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Employment Practices Insurance QUOTE

Employment Practices Liability Insurance is available through Centerpoint Insurance Group and should be considered by all employers. Coverage is comprehensive and affordable. Protection for allegations of discrimination, wrongful termination, and sexual harassment in the workplace can provide peace of mind to any employer.

EMPLOYMENT PRACTICES INSURANCE QUOTE REQUEST FORM

General Information
Legal Name of Business:
Contact Name:
Address:
City:
State:    Zip: 
Business Phone:   Fax:
Best Time To Call:   AM   PM
Contact Email Address:

Subsidiaries
Do you want to include all subsidiaries?  
Subsidiary Nature of Business Percentage Owned Date Acquired

Quote Questions
Does the parent organization, a subsidiary or any director or officer currently act in the capacity of general partner in a limited or general partnership?  If yes, briefly describe in box below.
Total number of U.S. employees
Total number of Fair Labor Standards Act exempt employees
Total number of Fair Labor Standards Act non-exempt employees
Total number of unionized employees in the U.S.
Is the insured organization owned by a non-U.S. parent?  If yes, please provide the name of the parent organization in box below.
Has the insured organization conducted any layoff, staff reduction or facility closing during the last 16 years?  If yes, briefly describe in box below.
Is the insured organization anticipating any layoffs or staff reductions?  If yes, briefly describe in box below.
Does the insured organization use outside employment counsel for employment advice or defense?  If yes, briefly describe in box below.
If outside employment counsel is not retained, who is responsible for employment advice and defense?
Does the insured organization have an employment-at-will statement and contract disclaimers?  If yes, briefly describe in box below.
Does the insured organization have a formal employment contract with any employee?  If yes, briefly describe in box below.
What is the total annual compensation paid pursuant to all employment contracts?
Does the insured organization provide outplacement for terminated employees?  If yes, briefly describe in box below.
Does the insured organization have an established termination procedure?  If yes, briefly describe in box below.
Does the insured organization have an established severance policy?  If yes, briefly describe in box below.

Loss History
Employment Lawsuits/Administrative Proceedings (e.g. EEOC) in last 3 years Type of Allegation Determination,Judgments, Defense Costs/Settlements

Is the insured organization presently subject to any judicial or administrative order, decree, judgment or conciliation agreement relating to employment?  If yes, briefly describe in box below.
Does the insured organization currently have Employment Practices Liability or similar insurance?

If yes, please provide the following.
Insurer  
Limit  
Deductible  
Policy Period  
Has the insured organization or any insured person given written notice under the provisions of any prior or current employment practices liability or similar insurance of specific facts or circumstances which might give rise to a claim being made against any insured?  If yes, briefly describe in box below.

Additional Comments
Please give any additional comments you feel appropriate for this quotation. If you have additional information where there was not enough space, please enter them here.


Please click on the "Submit Quote" button to send your quote request.
One of our representatives will respond to your submission as soon as possible.

   
 
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