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MACPA EPL Quote Form
 









 

 

 

The only Employment Practices Liability Insurance program endorsed by the MACPA

 

 


MACPA Main

MACPA Professional Liability Insurance Quote Form

 

 

 

  

 

In order to receive premium indications on this increasingly needed coverage, please complete the following questions:

Contact Information
Firm Name:
Contact Name:
Address:
City:
State:   Zip:
Business Phone:  
Fax:
E-mail Address:

Questionnaire
1. Does the firm currently have EPL insurance coverage? Yes No
2. Your Current Carrier:
3. Effective date:
4. Current limit of liability:
5. Current deductible:
6. Current premium:
7. Current number of employees:
8. Current number of equity owners:
9. Has the firm had a wrongful termination, discrimination or harassment (sexual or non-sexual) claim within the past 5 years?
Yes No
 
If so, please provide details:


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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The Zutz Group is licensed to provide Property and Casualty Insurance in all states except AK and HI.