ALOHA INSURANCE SERVICES

Hawaii's Full Service Agency
Aloha Insurance Logo
Insurance for
Business
Builders &
Developers
Condominium
Associations
Homeowners
Insurance
Life & Health
Insurance
Auto
Insurance
Marine
Insurance
GET A
QUOTE!

 Home
 Service Center
 Request Certificates
 File A Claim
 Pay A Bill
 Multimedia Library
 Contact Us
 Jobs@Aloha

Get A Quote

Homeowners
Alert!
Learn About...

Click to access your
Aloha Insurance eBinder

 

Just answer these simple questions to get a Professional Liability Quote

Policy Holder Information
Legal Entity Name
Business Name / dba
Please provide a detailed description of the nature of your business activities.
Mailing Address
City, State and Zip
Telephone Number
Fax Number
E-Mail Adddress
Estimated Annual Gross Revenues
Date Business Established:

 

Qualification

Limit of Professional Liability desired (Amount of Insurance):

Number of Principals, partners, officers and professional employees directly engaged in providing services to clients:

Number of Non-Professional employees (clerks, secretaries, etc.):

Number of Independent Contractors employed (if any):

Full Name of all Principals,
Partners or Key Employees
Professional Qualifications Date
Qualified
How Long
in Practice?
How Long as Principal/Partner

Please provide a list of your 5 largest projects during the past 3 years
Project/Client Name Services Performed Revenues Obtained

To what Professional Associations does your firm belong?

Does your firm employ a written contract with clients?

History

Aproximate Gross Income from the past 3 years: Last year:
Two years ago:
Three years ago:

Does your company receive more than 50% of its income from a single client?

Does your company have any subsidiaries?

Have your company changed it's name, merged with or acquired any other business in the past 5 years?

Has any similar insurance even been declined or cancelled?

Have any of the individuals listed above ever been the subject of disciplinary action by authorities as a result or their professional activities?
If Yes, please provide details.  

Are any of the indiviuals listed above aware of any fact, circumstance or situation which may result in a professional liability claim against the Organization or any of it's Directors, Officers, or Employees?

Current Insurance
Do you currently carry Professional Liability Coverage?
If so, what is the expiration date (month/day/year) of your current policy?
Company name of current Professional Liability Insurance provider:

Portions courtesy of and © Insurance Information Institute (www.iii.org) Copyright © 2001-2017 Aloha Insurance Services, Inc. Kona HI All rights reserved.
HOME | Contact Us | Our Partners | Jobs@Aloha | Site Map | Your Privacy | Insurance Glossary | Agent Login

Notary service available at our Kona location