In order to provide the most accurate estimate of ALPS insurance premium for your firm we need to collect a little information from you first. The estimate should only take ten minutes of your time. Thank you for considering ALPS as your malpractice insurer.



Please tell us about where your firm is located and how we can contact you. If you need assistance, please contact an ALPS representative at 800-367-2577 or learnmore@alpsnet.com



Required *

Firm Name:
Address:
City:
State:
Zipcode:
Phone:
Email Address:
    Website Address:

Please tell us about your firm’s insurance history so we get an idea of how much coverage you’ll need. If you need assistance, please contact an ALPS representative at 800-367-2577 or learnmore@alpsnet.com



Required *

Desired Effective Date (MM/DD/YYYY):
    Desired Limits:
    Other Limits:
 
    Desired Deductible:

Do you currently have malpractice insurance?

Please tell us a about the areas of practice your firm engages in so we know what aspects of law to cover. This information is required to receive an estimate. If you need assistance, please contact an ALPS representative at 800-367-2577 or learnmore@alpsnet.com



AOP information is required to receive an estimate.

% Admirality/Maritime% Entertainment/Sports% Oil/Gas
% Anti-trust/Trace Regulation% Environmental% Patents
% Arbitration/Mediation% Estate/Probate/Wills/Trusts% Copyright/Trademark
% Bankruptcy% ERISA/Employee Relations% Public Utilities
% Civil Litigation-Plaintiffs% Civil Litigation-Defendants% Real Estate
% Financial Institutions% Gaming/Casino/Representation% Securities Exempt/Bonds
% Collection/Repossession% Government% Securities/Registered Offerings
% Corporation/Business% Immigration% Social Security
% Mergers and Acquisitions% International Law% Taxation
% Criminal% Labor Law% Workers Compensation
% Domestic Relations% Natural Resources% Other - Describe Below
    Other Description* Required if Other % is > 0
Total (should equal 100%):    %

Please tell us a little general information about your firm so we get an idea about your firm’s composition and practices. If you need assistance, please contact an ALPS representative at 800-367-2577 or learnmore@alpsnet.com



Required *

Firm Established Date:
Firm Retroactive Date:
Total Number of Paralegals, Law Clerks, and/or Legal Administrators:
Total Number of Clerical and/or Office Staff Members:

The following questions help us better understand the risk management procedures already in place for your firm. If you are a newly established firm, please answer the questions below in terms of what you plan to do.


Are engagement letters used?

Is a conflict of interest system used?

Do you use a computerized docket and/or calendaring system?

Do you sue for fees?

Please tell us a little about the attorneys in your firm so we know who is being covered. If you need assistance, please contact an ALPS representative at 800-367-2577 or learnmore@alpsnet.com



At least one attorney is required to receive an estimate.

Total Number of Attorneys in the Firm:


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Please tell us about your claims history so we know what claims or disciplinary action occurred or is pending. If you need assistance, please contact an ALPS representative at 800-367-2577 or learnmore@alpsnet.com



Required *

During the last 5 years, how many Professional Liability claims have been made against the firm or any of its members?

In the last 5 years, has any attorney in the firm received a bar complaint?

Has any attorney ever been refused admission to practice, disbarred, suspended or formally reprimanded?