Tax Preparer's Errors & Omissions Insurance
Pennsylvania Only
Name of Business:
             Phone Number: 
Contact Person:
             E-Mail Address: 
 Street Address or PO Box:
(include any branch location addresses)
      State:       Zipcode: 
Check all that apply:
CPA Enrolled Agent (discount applies)
Financial Planner Attorney
Accountant Independent Practicitioner
Total Number of Owners & Employees (including parttime)  Number of Offices: 
Amount of Coverage Requested: $ 10,000 per claim/$ 20,000 aggregate $ 25,000 per claim/$ 50,000 aggregate
$ 50,000 per claim/$ 100,000 aggregate $ 100,000 per claim/$ 200,000 aggregate
Are you a member of a tax preparer's association:  Yes  No    If YES, which one: 
Do you want optional bookkeeping coverage?  Yes  No    What percentage of your business is bookkeeping?  %
Policy includes one year complimentary retroactive coverage.    Do you want to purchase a second year?  Yes  No
1. Have you sustained any prior losses? Yes No
2. Do you currently carry errors & omissions insurance?
    If Yes, please provide the amount, details, and insurance claim status of any prior losses: 
Yes No
3. Number of years of experience preparing tax returns? 
4. What types of returns does your firm prepare:  Personal  Commercial/Business
5. Does your firm subscribe to a tax reporter service or similar publication?

          If YES, are they required reading for all preparers?

6. Does your firm regularly check the accuracy of your computer software? Yes No
7. Does your firm utilize an outside tax preparation service?
       If YES, does the service hold you harmless for liability that may be incurred as a result of their performance?
8. Is there a review of all tax preparation by a supervisor who is not involved in that preparation prior to releasing the return? Yes No
9. Have you or any member of your firm been subject to a tax preparer's fine(s) or penalty levied by the Internal Revenue Service, or to disciplinary action by any state board of accountancy, AICPA, or state society?
        If YES, please list the dates, dollar amounts and other specifics:
Yes No
10. Has your firm had a peer review under the sponsorship of the AICPA, a state society, or any other professional association, in the last three (3) years? Yes No


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