App Form – Professionals' Best

Step 1 of 6

Thank You For Using AE123

AE123 is a guaranteed issuance Professional Liability product for small architect & engineering firms. Qualifying risks must be under $250,000 in gross receipts and meet the underwriting criteria detailed in our Qualifying Questions. Once the insured has verified the information on the PDF with a signature, all you need to do is send the signed app to [email protected] and a policy will be issued within minutes. Producers will receive 17.5% commission on all AE123 business.

Disclosure

AE123 is written on a non-admitted basis through excess & surplus lines carriers. For questions regarding the AE123 policy form please contact [email protected].

Producer Entity Name(Required)

Enter the official name of the agency you own or work for.

Producer First & Last Name(Required)

First Last

Producer Email Address(Required)

A copy of the finalized application will be emailed to you upon clicking the submit button at the end.

Contact Information & Current Insurance

Please provide information on the applicant's contact information and current insurance programs.

Applicant Official Legal Name:(Required)

DBA or Trade Name:

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DBA

Business Type

Street Address:(Required)

Address Line 1 Address Line 2 City State ZIP Code

Different Mailing Address?

No (Same as Above)

Yes

Mailing Address (if different)

Address Line 1 Address Line 2 City State / Province / Region ZIP / Postal Code Country

Applicant Primary Contact Name(Required)

First Last

Applicant Primary Contact Email(Required)

Applicant Phone(Required)

Website, social media page, or LinkedIn profile(Required)

Please enter the applicant firm's website above. If the firm does not have a website, an alternative online representation of their business/professional profile is required to proceed.

Does the applicant's firm currently maintain professional liability insurance?(Required)

Yes

Expiration Date of current policy

Current PL Policy Limits

Does the applicant's firm currently maintain general liability insurance?(Required)

Yes

Expiration Date of current policy

Current GL Policy Limits

Question 2.1 - Gross Receipts(Required)

What number best approximates the average annual receipts for the applicant's firm over each of the last two years?

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Q 2.1 Value

Question 2.2 - Professional Discipline(Required)

Which would best describe the applicant's professional discipline focus over the last two years?

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Q 2.2 Value

Question 2.3 - Project Types(Required)

Which best describes the applicant's project types over the last two years?

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Q 2.3 Value

Question 2.4 - Previous Coverage(Required)

For how many years has the applicant's firm maintained continuous professional liability coverage?

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Q 2.4 Value

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Question 2.5 - Territory (Original Rate Factors)

Select the applicant's State and Territory

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Question 2.5 - Territory(Required)

Select the applicant's State and Territory

Question 2.5 - Territory(Required)

Select the applicant's State and Territory

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Q 2.5 Value

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Q 2.5 Text

Question 2.6 - Claims(Required)

How many professional liability claims has the applicant's firm reported in the last five years?

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Q 2.6 Value

Question 2.7 - Written Agreements(Required)

What percent of the applicant's projects are delivered under written agreements?

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Q 2.7 Value

Question 2.8 - Limitation of Liability(Required)

Approximately what percentage of the applicant's client contracts contain a Limitation of Liability provision capping the firm's liability?

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Q 2.8 Value

Question 2.9 - Contract Agreements(Required)

Approximately what percentage of the applicant's contracts or agreements are either standard AIA/EJCDC or reviewed by an outside professional?

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Q 2.9 Value

AE123 App

Thank You For Using AE123

Disclosure

AE123 Qualifying Questions (all answers must be "Yes" to proceed)

Contact Information & Current Insurance

General Liability

Taxes & Fees