Cotizacion de Abogados

Seguros JCE valoran tenerle como uno de nuestros posibles clientes y agradecen su confianza y su patrocinio de nuestros productos y servicios. Seguros JCE respeta la privacidad de la información que nos comparten nuestros clientes y se compromete con éstos a mantener la confidencialidad y seguridad de la misma. JCE GROUP, INC no comparte ningún tipo de información de nuestros clientes o consumidores con personas no afiliadas, solo con aseguradoras según permitido por Ley.

GENERAL FIRM INFORMATION

Name of the Applicant:*

First Last

LAWYERS AND STAFF

Total number of attorneys in the principal office and branch (es), if any, (excluding attorneys engaged as independent contractors or on a per diem basis):

This year:

Last year:

Please provide the information for each attorney in your firm (including “Of Counsels”) to be insured. If you need additional space, please use the Supplemental Lawyer Information form.

Attorney’s Name

Date of Birth

Month and Years Admitted to Bar (list State Bar)

*Years in Private Practice

Primary Area of Practice (PAP)

%of Attorneys Billing from PAP

Location of Practice (State)

Month & Years Joined This Firm

Current Number of:

Partners/shareholders/owners:

Associates/employed lawyers:

Of Counsel/ counsels who are expected to bill more than 1200 hours:

Independent Contractors who are expected to bill more than 1200 hours:

Current Number of:

Paralegals:

Clerical staff:

Other (please describe):

If Applicant is a solo practitioner, please provide name of attorney who would manage your practice in the event of your Incapacitation.

Name:

Insurance Carrier:

Address:

Limits of Liability:

INSURANCE HISTORY:

Current policy expiration date:

What is the inception date of your earliest “claim made” policy maintained without interruption?

Please list all primary and excess (if applicable) lawyer professional liability insurance policies carried by the Applicant for the past five (5) years:

POLICY PERIOD

Insurance Company

Limits of Liability Per Claim/Agg

Deductible

Annual Premium

No. of Attorneys Covered

Does your current policy have a prior acts exclusion (retroactive) date?

Yes
No

Date:

Has any of the Applicant’s professional liability insurance been canceled or nonrenewed during the last 5 years? If yes, ok please provide details in a separate addendum.

Yes
No

PRACTICE PROFILE

Indicate the percentage of gross income for the pass fiscal years derived from the following areas of practice.

Admiralty/Maritime

Litigation

Antitrust/Trade Regulation

Commercial

Arbitration/Mediation

Insurance Defense

**Banking/Financial Institutions

*Personal Injury Plaintiff

Bankruptcy

*Personal Injury Defense

*Oil &Gas

Commercial Transactions

Pension and Employee Benefits

*Copyright/Patent/Trademark

*Real State

Corporate Law

Commercial

Formation /Alteration

Residential

Mergers/Acquisitions

Land Use/Zoning

Criminal Law

Title Examinations

Domestic Relations

*Securities

*Entertainment/ Sport

Tax

*Environment Law

Opinions

Estate/Trust/Probate

Preparation of Tax Returns

Government/Municipal (other than bond work) % Work Compensation %

Work Compensation

**International Law

Preparation of Tax Returns

Labor Relations

Plaintiff

Labor Representation

Defense

Management Representation

Other: (describe)

*Supplemental application must be completed.

**Provide a brief description of this area of practice.

Approximately what percentage of total practice consists of defense work?

According to gross billing, please list the largest clients of the Applicant. If confidentiality is required, please describe only the nature of business and legal services provided.

Name of Client

Nature of client’s business

Legal services provided

Has your firm, or anyone in your firm, in the past five years, ever represented issuers, under writers, or a affiliates thereof with respect to the issuance, offering or sale of securities or bonds? If yes, please complete the Securities supplement

Yes
No

Have your firm, or anyone ever affiliated with your firm, provided legal services for any Financial Institution during the last 5 years? If yes, please complete the Financial Institution Supplement.

Yes
No

RISK MANAGEMENT

Does the Applicant employ a firm administrator?

Yes
No

Is the firm managed by a committee that meet on a regularly scheduled basic?

Yes
No

Does the firm have written risk management procedure?

Yes
No

Does the Applicant use a formal system to evaluate the performance of all practicing lawyers?

Yes
No

Does the Applicant use a formal system to evaluate the performance of all staff?

Yes
No

How many suits against your clients for recovery of attorney’s fees have filed in the last two years?

How many of these suits have been resolved?

What percentage the Applicant’s billing are ninety (90) days or more overdue?

Are new client and new matter approved by a committee or by a partner in the firm? If no, please explain on a separate addendum.

Yes
No

Are engagement letters or retainer agreements, which establish the scope of the Applicant’s representation, required to be sent on all new client engagements? If no, please explain .

Yes
No

Are billing arrangements, if any , explained n writing to the client at the outset of Applicant’s representation ? If no, please explain.

Yes
No

Are non-engagement letters required to be used when declining representation? If no, please explain.

Yes
No

Are disengagement letters or termination letter required to be used upon termination or completing the legal representation?

Yes
No

Does the Applicant share any of the following with other attorneys or law firms? (Use separate attachment if necessary.)

Office space:

Yes
No

If yes, name of office sharing attorney(s) or firm(s)

Cases:

Yes
No

If yes, please describe case sharing arrangement on separate addendum.

Letterhead:

Yes
No

If yes, please explain relationship on separate addendum and provide sample letterhead.

Which of the following are incorporated in the Applicant’s docket control system? (check all that apply)

Calendar
Mater Listing
Tickler File
Pocket Diary
Computerized System
Others

How does the Applicant’s maintain its conflict of interest system? (check all that apply)

Oral/memory
Index File
Computer
Conflict Committee
Others

Indicate the items captured by this conflict of interest system? (check all that apply)

Client Name
Client Principal
Client Subsidiaries
Opposing Party
Opposing Counsel

Are potential conflict referred to an independent conflict committee?

Yes
No

Describe how the Applicant resolves potential and actual conflict (attach separate addendum if necessary):

After matters have been opened, what steps does the Applicant take to supplement conflict of interest searches regarding new parties?

Are any of the Applicant’s lawyers a director or officer of, a partner in, holding equity , interests in, or an employee of a business entity other than the Applicant? If yes, please complete the Outside Interest Supplement.

Yes
No

CLAIM HISTORY

Has any attorney of the Applicant firm ever been refused admission to practice, disbarred, suspended, reprimanded, sanctioned or held in contempt by any court, administrative agency or regulatory body? If yes, please provide details on a separate addendum.

Yes
No

Has any attorney of Applicant had a disciplinary complaint made to any court, administrative agency or regulatory body in the past 5 years? If yes, please complete a Claim Supplement for each disciplinary complaint

Yes
No

Has any attorney liability claim or suit been made against any attorney of Applicant or any previous member or your current firm or predecessor firm within the last five (5) years?If yes, please complete a Clam Supplement for each claim/incident

Yes
No

Does any attorney of Applicant know of any incident, circumstances, acts, errors, omissions, or personal injuries that could result in a professional liability claim against any attorney of the firm or its predecessors irrespective of the actual validity of such claim? If yes, please complete de Claim Supplement for each incident.

Yes
No

Have all of the matter indicated above been reported to the Applicant’s appropriated professional liability carrier(s)? If no, please explain on a separate addendum.

Yes
No

COVERAGE SELECTION

Please provide limits of liability and deductible options requested

LIMITS OF LIABILITY

DEDUCTIBLE

Zero deductible
$2,500
$5,000
$10,000
$15,000
$25,000
$50,000
$100,000

Aviso Anti Fraude:

Cualquier persona que a sabiendas y con la intención de defraudar presente información falsa en una solicitud de seguro o, que presentare, ayudare o hiciere presentar una reclamación fraudulenta para el pago de una perdida u otro beneficio o, presentare más de una reclamación por un mismo daño o perdida, incurriría en delito grave y convicto que fuere, será sancionado, por cada violación con pena de multa no menor de cinco mil ($5,000) dólares, ni mayor de diez mil ($10,000) dólares o pena de reclusión por termino fijo de tres (3) anos, o ambas penas. De mediar circunstancias atenuantes, podrá ser reducida hasta un mínimo de dos (2) anos. Artículo 27.320 de la ley #18 de 2004