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LAWYERS PROFESSIONAL LIABILITY INSURANCE
Issued to The
NATIONAL DISTRICT ATTORNEYS ASSOCIATION
SPECIFIED MEMBER ORGANIZATIONS
(This policy does not cover Private Law Practice)
THIS IS AN APPLICATION FOR A CLAIMS MADE POLICY
In the event that a claim or claims against the Organization or the Lawyers named in this application have been reported to Underwriters or disclosed in this application, Underwriters reserve the right to individually rate insurance for the above applicant based upon the applicant's experience.
It is understood that the policy applied for will issue on the 1st day of the month following receipt of the premium and the acceptance of the application by the insurer. I/We hereby declare, based upon my/our knowledge and upon reasonable investigation, that the above statements are true and that I/we have not suppressed or misstated any material facts and that this Proposal Form shall be the basis of the contract with the Underwriters at Lloyd's, London.
Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance containing any materially false information or conceals, for the purpose of misleading, information concerning any fact material thereto commits a fraudulent insurance act, which is a crime.
Pursuant to the provisions of the Electronic Signatures in Global and National Commerce Act (E-SIGN, 2000) execution of the application form by means of typing ones name, title and date below carries the same weight and legal effect as traditional paper documents and handwritten signatures. Further, as a principal of Applicant, I confirm that I have authority to execute this application on behalf of Applicant.