Employment Practices Liability Insurance Quote RequestStep 1 of 333%Your Contact InformationName* First Name Last Name Phone*Email Address* Address* Address 1 Address 2 City State / ProvinceAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Information About Your CompanyBusiness Name*Address* Street Address City State / ProvinceAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Total Full Time Employees employed less than 5 years*Total Full Time Employees employed more than 5 years*Number of employees terminated in the last 12 months*Number of employees terminated in the last 24 months*Number of employees with annual compensation over $100,000*Employee turnover rate most recent year(%)*Employee turnover rate first prior year (%)*Employee turnover rate second prior year (%)*How many plant or office closings have occurred in the last 24 months?*How many plant or office closings are expected in the next 12 months?*Employment Practices Liability InsuranceDoes your company currently have an Employment Practices Liaiblity Insurance policy?*YesNoIf so, who writes the coverage?What is the policy deductible?What is the approximate premium?When does the policy expire? Have any loss payments been made or claims submitted under an EPLI or similar policy?*YesNoIf yes, please provide detailsHas the parent company, any subsidiary, director or other proposed insured had any EEOC, NLRB charges , judgements, demand letters from attorneys, current or former employers; or, had any lawsuits, mediations, arbitrations or negotiated settlements with any current or fomer employee?*YesNoIf yes, please provide details Please note, this is a request only. One of our agents will contact you to confirm the information you have provided.Insurance Coverage can not be bound online or over the phone.
