4. Have Attorneys in the firm attended the Colorado Bar Association Risk Management Seminar or
Yes
No
Yes
No
completed the Home Study program in the past 12 months? If yes, provide the names of the attorneys. 5. Has the firm initiated lawsuits or arbitration proceedings during the last 12 months to enforce the collection of unpaid fees to the firm? 6. Since January, 2003, has the firm represented any publicly traded clients in any practice area?
If yes, provide details on the fee suit supplement
Yes
No
Yes
No
If yes, answer the following: a. What percentage of the firm’s gross billings is attributable to this representation? ______% b. Provide the following information on a separate attachment: Name of Client, date of first affiliation, services rendered and whether this is a current client of the firm. 7. Has the firm been involved in any mass tort/class action cases within the past 12 months?
If yes, complete the Mass Tort/Class Action supplement
8.
Does your firm or any attorney affiliated with the firm do the following: a. Provide Securities, Copyright Patent & Trademark, Entertainment Law, Mergers & Acquisitions services? b. Practice in any of the following areas: Environmental, Natural Resources/Oil & Gas and/or Water Law? c. Act as Director, Officer or have equity interest in any other entity besides your law firm or have any one client which represents more than 25% of the firm’s billings?
Yes
No
If yes, complete the appropriate supplement
Yes
No
If yes, provide details on the area of practice grid page
Yes
No
If yes, complete the Equity/Outside Interest/Gross Billings Supplement.. Applicant affirms that the responses herein shall attach to and become an integral part of the application for insurance. Applicant warrants on its behalf and on behalf of each and every partner, officer, director, associate, manager, member and employee that after full investigation and inquiry, the information contained herein and in any supplemental applications or forms required hereby is true, accurate and complete and that no material facts have been suppressed or misstated. Applicant further warrants on its behalf and on behalf of each and every partner, officer, director, associate, manager, member and employee that after full investigation and inquiry (1) there are no known claims by reason of an act or omission or related acts or omissions in the rendering of legal services by the Applicant or any of its partners, officers, directors, associates, managers, members or employees, prior to the effective date of this policy; and (2) neither applicant nor any of its partners, directors, associates, managers, members or employees are aware of any act or omission or related acts or omissions in the rendering of legal services which a reasonable person would view as likely to give rise to a claim in the future. Applicant further warrants on its behalf and on behalf of each and every partner, officer, director, associate, manager, member and employee a continuing obligation to report to the Company immediately any material changes in all such information after signing the application and prior to issuance of the policy, and acknowledges that the Company shall have the right to withdraw or modify any outstanding quotations and/or authorization or agreement to bind the insurance based upon such changes. Further, Applicant and each and every partner, officer, director, associate, manager, member and employee understand and acknowledge that: 1.
2. 3.
If a policy is issued, the Company will have relied upon as representations: the application and any supplemental applications, and any other statements furnished to the Company in conjunction with this application, all of which are hereby incorporated by reference into this application and made a part hereof; This application will be the basis of the contract and will be incorporated by reference into and made part of such policy; and Applicant’s failure to report to its current insurance company during the current policy term any claim made against it or any of its partners, officers, directors, associates, managers, members or employees and any act, omission or circumstance which may give rise to a claim in the future against it or any of its partners, officers, directors, associates, managers, members or employees may create a lack of coverage.
Applicant hereby authorizes the release of claim information to the Company from any current or prior insurer of the Applicant. If Applicant is a Professional Association (PA), each lawyer in the association, regardless of designation, must sign and date this Warranty Statement. Additional signatures should attach in like format by attachment.
Signature of Officer or Partner of the Firm Signature of Lawyer in Professional Association
Print Name of Officer or Partner Print Name of Lawyer
Date
Signature of Lawyer in Professional Association
Print Name of Lawyer
Date
G\USER\LPLADA\Colorado CNA\Applications\CO CNA EZ Renewal App
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