Lawyer's Professional Liability
Pennsylvania
McGRATH INSURANCE GROUP

4170 William Penn Highway   Murrysville, PA.   15668-1809
(724) 327-8474     Fax: (724) 327-7911
Toll Free: 1-800-977-2999       Fax:  1-888-800-0034
Firm / Applicant Name:
Principal Business Address
City:
  County:   State:     Zipcode: 
Phone:
    Fax: 
E-Mail Address:

Current Malpractice Insurance
Current Insurance Company Current Liability Limits Current Deductible Retroactive Date
Desired Limits of Liability (each claim/aggregate limit)
$ 100,000 / $ 300,000
$ 200,000 / $ 600,000
$ 500,000 / $ 1,00,000
$ 1,000,000 / $ 1,000,000
$ 2,000,000 / $ 2,000,000
Other: 
Deductible (each claim)
$ 0
$ 1,000
$ 2,500
$ 5,000
$ 10,000
Other: 

Please list all the attorneys practicing on behalf of your firm.   Additional attorney's can be listed in the comment's section, if necessary:
Attorney's Name Social Security Number Years in Private Practice Designation Code Current Legal Malpractice Insurance Carrier Retroactive Date
AREA OF PRACTICE % AREA OF PRACTICE %
Admiralty/Maritime % GOVERNMENT
Antitrust % Federal and State %
Business Transactions- Commercial Law % Local (not bond work) %
Business Transactions - Entertainment % Immigration/Naturalization %
Civil Rights/Discrimination % International %
Collection/Bankruptcy % Labor Law %
Consumer Claims % LITIGATION
CORPORATE LAW and BUSINESS ORGANIZATION PI/PDPlaintiff %
Formation/Alteration & Mergers/Acquisitions % Insurance Defense %
Secured Transactions % Workers Compensation: Defense %
Administrative Law/Record Keeping % Workers Compenstation: Plaintiff %
Criminal % Securities Law %
Environmental Law % State or Federal (both exempt and registered) %
Estate/Trust/Probate % Municipal Bonds %
Family Law % Natural Recourses/Oil & Gas %
Patent/ Trademark/Copyright (Intellectual Property) %
Must equal 100% Real Estate %
Taxation/Tax Opinions %
Have any members of your firm been reprimanded, censured, suspended or disbarred within the past five (5) years? If "YES", provide full details in comments section
Yes
No
Have any professional liability claim(s) or suit(s) been made against you or any attorney(s) in the firm or former attorney(s) in the firm within the past five (5) years?
Yes
No
After inquiry, are you or any attorney in your firm aware of any circumstances, incidents, acts, or omissions that has led to a professional liability claim that has not yet settled or which could lead to a professional liability claim being made against your firm?
Yes
No
Comments and/or additional information for any "YES" answers from above:


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M c G R A T H   I N S U R A N C E   G R O U P

4170 William Penn Highway, Murrysville, PA. 15668-1890
(724) 327-8474           Fax: (724) 327-7911
Toll Free: 1-800-977-2999     Fax: 1-888-800-0034
www.McGrathInsuranceGroup.com        McGrathInsurance@verizon.net