Request a Quote - Virginia Bar Association Insurance

Select Coverage(Required)

Legal Name of Firm

Date Firm Established

Legal Status (Sole Proprietor, GP, LLP, LLC, PC/PA, Other)

Desired Effective Date

Contact Name(Required)

First Last

Primary Areas of Practice

Address

Street Address Address Line 2 City State ZIP Code

Phone

Please list all attorneys associated with your firm

Press the plus icon to add more lines if necessary

Firm's Retroactive Date

Number of non-attorney employees

Areas of Practice for the Firm

Revenue

Estimated Current Year

Prior Year

Second Prior Year

Maximum case value over past 24 months

Does any client represent more than 20% of the firm’s annual gross revenue? If Yes, please provide the name and type of legal services provided

Current Insurance Information

Name of Carrier

Desired Effective Date or Renewal Date

Limits

Deductible

Premium

Check any of the following circumstances that apply

1. Addresses, if you have more than one office location.

2. You share office space, staff, or letterhead with a firm or attorneys who are not affiliated with your firm.

3. Your firm provides a unique or exclusive service not available from other firms.

4. Attorney(s) provides professional services outside of Virginia and/or the U.S. If yes, please list the states or countries and percentage of practice (in time).

5. Attorney(s) serves as a public defender, public official, in-house attorney for a corporation or government agency, or IC or OC to another firm.

6. Attorney(s) also serves as an accountant, insurance agent/broker, investment advisor, real estate agent/broker, or securities agent/broker.

7. Attorney(s) serves or has served as an officer, director, partner or trustee of another entity (for- or non-profit).

8. Attorney(s) owns or has owned equity or financial interest in a client, or has engaged in any business venture with a client.

Please provide additional information for the circumstances above

Check any of the following that apply

1. Within the past five years, a disciplinary complaint has been filed, or if an attorney has been disbarred, suspended, reprimanded by a regulatory body or agency.

2. Within the past five years, a Professional Liability claim or suit has been made against an attorney or your firm.

3. Any member or employee of the firm has knowledge of an incident, act, error or omission that could potentially give rise to a claim under a professional liability policy.

Please attach documentation related to the circumstances above

Drop files here or

Max. file size: 50 MB.

Please Note

This is not an application for coverage; it allows VBAI to obtain non-binding, preliminary quotes from multiple insurance carriers. Any quotes presented are subject to a completed application and any subjectivities. All carriers retain the right to decline to quote based on risk assessment.

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