D&O Quick Quote

General Information...
Do you currently have D&O Insurance?
 D&O Insurance Information...
What is the expiration date?
Current D&O insurance carrier
Current limit
Does the organization do credentialing, accreditation, licensing, peer review or standards setting?
Subsidary Coverage Needed?
 Subsidary Coverage Information
Please indicate the nature of the operations
Subsidary Name
Please indicate if the subsidary is Not for Profit or For Profit
Subsidary Organization Annual Revenue
Subsidary Organization Annual Payroll
Subsidary Organization Total Assets
Subsidary Organization Fund Balance
In the last five years has there been any
civil, criminal, or administrative proceedings    
brought against the organization, its     
subsidiaries, board, staff or volunteers?
In the last five years has there been any
merger, acquisition or similar reorganization,   
or are you expecting one in the next year?
Are you aware of any fact, circumstance
or situation that may result in future claim(s)?

Please note: Pending or prior claims, or known circumstances, that result in a claim will not be covered under a new D&O policy.

Disclaimer Notice - The premiums quoted are estimates based on information you provided. This quotation does not constitute a contract of insurance, nor does it provide coverage for any loss or claim. Further information may be required in order for a complete quote to be provided. This quote request contains some information about coverage offered but it does not list all of the conditions and exclusions that apply to the described coverage. The actual wording of the policy governs all situations.

This is not an “Application” for insurance.  We ask that you provide general quote request information on this online form for the purposes of gathering general information on your interest in our insurance products and services.  A Marshall & Sterling representative will be in contact with you shortly to discuss the formal application process.