Delaware State Bar Association Quote Form

Life, Health, and
Disability Quote

The Delaware State Bar Association formally endorsed our Lawyers Professional Liability Insurance programs in 1980. In 1999, PLI and Zutz Insurance Group were also endorsed by the Delaware State Bar Association for Health Insurance coverages. Delaware Lawyers can support their Bar Association and their many important programs through the purchase of insurance through Zutz.

PLI's Lawyers Underwriting Staff:

Name	E-mail	Extension (302-658-8000)
Sharon Ruth, Underwriting Mgr.		173
Mary Halter		174
Judy Grater, CPCU		153

Delaware State Bar Association
Professional Liability Insurance
Quote Form

Contact Information
Firm Name:
Contact Name:
Address:
City:
State:	Zip:
Business Phone:
Fax:
E-mail Address:
Person at Firm responsible for Professional Liability Insurance:

Questionnaire
1.	Provide the number of attorneys in your firm by their years in private practice:
	6 yrs.+ 5 yrs. 4 yrs. 3 yrs. 2 yrs. 1 yr.
	Total Attorneys Total Other Staff
2.	Have MOST of the attorneys in your firm had some type of continuing legal education within the last year? Yes No
3.	Indicate the percentage of time devoted in each specialty during the last year:
	Administrative Law Admiralty Defense Admiralty - Other than Defense Anti-Trust / Trade Regulation Arbitration Bankruptcy Bonds Civil Rights Class Action Suits Collection / Repossession Commercial Litigation Communications (FCC) Construction Litigation Contract Law Corporation Formation Publicly Corporation Formation - Close Criminal Matters Domestic Relations/Family Law DUI Elder Law Election Law Employ. Practice - Defense Entertain. - w/Money Mgmt Entertain. - w/o Money Mgmt Environmental - Defense Environmental - Not Defense ERISA or Employee Benefits Financial Institutions General Civil Matters General Corporate Litigation	Health Care Immigration Insurance Company Defense International / Foreign Law Investment Counseling / Money Juvenile Law Labor - Employee Representation Labor - Management Rep. Labor - Union Representation Management Mediation Mergers / Acquisitions Municipal Law Oil, gas or mining Other Defense Patent / Copyright / Trademarks Personal / Bodily Injury Defense (plus for banks) Plaintiff Representation Product Liability Defense Public Utilities Real Estate School Law Securities, exclud. bonds Corp. - Non-Publicly held Social Security Companies Taxation - Opinions Taxation - Preparation held Wills, Estate Planning. Probate Workers Compensation Defense

4.	Do you have a computerized Docket System? Yes No
5.	In the last live years, has any attorney in your firm:
	Had a disciplinary action filed against them or currently pending? Yes No
	Had a claim or lawsuit filed against them? Yes No
	If Yes, please furnish complete details on your firm letterhead, including date of claim, total paid, loss reserve or claimants settlement demand.
6.	Is your firm currently insured? Yes No
7.	If Yes, Current Carrier:
	Current Expiration Date:
	Current Limits and Deductible:
	Current Prior Acts Date:
8.	Number of Fee Suits
9.	Date Firm Established

Additional Comments

Please click the "Submit Quote" button to send your quote request.

This is a request for quotation only. No coverage is in effect until bound by an insurance carrier.

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