote

How many employees have been terminated in the past 12 months?

If any reduction of employees or change of status is anticipated or being contemplated in the next year, enter the estimated number of each.

Finance Information

Final Details