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Accountants Professional Liability Quick Quote


Name of Firm


Name of Contact


Business address


City

State ZIP

Phone


Fax


Email


Type of Insurance Quote Desired
Accountant's Professional Liability Insurance
Accountant's Professional Liability Limited Insurance
Employment Practices Liability Insurance
All


Staff Size
a)Number of full time proprietor(s), partner(s), and owner(s)

b)Number of CPAs (excluding those listed above)

c)Number of all other professional staff

d)Number of administrative support and clerical staff

e)Number of part-time equivalent employees
(Total part-time hours during past 12 months divided by 2080)



Total Staff:


Est. Annual Billings


Public Company's Billings




Has the prospective applicant carried continuous accountants' professional liability insurance during the past five years?

Yes
No

a) Current professional liability insurance coverage
Insurance Company:

Limits of Liability:

Deductible:

Annual Premium:


b) Date Current Policy Expires
/ /

c) Retroactive/Prior Acts Date
/ /


Desired Limit of Liability



Deductible Desired
Staff Size 1-15: $1,000 $2,500

Staff Size 1-24: $5,000 $10,000

Staff Size 25-49: $10,000 $25,000

Staff Size 50+: $25,000 $50,000

$1,000 or $2,500 deductible available only with $250,000 or $500,000 limit of liability.
Other deductibles available upon request.


Other Info
Does your firm perform audit and/or review services:
yes    no

Do you desire coverage for audit and/or review services:
yes    no


Validation Test
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Please check your information carefully.



11801 Research Drive
Alachua, FL 32615-6818
(800) 543-3029 or (386) 418-4003
Fax: (386) 418-4004
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CPA Mutual
Insurance Company of America
Risk Retention Group