Employment Practices Liability

Employment practices liability insurance has rapidly emerged as one of the most significant exposures in today's business world. Not only is the number of employment-related claims increasing, so are businesses' financial and legal risks. EPLI insurance offers protection against claims filed by employees, clients, customers and vendors for a wide range of exposures, including:

Sexual harassment
Discrimination
Wrongful termination
Disabilities
Drug testing
Emotional distress
Invasion of privacy
Libel
Mental anguish
Negligent hiring
Slander

Customer Information
First Name
Last Name
Business Name
Address
City
State
Zip Code
Phone Number
Fax Number
E-mail Address

Location Detail Information
Additional Business Address		F/T Employees	P/T Employees	Seasonal
Loc #1	Same Address As Above
Loc #2
Loc #3

Underwriting Information
Please Describe the Nature of Your Business
Type of Ownership
Years of Experience
Number of employees under age 40
Number of employees over age 40
Number of employees by salary range (under $25,000 year)
Number of employees by salary range ($25,000-$75,000 year)
Number of employees by salary range (over $75,000 year)
Number of employees that left the company (last year)
Number of employees that left the company (year before last)
How Many Years Have You Operated This Business
Business License Number
License Type
This Years Estimated Gross Receipts
Last Years Gross Receipts
Year Before Last Gross Receipts
Is This Business Open 24 Hours A Day?	YesNo
Are you aware of any claim situation not filed?	YesNo
Any inquiries from the National Labor Relations Board?	YesNo
Any inquiries from the Equal Employment Opportunity Commission?	YesNo
Any inquiries from the Fair Labor Standards Enforcement Act?	YesNo
Any inquiries from the Civil Rights Act of 1991?	YesNo
Any inquiries from the U.S. Department of Labor?	YesNo
Any inquiries from any state or local government agency?	YesNo
Any inquiries from the Age Discrimination Employment Act?	YesNo
Any inquiries from the Americans with Disabilities Act?	YesNo
Do you have Federal contracts or serve as a subcontractor on contracts over $50,000 per year?	YesNo
Has there been a Company merger within the last 24 months?	YesNo
Is a Company merger expected within the next 24 months?	YesNo
Do you anticipate layoffs within the next 24 months?	YesNo
Do you have an affirmative action plan?	YesNo
Has your affirmative action plan been updated within the last 12 months?	YesNo
Do you have a written policy regarding harassment?	YesNo
Do you have a written pay raise program for your company?	YesNo
Do you have an established internal dispute resolution or grievance process?	YesNo
Do you have a written disciplinary process?	YesNo
Do you have a performance appraisal process?	YesNo
Do you evaluate all employees annually?	YesNo
Are employee terminations reviewed by Human Resources?	YesNo
Are employee terminations reviewed by legal counsel?	YesNo
Do you have written policies for Americans with Disabilities Act?	YesNo

Loss Information
Describe any Losses-Claims in the last 5 years related to allegations of wrongful termination, discrimination or sexual harassment

Coverage Information
Liability Limits Requested
Deductible Requested
Current Insurance Company
Current Annual Premium
Misc Information to help the agent




Premier One offers insurance products and services through its licensed affiliate Premier One Insurance Services, Inc. (Licenses), Insurealty Insurance Services, and other affiliates. Insurance products and services are provided by insurance companies and similar providers. Rates and coverage are subject to individual qualification. Not all products are available in all states.

Home \| Contact Us \| About Us \| Resources \| Customer Service \| FAQs \| Careers \| Locations \| Privacy & Security Auto Insurance \| Home Insurance \| Renter Insurance \| Life Insurance \| Health Insurance \| Business Insurance Specialty Coverages \| Wedding Insurance \| Travel Insurance \| Mexico Insurance \| Dealers Click Here

Copyright © 2010, Premier One Insurance Services, Inc. For comments or suggestions, Click Here