Application for
(This policy does not cover Private Law Practice)
This is an application for Claims Made Insurance.

5. Does the Organization accept cases for clients who are not indigent and whose incomes are above the national poverty level? (Written guidelines for client eligibility MUST be attached.)
7. Does your Organization provide services other than legal (social, medical, recreational or other)?
8. Does your organization utilize the services of attorneys outside of your Organization on a pro bono, judicare or contract basis?
If YES, please respond to the questions below.
(d) Does your organization check to see if the participating attorneys are admitted to practice law in your state?
(e) Does your organization check to see if the participating attorneys have had any legal malpractice or disciplinary complaints filed against them?
(f) Does your organization inform the client and the participating attorney of the terms and conditions of the referral (e.g. the termination of representation by your organization)?
9. Describe your Organization's practice of law by showing approximate percentages of cases involving the following:
(Total should equal 100%)
10. Does your Organization provide legal services to groups, corporations or associations?
12.                            LAWYERS                                             LAW STUDENTS/PARAPROFESSIONALS                    
13. Is your organization an ACLU that utilizes the services of cooperating volunteer attorneys outside of your organization?
14. Does your organization permit attorneys to engage in uncompensated outside practice of law as defined in the Legal Services Corporation regulations?
15. Has any claim, suit, charge, investigation or proceeding ever been made or instituted against the Organization or any Lawyer or other person providing professional services on behalf of the Organization which (Please check appropriate box):

Seeks an injunction or functionally similar order (including but not limited to a restraining order, a writ of mandamus, a writ of prohibition or an order compel prosecution)?
Alleges any of the following types of conduct listed on the next page:

(a)Negligent acts or omissions in the course of rendering professional services as a Lawyer, under the direction of a Lawyer, or Notary Public?
(b) Attorney misconduct or breach of professional ethics?
(c) False arrest, detention or imprisonment or malicious prosecution?
(d) Publication or utterance of a libel or slander or of any other defamatory or disparaging material or publication or utterance in violation of an individual’s right of privacy?
(e) Wrongful entry or eviction, or other invasion of the right of private occupancy?
(f) Conduct for which the claimant seeks an award of punitive or exemplary damages?
(g) Violation of a federal, state, municipal or local criminal statute or law?
(h) Conduct which may give rise to a contempt proceeding?
(i) Any conduct in connection with the employment, hiring, failure to hire, discharge or termination of the employment of an employee, former employee or application for employment?
(j) Conduct of Directors/Officers and/or other management personnel alleging negligence in their official capacity as management?
16. Does the Organization or any person specified in response to Question 12 know of any circumstance, act, error, omission or inquiry that could result in a claim, suit, charge, investigation or proceeding against the Organization or any Lawyer or other person providing professional services on behalf of the Organization that seeks an injunction or functionally similar order or is based on any of the types of conduct described in Question 15 above?
(f) Retroactive Date: Please attach a copy of your current policy.
18. Does you organization provide legal services to farmers regarding the creation, adjustment, restructuring or discharge of indebtedness secured by farm real estate or crops?
If YES, do you charge fees to the recipient client directly for the services rendered?
1. Does your Organization...

   - have at least two independently maintained calendars on which litigated and non-litigated items are entered by separate individuals?
   AND are the calendars cross-checked at least weekly by separate individuals responsible for cross-checking?
   AND does ultimate responsibility for docket control rest with the attorney responsible for the case?
If any of the above answers are NO, please explain on a separate sheet.
2. Does your organization use a computer-driven calendar and docket control system?
3. If your organization becomes aware of a conflict, do you disclose it in writing to all parties?
4. Does your Organization have written procedures for identifying potential or actual conflicts of interest?
5. How does your Organization avoid conflicts of interest?
6. Does your Organization generate engagement letters for all its clients?
7. Does your Organization notify clients in writing when your services are completed and when a relationship is terminated?
8. Does your Organization notify clients or prospective clients in writing when you decline to represent them?
9. Does your Organization have an internal grievance procedure to address complaints by clients?
3. Staff
Number of officers and/or directors (including Executive Director)
Number of Staff members (not including clerical employees)
Number of clerical employees
Is the Executive Director full-time or part-time?
4. Is the Organization a Not-for-Profit corporation chartered in its state of domicile?
5. Is the Organization directly in the insurance agency or brokerage business in any way?
6. Is your Organization unionized?
7. Does your organization have an internal grievance procedure to address complaints by employees?
8. Does the Organization publish any publication for limited or general distribution?
If YES, please attach sample of each.
9. Does the Organization sponsor any private or public meetings or conventions?
10. Total Annual budget (all sources) Year


In the event that a claim or claims or any circumstance, act, error, omission or inquiry that could result in a claim against the Organization or the persons named in this application have been reported to Underwriters or disclosed on this application, or if the Organization charges fees for its services, or if the Organization does not utilize income eligibility guidelines for clients, Underwriters reserve the right to individually rate insurance for the above Organization.

It is understood that the insurance applied for will issue on the 1st day of the month following receipt of the premium and the acceptance of the application by Underwriters.  I/We hereby declare, based upon my/our knowledge and upon reasonable investigation, the above statements are true and that I/We have not suppressed or misstated any material facts and this application shall be the basis of the contract with Underwriters at Lloyd's, London.


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