Insurance E&O Quote

INSURANCE E&O QUOTE

This Insurance Errors & Omissions (E&O) Quote is an underwriting indication prepared for the Applicant identified below. This Quote is non-binding and does not constitute a policy or binder. Coverage, terms, conditions, premiums, and limits are subject to satisfactory underwriting, receipt of required documentation, verification of representations, and issuance of a written policy or binder. Applicant must disclose all material facts and prior loss history. Misrepresentation or omission of material facts may void coverage or render a policy unenforceable.

Applicant / Insured Information

Individual    Partnership    Corporation    LLC    Other:

Professional Services & Operations

Policy Details (Proposed)

Policy Type: Claims-made    Occurrence

Coverage Options & Endorsements

Select requested coverages and endorsements. Availability subject to underwriting and may alter premium or terms.

Defense costs within the limit    Defense costs outside the limit (Supplementary Payment)

Privacy/Cyber Liability endorsement    Fiduciary Liability endorsement

Prior Acts coverage included    Contractual liability coverage

Exclusions — Standard & Noted

The following exclusions are commonly applied to E&O coverage. Indicate acknowledgement of each exclusion as part of underwriting review. Coverage may be offered with endorsements or carve-backs subject to additional premium and underwriting.

Claims arising from intentional non-compliance, fraud, or dishonest acts

Claims arising from criminal acts or penalties

Asbestos, silica, lead, or pollutant removal liabilities

Political risk, war, or government seizure

Applicant acknowledges that the stated exclusions may apply and that final exclusions will be set forth in the issued policy.

Prior Claims / Loss History (last 5 years)

Provide all known claims, suits, incidents, or potential claims. Attach loss runs where available.

Documentation Checklist (attach with submission)

Current policy declarations page(s)    Loss runs for last 5 years

Sample client contracts / engagement letters    Resumes of key professionals

Financial statements (most recent)

Underwriting Questions

Has any insurer cancelled or non-renewed E&O coverage in the past 5 years?    Yes    No

Are any of the Applicant's services provided to clients outside of the country of domicile?    Yes    No

Premium Summary (Underwriter Indication)

Declaration & Authorization

The undersigned Applicant certifies that the information provided in this Quote request is true, complete, and accurate to the best of Applicant's knowledge. Applicant understands that this Quote is an indication only and is subject to the insurer's standard underwriting and approval processes and to the terms, conditions, limitations and exclusions of any policy issued. Applicant authorizes the insurer and its representatives to obtain loss histories, claim information, and other underwriting information from prior insurers, regulatory authorities, and other third parties as necessary to evaluate this application. Applicant acknowledges that any material misstatement or omission may be cause for denial of coverage or rescission of any issued policy.

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