Quote - Employment Practices & Liabiliy Insurance


	Name of Insured


	Email address


	Location of Business


	Full-time Employees


	Part-time Employees


	Description of primary business activities


	Number of involuntarily terminated over the last 3 years?


	Annual Sales?


	Annual Payroll?


	How many insured business locations are there?


	Do you have a personnel or human resources department?


	Yes


	No


	Do you have an employee manual that states your right to terminate employment at will?


	Yes


	No


	Are you aware of any present situation that may result in a claim in the next year?


	Yes


	No


	How many EEOC/state agency charges have been filed against the insured over the last seven years?

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	The insurance policy, not summaries on this site, form the contract between the insured and the company. The policy contains limits, exclusions and limitations that are not detailed here. This information presented here is for informational purposes only.