Request an Employment Practices Liability Quote

Just answer these simple questions to get an EPLI Quote

Policy Holder Information
Legal Entity Name
Business Name / dba
Please provide a brief description of the nature of your business
Is this a Franchise?
Mailing Address
City, State and Zip
Telephone Number
Fax Number
E-Mail Adddress
Estimated Annual Gross Revenues
Estimated Annual Payroll
Is This a New Venture?
Full Time and Temporary Employees:
Part Time and Seasonal Employees:
Independent and Leased Contractors:

Qualification

Do you have more than one location?

Have you been in operation more than one year?

Have you closed, downsized, laid off, reduced staff, sold, merged or acquired any company in the last 12 months or do you plan to do so in the next 12 months?
Subsidiaries (If none, please skip to History)
Are you a subsidiary of another organization?

If so, please provide name and address of parent:

Is your parent domiciled outside the U.S.?

Are more than 50% of the applicant's staff earning more than $75,000/year ($100,000/year if a consultant)?

Do you wish any subsidiary(s) to be covered?

If so, enter subsidiary(s) name:

Is the subsidiary(s) at least 50% owned by you?

Does the subsidiary(s) fall within the same class of business as you?

Have you included the subsidiary(s) employees in your total employee count?
History
Within the last 5 years has any employment related or third party discrimination or third party sexual harassment inquiry, complaint, notice of hearing, claim or suit been made against the Organization or any person proposed for Insurance in the capacity of either Director, Officer, or Employee of the Organization?

Is any person proposed for this Insurance aware of any fact, circumstance or situation which may result in an employment claim or third party discrimination or third party sexual harassment claim against the Organization or any of it's Directors, Officers, or Employees?

Do you currently carry Employment Practices Liability Coverage?

If so, what is the effective date (month/day/year) of the beginning of continuous coverage?

Would you like "Full Prior Acts" Coverage?

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