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LAWYERS PROFESSIONAL LIABILITY INSURANCE
NATIONAL DISABILITY RIGHTS NETWORK, INC.
(This policy does not cover Private Law Practice)
This is an application for a Claims Made Policy.

SECTION I -- Coverage A-1

  1. LAWYERS PROFESSIONAL LIABILITY COVERAGE
    (including Notary Public Professional Liability)
  2. PERSONAL INJURY LIABILITY
  3. SOCIAL ENGINEERING FRAUD LIABILITY
  4. DISCIPLINARY PROCEEDINGS COSTS
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2. List Branch Offices and Addresses, if any:
6. Does the Organization accept cases for clients who are not indigent and whose incomes are above the national poverty level? (Please send a copy of guidelines for client eligibility.)
8. Does your Organization provide services other than legal (i.e. social, medical, recreational, or other)? If YES, please send written explanation.
9. Does your Organization operate a pro bono or judicare program whereby your Organization utilizes the services of attorneys outside of your Organization?
10. Understanding that:
Paid means both salaried and hourly employees.
Full-time means an employee working 30 or more hours per week.
Part-time means an employee working less than 30 hours per week.
Attorney/Lawyer means any employee who is allowed to practice law in any U.S. State or Territory or Canada or any of its Territories regardless of whether or not the employee represents clients for and on behalf of the Organization.
Non-Attorney Professionals means employees (excluding strictly clerical employees and attorneys) working in any of the following capacities: non-attorney executive director, paraprofessional, advocate, representative payee reviewer, legal secretary, law student, intern, social worker, intake & referral, notary public, outreach, publications that are made available to the public including website and social media content, legal research and/or advocacy research, personnel who oversee any attorney or non-attorney professionals, and personnel performing duties in any like manner to any of the above named capacities.
Strictly Clerical means an employee with minimal or zero client contact that does not fit into any of the above categories and who is overseen by an Assured employee.

All employees other than Strictly Clerical employees must be listed for coverage in one of the two following charts (send a separate sheet if necessary).
 Lawyers NameFull-Time/Part-Time StatusPaid/Volunteer StatusRep Payee Reviewer (check if Yes)Percent of time spent performing Rep Payee Reviews
.
.
.
.
.
10b)
 Non-Attorney Professionals NameFull-Time/Part-TimePaid/VolunteerRep Payee Reviewer (check if Yes)Percent of time spent performing Rep Payee Reviews
1
2
3
4
5
6
7
11. Do you have any vacant positions (excluding Strictly Clerical positions)?
If Yes, please indicate the following: (send a separate sheet if necessary).
 Position and Expected Fill-By DateFull-Time/Part-TimePaid/VolunteerRep Payee Reviewer (check if Yes)Percent of time spent performing Rep Payee Reviews
.
.
12.  Are any staff included in answer to Question 10, Social Workers?
If Yes, please provide:
13. Does your Organization utilize Outside Contractors, Consultants or Co-Counsels for Attorney or Non-Attorney Professional type work?
0/255 characters
14. Please describe the activities of your Organization by showing approximate time spent involving the following: (Total should equal 100%) 🛈
0/100 points
15. Describe your Organization's practice of law by showing approximate percentages of cases involving the following: (Total should equal 100%) 🛈
0/100 points
16. Has any claim, suit, charge, investigation or proceeding ever been made or instituted against the Organization or any Lawyer or other person providing professional services on behalf of the Organization which alleges any of the following types of conduct?
(a) Negligent acts or omissions in the course of rendering professional services as a Lawyer under the direction of a Lawyer or Notary Public?
(b) Attorney misconduct or breach of professional ethics?
(c) False arrest, detention or imprisonment or malicious prosecution?
(d) Publication or utterance of a libel or slander or of any other defamatory or disparaging material or publication or utterance in violation of an individual's right of privacy?
(e) Wrongful entry or eviction, or other invasion of the right of private occupancy?
(f) Conduct for which the claimant seeks an award of punitive or exemplary damages?
(g) Violation of a federal, state, municipal or local criminal statute or law?
(h) Conduct which may give rise to a contempt proceeding?
(i) Any conduct in connection with the employment, hiring, failure to hire, discharge or termination of the employment of an employee, former employee or applicant for employment?
(j) Conduct of Directors/Officers and/or other management personnel alleging negligence in their official capacity as management?
0/255 characters
17. Does the Organization or any person specified in response to Questions 10 and 13 know of any circumstance, act, error, omission or inquiry that could result in a claim, suit, charge, investigation or proceeding against the Organization or any Lawyer or other person providing the professional services on behalf of the Organization based on any of the types of conduct described in Question 16 above?
0/255 characters
18. Does your Organization provide legal services to groups, corporations or associations?
0/255 characters
0/255 characters
Please fill out the application and click the SUBMIT BUTTON at the end of the form. 
You will have a chance to save a copy for your records.