Architects & Engineers Insurance Application

Your Contact Information

So we can follow up with your quote.

Full Name *

Email *

Phone *

Firm Name *

Website

Firm Information

Date Established

Street Address

City

State

Zip

Do you have any overseas locations?

Yes

No

In the past 5 years, has the firm name changed or merged with another business?

Yes

No

Description of Operations

Briefly describe what your firm does — disciplines practiced, services offered, typical project scope, and any specialty areas.

Personnel

Number of staff in each role (include all professional and non-professional).

Principals

Architects, Engineers & other Design Professionals

Project / Construction Managers

Other (construction / admin / clerical)

Revenues & Services

Gross receipts — last 12 months ($)

Estimated gross — next 12 months ($)

% of receipts from overseas services

Do you perform any building, contracting, fabrication, manufacturing, or installation services (in-house or via subs)?

Yes

No

Disciplines & Professional Fees

Discipline % breakdown

e.g. Architecture 40%, Civil 20%, Structural 20%, MEP 10%, Interior Design 10%

Total professional fees — last 12 months ($)

Estimated professional fees — next 12 months ($)

Do you subcontract any professional services?

Yes

No

Projects

Project type % breakdown (last 12 mo, total 100%)

e.g. Public buildings 30%, Hospitals 20%, Schools 20%, Hotels 15%, Roads/transit 15%

Is the above split likely to change in the next 12 months?

Yes

No

In the past 5 years have you provided services on residential condominium or townhouse projects?

Yes

No

Five largest projects in the past 3 years

For each: project/client, construction value, professional fee, start/completion dates, services provided.

Clients

% of services attributable to each client type (must total 100%).

Private sector %

Public sector %

Foreign %

% of work from repeat clients

Has the applicant entered into any joint venture?

Yes

No

Does the applicant have any abandoned projects?

Yes

No

Risk Management

Do you perform all third-party services under a written contract?

Yes

No

Are all non-standard agreements reviewed by your legal counsel or insurance broker before execution?

Yes

No

Do you have procedures for monitoring and collecting outstanding fees?

Yes

No

Do you have an in-house continuing education program for professional employees?

Yes

No

Do you have procedures to evaluate and screen potential new clients?

Yes

No

Do you have a written in-house quality control procedure?

Yes

No

Do client deliverables undergo an internal peer review?

Yes

No

Current Professional Liability Insurance

Insurer / Carrier

Limits ($)

Deductible / Retention ($)

Annual Premium ($)

Retro Date

Expiration Date

Cyber & Claims History

Has the firm suffered a privacy breach, network security violation, cyber extortion, or other cyber-related incident in the past 5 years?

Yes

No

Has any professional claim or legal action been brought against the firm or any past principal/partner/director/officer in the past 10 years?

Yes

No

After inquiry, is anyone aware of any act, error, omission or circumstance that may result in a claim?

Yes

No

Any pending disputes concerning payment of fees for services rendered?

Yes

No

Has any prior PL application been declined, or has insurance ever been cancelled or non-renewed?

Yes

No

Have any principals/partners/directors/officers ever been subject to disciplinary action for professional activities?

Yes

No

Any open CGL claims (incl. products/completed ops) and/or closed claims with total incurred exceeding $100,000?

Yes

No

Architects & Engineers Application