Architects & Engineers Professional Liability Application

NOTICE

Notice: Professional liability policies for design firms are generally written on a claims-made basis: only claims first made during the policy period (and reported as the policy requires) are covered, and defense costs may reduce the limit of liability. This application is not a binder.

Prefer paper? Download the printable PDF · Questions? Call (469) 777-3025 or email contactus@proiexp.com.

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1. FIRM INFORMATION

Name of Firm*

Contact Name*

Street Address*

City*

State*

ZIP*

Phone #*

Email Address*

Website Address

DBA (if any)

Contact Title

Business Structure*

Sole Proprietorship

Partnership

LLC

Corporation

Other

Year Firm Established (YYYY)

Please enter a number from 1800 to 2026.

Fiscal Year End (MM/DD)

List branch office locations (if any) and the percentage of fees derived from each location

City, state and % of last fiscal year fees for each branch (one per line)

Other related companies or prior company names (if any)

Owners / Principals: name, title, % owned, license / discipline and years of experience (one per line)

Provide the number of personnel in each of the following categories

Number employed

Number Registered/Licensed

Principals, Partners, Officers & Directors

Principals, Partners, Officers & Directors – # registered/licensed

Construction Managers

Construction Managers – # registered/licensed

Licensed Architects

Licensed Architects – # registered/licensed

Licensed Engineers

Licensed Engineers – # registered/licensed

Other Technical / CAD

Other Technical / CAD – # registered/licensed

All Others (describe):

All Others – # registered/licensed

Total number of employees

Total registered/licensed

2. REVENUE

Please provide the following information regarding your gross fees. Gross fees means the exact dollar amount of gross revenues from Professional Services including fees paid to subconsultants, however, excluding direct reimbursables by contract (i.e., travel, per diem, reproduction costs, etc.).

Total Gross Fees

Current FY (est.)*

Last complete FY*

Two years ago*

Next 12 months (projected)

Please identify the approximate percentage of fees earned on projects by construction value (Must total 100%)

Up to $1,000,000

Please enter a number from 0 to 100.

$1,000,001 to $5,000,000

Please enter a number from 0 to 100.

$5,000,001 to $25,000,000

Please enter a number from 0 to 100.

$25,000,001 to $50,000,000

Please enter a number from 0 to 100.

$50,000,001 to $100,000,000

Please enter a number from 0 to 100.

Over $100,000,000

Please enter a number from 0 to 100.

Total % (fees earned on projects by construction value):*

Must total 100%. The Submit button appears once every percentage table totals 100%.

Do you do any work outside the US?*

Yes

If yes, please describe (countries and % of fees)

3. SERVICES YOU PROVIDE (% of fees)

Please indicate the approximate percentage of last fiscal year gross fees in the disciplines below (Must Total 100%)

Architecture

Please enter a number from 0 to 100.

Interior Design

Please enter a number from 0 to 100.

Landscape Architecture

Please enter a number from 0 to 100.

Civil Engineering

Please enter a number from 0 to 100.

Structural Engineering

Please enter a number from 0 to 100.

Mechanical / Plumbing (MEP)

Please enter a number from 0 to 100.

Electrical Engineering

Please enter a number from 0 to 100.

Geotechnical Engineering

Please enter a number from 0 to 100.

Environmental Engineering

Please enter a number from 0 to 100.

Surveying / Mapping

Please enter a number from 0 to 100.

Construction Mgmt. / Inspection

Please enter a number from 0 to 100.

Other

Please enter a number from 0 to 100.

Other discipline – please describe*

Total % (last fiscal year gross fees):*

Must total 100%. The Submit button appears once every percentage table totals 100%.

Does your firm perform structural engineering in-house (by your own employees)?*

Yes

Briefly describe the firm's services and typical clients

Number of staff in each discipline above (e.g. Architecture – 4, Civil – 2)

Does the firm perform any of these services: geotechnical drilling or laboratory testing, CM at-risk, marine engineering or naval architecture, process engineering, acoustical, illumination or traffic engineering, architectural planning, or environmental science?*

Yes

If yes, which ones and the approximate % of last fiscal year fees for each

4. SUBCONSULTANTS

What percentage of the firm’s total gross fees for the last fiscal year were paid to subconsultants in the following disciplines (note: should be less than 100%)

Does the firm use subconsultants?

Yes

Do you require subconsultants to carry their own professional liability insurance?

Yes

Insured for Professional Liability

Uninsured

a. Structural

Please enter a number from 0 to 100.

Structural – % uninsured

Please enter a number from 0 to 100.

b. Environmental Services

Please enter a number from 0 to 100.

Environmental Services – % uninsured

Please enter a number from 0 to 100.

c. Other professional services

Please enter a number from 0 to 100.

Other professional services – % uninsured

Please enter a number from 0 to 100.

Total % (firm’s total gross fees for the last fiscal year were paid to subconsultants):

Should be less than 100%.

5. CLIENTS

a. Does any one contract or client represent more than 50% of the firm’s last fiscal year gross fees?

Yes

If ‘yes’, please describe below:

Indicate the percentage of last fiscal year gross fees derived from each of the following types of clients (Total Must Equal 100%)

Contractors

Please enter a number from 0 to 100.

Federal Government

Please enter a number from 0 to 100.

Owners

Please enter a number from 0 to 100.

Design Professionals

Please enter a number from 0 to 100.

Foreign

Please enter a number from 0 to 100.

State Governments

Please enter a number from 0 to 100.

Developers

Please enter a number from 0 to 100.

Local Government

Please enter a number from 0 to 100.

Environmental Consultants

Please enter a number from 0 to 100.

Other

Please enter a number from 0 to 100.

Other client type – please describe*

Total % (last fiscal year gross fees derived from types of clients):*

Must total 100%. The Submit button appears once every percentage table totals 100%.

Indicate the percentage of last fiscal year gross fees attributable to the following services. Leave blank if not applicable

Abandoned projects

Please enter a number from 0 to 100.

Alarm or security systems

Please enter a number from 0 to 100.

Asbestos evaluation, remediation or analysis

Please enter a number from 0 to 100.

Boundary and construction staking

Please enter a number from 0 to 100.

Building commissioning services

Please enter a number from 0 to 100.

Building inspections or property condition assessments

Please enter a number from 0 to 100.

Conceptual, schematic, or other design without construction documents

Please enter a number from 0 to 100.

Construction Engineering Inspections

Please enter a number from 0 to 100.

Construction observation/review without design

Please enter a number from 0 to 100.

Construction materials testing (including compaction testing) and related laboratory analysis

Please enter a number from 0 to 100.

Design with construction observation/review

Please enter a number from 0 to 100.

Drafting services – performed for others for a fee

Please enter a number from 0 to 100.

Environmental preliminary site assessments or investigations (Phase 1, PSA, drilling, sampling, Phase 2)

Please enter a number from 0 to 100.

Environmental site remediation

Please enter a number from 0 to 100.

Expert witness

Please enter a number from 0 to 100.

Feasibility, economic, seismic or forensic studies or reports

Please enter a number from 0 to 100.

Lead evaluation, remediation or analysis

Please enter a number from 0 to 100.

LEED services

Please enter a number from 0 to 100.

Mold evaluation, remediation or analysis

Please enter a number from 0 to 100.

Operation and maintenance services

Please enter a number from 0 to 100.

Permitting

Please enter a number from 0 to 100.

Plan checking without design

Please enter a number from 0 to 100.

Program Management or other non-design related services

Please enter a number from 0 to 100.

Quantity or cost estimates without design

Please enter a number from 0 to 100.

Remediation design services / remediation of construction defects – non-environmental

Please enter a number from 0 to 100.

Sheeting, shoring, underpinning, scaffolding, temporary work platforms, or similar

Please enter a number from 0 to 100.

Temporary structures

Please enter a number from 0 to 100.

Training services – non-safety related

Please enter a number from 0 to 100.

Training services – safety related

Please enter a number from 0 to 100.

6. CONTRACTS

Please specify the types of contracts used by the firm in the last fiscal year (% of projects, must total 100%).

Client contract

Please enter a number from 0 to 100.

Standard industry/association contract

Please enter a number from 0 to 100.

Firm’s own standard contract

Please enter a number from 0 to 100.

Verbal agreements

Please enter a number from 0 to 100.

Letter of agreement

Please enter a number from 0 to 100.

Other

Please enter a number from 0 to 100.

Purchase order forms

Please enter a number from 0 to 100.

Other contract type – please describe*

Total % (types of contracts used):*

Must total 100%. The Submit button appears once every percentage table totals 100%.

What percentage of your professional service agreements include a Limitation of Liability to $250,000 or less?

% of agreements with a Limitation of Liability of $250,000 or less

Please enter a number from 0 to 100.

% of projects with a written contract

Please enter a number from 0 to 100.

7. PROJECTS & RISK QUESTIONS

Indicate the percentage of last fiscal year gross fees derived from each of the following types of projects (must total 100%):

Single-family / custom homes

Please enter a number from 0 to 100.

Condominiums / townhomes

Please enter a number from 0 to 100.

Apartments / multi-family

Please enter a number from 0 to 100.

Commercial / office / retail

Please enter a number from 0 to 100.

Industrial / manufacturing

Please enter a number from 0 to 100.

Public / municipal / government

Please enter a number from 0 to 100.

Schools / colleges

Please enter a number from 0 to 100.

Hospitals / healthcare

Please enter a number from 0 to 100.

Roads, bridges, transportation

Please enter a number from 0 to 100.

Water / wastewater / utilities

Please enter a number from 0 to 100.

Hotels / hospitality

Please enter a number from 0 to 100.

Other

Please enter a number from 0 to 100.

Other project type – please describe*

Total % (last fiscal year gross fees by project type):*

Must total 100%. The Submit button appears once every percentage table totals 100%.

In the past 10 years, has the firm worked on any of these project types: airport runways; bridges or trestles; tunnels; dams, reservoirs or levees; harbors, docks, piers or offshore structures; high-rise buildings over 15 stories; parking garages; building envelopes, façades or curtain walls; retaining walls; oil refineries, chemical plants or pipelines; nuclear facilities; mines or quarries; landfills, Superfund sites or waste treatment/disposal facilities; underground storage tanks or gas stations; amusement rides, ski lifts, sports arenas, grandstands or theaters; swimming pools; correctional institutions; retirement or assisted-living facilities; single-family residential subdivisions?*

Yes

If yes, list each project type and the approximate % of last fiscal year fees

Describe your 3 largest projects in the last 3 years (project name, type, construction value, your fee)

Has the firm provided professional services for condominium projects in the last 10 years?*

Yes

If yes, we will send you a short condo questionnaire.

Does the firm perform services under a Design-Build or Fast-Track delivery method?*

Yes

If ‘yes’, what is the total percentage of your gross fees for the last fiscal year attributed to this delivery method?

Does the firm provide or take responsibility for any site safety or construction means, methods, sequences or techniques?*

Yes

Is the firm or any principal involved in real estate development or ownership?*

Yes

Has the firm become involved in the manufacture, fabrication, sale, leasing or distribution of any product, process, component, device or system?*

Yes

Has the firm designed a building, component or system which might be used on more than one project without services for site adaptation?*

Yes

Has the firm entered into a joint venture agreement with an entity that did not provide professional design services?*

Yes

Does the firm provide Professional Services on any project in which it has an equity interest?*

Yes

If ‘yes’, please describe below:

Are your negotiated contracts reviewed by a qualified attorney before they are signed?

Yes

Does the firm follow written quality control procedures?

Yes

Please explain any 'Yes' answers above, and any 'No' answer to the contract review or quality control questions

8. CLAIMS HISTORY

In the last 5 years, have any professional liability claims been made against the firm, its predecessors or any past or present principal, partner, officer, director or employee?*

Yes

Does the firm or any of the principals, partners, officers, directors or employees, have knowledge of any act, error, omission, unresolved job dispute, complaints, accident or any other circumstance which might reasonably be expected to give rise to a claim under this insurance?*

Yes

In the last 10 years, has any disciplinary action been filed against the firm, its predecessors or any past or present principal, partner, officer, director or employee?*

Yes

Has the firm reported the matters disclosed above to its current or former insurance carrier(s)?

Yes

If yes, for each claim or circumstance give: date, project / claimant, what happened, amount paid, and whether it is open or closed

Upload claim details (optional)

Drop files here or

Accepted file types: pdf, doc, docx, jpg, jpeg, png, xls, xlsx, Max. file size: 10 MB, Max. files: 5.

Any claim arising from facts or circumstances that should have been disclosed above may be excluded from the proposed insurance.

9. CURRENT COVERAGE & QUOTE REQUEST

Is the firm currently insured for Professional Liability coverage?*

Yes

Do you know the retroactive date on your current policy?

Yes

Unknown

Retroactive date on your current policy*

Current carrier

Policy expiration date

Current limit

Current deductible

Current annual premium

Years continuously insured

Please enter a number from 0 to 100.

Desired effective date

Would you like a quote for Cyber Liability?

Yes

If yes, we'll send a short cyber questionnaire.

Would you also like a quote for General Liability insurance?

Yes

Has any insurer cancelled or refused to renew any similar insurance to the firm or its members?

Yes

If yes, please explain

Describe any pending corporate acquisitions or historical corporate name changes or mergers and acquisitions that have occurred in the past 5 years:

Indicate the options the Applicant would like quoted for Professional Liability coverage:

Limit Requested*

Please specify

Deductible Requested*

Please specify

10. UPLOAD DOCUMENTS

Upload your current policy declarations page, 5 years of loss runs, a sample client contract and any other documents (optional)

Drop files here or

Accepted file types: pdf, doc, docx, jpg, jpeg, png, xls, xlsx, Max. file size: 10 MB.

11. DECLARATION & SIGNATURE

Applicant Statement:

By signing below, I confirm that the information in this application is true and complete to the best of my knowledge. I understand that Professional Insurance Experts will keep this application in our file and share it with insurance companies to obtain quotes, and that it may become part of any policy issued. I agree to tell Professional Insurance Experts right away if any of this information changes before coverage starts. Submitting this application does not bind coverage.

Fraud Warning: Any person who knowingly provides false or misleading information on an application for insurance may be committing a crime and may be subject to fines, imprisonment and denial of coverage.

Nothing in this application is notice of a claim or potential claim under any policy.

Thank you.

Signature*

Your Name
Your Name
Your Name

Date

Name of Principal, Partner or Officer*

Title*

How did you hear about us

The Submit button will appear once each percentage table totals 100%: Services (section 3), Construction value (section 2), Clients (section 5), Contracts (section 6) and Project types (section 7).

Architects & Engineers Professional Liability Application

NOTICE

1. FIRM INFORMATION

List branch office locations (if any) and the percentage of fees derived from each location

Provide the number of personnel in each of the following categories

Number employed

Number Registered/Licensed

2. REVENUE

Please provide the following information regarding your gross fees. Gross fees means the exact dollar amount of gross revenues from Professional Services including fees paid to subconsultants, however, excluding direct reimbursables by contract (i.e., travel, per diem, reproduction costs, etc.).

Total Gross Fees

Please identify the approximate percentage of fees earned on projects by construction value (Must total 100%)

3. SERVICES YOU PROVIDE (% of fees)

Please indicate the approximate percentage of last fiscal year gross fees in the disciplines below (Must Total 100%)

4. SUBCONSULTANTS

What percentage of the firm’s total gross fees for the last fiscal year were paid to subconsultants in the following disciplines (note: should be less than 100%)

Insured for Professional Liability

Uninsured

5. CLIENTS

Indicate the percentage of last fiscal year gross fees derived from each of the following types of clients (Total Must Equal 100%)

Indicate the percentage of last fiscal year gross fees attributable to the following services. Leave blank if not applicable

6. CONTRACTS

Please specify the types of contracts used by the firm in the last fiscal year (% of projects, must total 100%).

What percentage of your professional service agreements include a Limitation of Liability to $250,000 or less?

7. PROJECTS & RISK QUESTIONS

Indicate the percentage of last fiscal year gross fees derived from each of the following types of projects (must total 100%):

8. CLAIMS HISTORY

9. CURRENT COVERAGE & QUOTE REQUEST

Indicate the options the Applicant would like quoted for Professional Liability coverage:

10. UPLOAD DOCUMENTS

11. DECLARATION & SIGNATURE

Applicant Statement:

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