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Insured Professional / Firm Information

Insured Information

Entity Type Individual Person Corporation Limited Liability Company (LLC) Partnership Sole Proprietorship Trust Non-Profit Organization Government Entity

Select the type of entity

Full Legal Name

As it should appear on the document

Doing Business As (DBA)

Optional trade name

State of Formation Select state... Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming District of Columbia

Where the entity was formed

Authorized Representative

Person authorized to sign

Representative Title

Title or position

Address

Street Address

Full street address including suite or unit number.

City

City of insured residence or business.

State Select... Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming District of Columbia

State where this address is located.

ZIP Code

5-digit ZIP code.

Email Address

Used for correspondence and notices.

Phone Number

Best number for direct contact.

Requiring Party / Client Information

Client / Certificate Holder Information

Entity Type Individual Person Corporation Limited Liability Company (LLC) Partnership Sole Proprietorship Trust Non-Profit Organization Government Entity

Select the type of entity

Full Legal Name

As it should appear on the document

Doing Business As (DBA)

Optional trade name

State of Formation Select state... Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming District of Columbia

Where the entity was formed

Authorized Representative

Person authorized to sign

Representative Title

Title or position

Address

Street Address

Full street address including suite or unit number.

City

City of client / certificate holder residence or business.

State Select... Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming District of Columbia

State where this address is located.

ZIP Code

5-digit ZIP code.

Email Address

Used for correspondence and notices.

Phone Number

Best number for direct contact.

Policy Details

Profession / Service Type * Select… Attorney / Law Firm Accountant / CPA Engineer Architect Business Consultant IT Professional / Managed Services Real Estate Agent / Broker Financial Advisor Healthcare Professional Other Professional

E&O (errors and omissions) insurance is also called professional liability or malpractice insurance in some fields. The policy type must match your specific profession.

Coverage Type Claims-Made (most common for E&O) Occurrence-Based

Claims-made policies only cover claims filed while the policy is active. An "occurrence" policy covers incidents that occurred during the policy period regardless of when the claim is filed. E&O is almost always claims-made.

Per-Claim Limit ($) *

The maximum payout per single claim. $1–2M per claim is standard for most professional services. Higher limits may be required for large engagements.

Aggregate Annual Limit ($) *

The total maximum payout for all claims during the policy period. Typically 2× the per-claim limit.

Policy Effective Date *

The start date of coverage. For claims-made policies, no claims can arise from services provided before the retroactive date.

Retroactive Date

The earliest date from which claims can arise. Matching this to your business start date ensures full coverage of your professional history.

Deductible ($)

The amount you pay per claim before insurance responds. Higher deductibles reduce premiums but increase out-of-pocket exposure for small claims.

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Professional Liability Insurance Agreement — Preview

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Not Legal Advice: This automated form assistance tool provides general information and document templates. It is not a substitute for legal advice from a qualified attorney. Laws vary by jurisdiction and change over time. Consult with a licensed attorney for advice specific to your situation.
Last updated: January 2026