Fenner & Esler Insurance- The Professional's Choice

QUOTES

Architects & Engineers
A/E EZ Form
Fenner & Esler Insurance -- A/E EZ Questionnaire
For A/E, Surveying and Landscape Architecture firms with
annual gross billings from $0 to $5,000,000
1.
Firm Name:
Contact Name:
Contact Email:
Firm Website Address:
Principal Location:
Telephone:
City:
State:
Zip Code:
Fax:

2.
Is a principal, partner, officer or director a licensed architect, engineer or registered land surveyor?
A. Is your firm currently insured?
Date firm established

3.
Current carrier
Expiration date
Current limits of liability
Deductible
Current premium
C. Does the current policy provide full Prior Acts coverage?
If so, what is your Prior Acts date?
D. Number of years continuously insured?

4. Please provide your professional service billing information, including billings attributable to consultants.
Most Recently Completed
Fiscal Year 		Second Most Recently
CompletedYear		 Estimated Billings
Dates of Reporting Periods to to to
A.  Projects currently covered by specific project policy
B. Feasibility studies, reports, opinions, landscape architecture,
land surveying, interior design and abandoned projects
C.  All Other Billings
D.  Direct Reimbursables
(e.g. travel per diem, etc.)
E.  Total Gross Billings

5. Are greater than 10% of your billings attributable to: (Please check the appropriate boxes below) If yes, please explain in Question 10.
Design/Build
Pollution
Product
Design
Asbestos Services

6. Are you owned by or do you own another entity which provides construction related services?
If yes, please provide details in Question 10. 		 
7. Please indicated the percentage of the following disciplines in which the Applicant is engaged. Total must equal 100%
Acoustical Engineering Interior Design
Architecture Land Surveying
Chemical Engineering Landscape Architecture
Civil Engineering Mechanical Engineering
Communication Engineering Process Engineering
Construction Management Geo Technical
Electrical Engineering Structural Engineering
Environmental Engineering Testing Lab
Forensic Engineering Other (specify below)
HVAC Engineering  
8. Based on your Firm's gross billings for the most recent completed year, indicate the approximate percentages of
the projects listed below in which your firm is engaged (Note: Total must equal 100%)
Airports Parking Structures
Amusement Rides Residential - Custom
Apartments/Townhouses Residential - Subdivisions
Arenas/Stadiums Recreation
Bridges Roads/Highways
Condominiums Schools/Colleges
Dams Sewage Systems
Harbors/Piers/Ports Shopping Centers/Retail
Hospitals/Healthcare Telecommunications
Hotels/Motels Theaters
Jails Tunnels
Landfills Underground Storage Tanks
Libraries Utilities
Manufaturing/Industrial Warehouses
Mines Wastewater Treatment Plants
Municipal Buildings Water Systems
Office Buildings Other (specify below)
   
9.
A. In the past 10 years, have any claims, suits, demands been made against the firm or its predecessor?
or any past or present principal?
Number
Total Paid/Incurred (Includes reserves)
B. After inquiry, is the Applicant aware of any act, error, omission or circumstance which may possibly
result in a claim being made against them? If yes, please explain in Question 10. below:

10. Risk Management
A. Does your firm:
1. Use written in-house quality control procedures?
2. Have an automated master specification system?
3. Have an in-house program for continuing education?
4. Have a TQM program?
B. Has your firm:
1. Participated in an Organizational Peer Review?
C. Number of employees who have had at least six hours of continuing education in the past 12 months:
D. Please list the percentage of your firm's services rendered under AIA or EJCDC standard forms of agreement:

11. Explanations to "Yes" Answers

12. For Surveyors Only
A. Are all registered land surveyor members of ACSM?
B. Services percentage breakdown should total 100%.
Subdivision Work, Topographic, Construction Stakeout, Hydrographic
Engineering Services
All Other Services
 
“Insurance for Design Professionals”

467 Kinderkamack Rd
Oradell, NJ 07649

Timothy P. Esler, CPCU x208 (tesler@fenner-esler.com)
Kevin M. Esler, CPA x202 (kesler@fenner-esler.com)

www.fenner-esler.com
direct: (201) 262-1200
toll free: (866) 737-7683
fax: (201) 262-7810
PROFESSIONAL LIABILITY APPLICATIONS:
 
Large firm application:  Click here
 
Small firm application (< $1 million in billings):  Click here


To request references, please contact us.


NOTE: A completed and signed Architects & Engineers program application
will be required in order to issue a policy.
Please fax new business questionnaires to
Fenner & Esler Insurance: [201] 262-7810
Or attach as an e-mail and send to:kesler@fenner-esler.com


View this quote application as a PDF

Timothy P. Esler, CPCU Agent, Broker, Consultant