Backup Documents 12/01/2009 Item #16K 6
ORIGINAL DOCUMENTS CHECKLIST & ROUTING sJp6 K 6
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE
Print on pink paper. Attach to original document. (Jriginal documcnts should be hand ddiv(;l'I:d to l11e [30a1'd Office. Ille completed routing slip ,md original
documents arc to be fllTwarded to the Board Office only aftcr' the Board IH1s taken action 011 the item.)
ROUTING SLIP
Complete routing lines # 1 through #4 as appropriate for additional signatures, dales. and/or intormation needed. If the document is already complete with the
excention of the Chairmilll's sip-nature, draw a line thnHwh routin T llllcs #1 throu"h #4, comnlelc the checklist, and filnvard 10 Sue Filson (line #5).
Route to Addressee(s) Office Initials Date
(List in routinl1 orderl
1. ,-,,-
--- --,,-
2. --
- ...------
3. ..----------
4. Scott R. Teach, Deputy County Attorney County Attorney <:72-1' 12/01/09
5 Ian Mitchell, BCC Supervisor Board ofeounty Commissioners L~ 12(0" 0'
6. Minutes and Records Clerk "fCourt's Office
7. Scott R. Teach, ACA County Attornev
PRIMARY CONTACT INFORMATION
(The primary contact is the holder oflhc original document pending BCe approval. Normally the primary contact is the person who created/prepared the executive
summary. Primary contact information is needed in the event one orthc addressees ahove, including Sue Filson, need to contact staff for additional or missing
information. All original documents needing the Bee Chairm<Ul 's signature arc to be delivered to the Bee' office only alter the Bee has acted to approve the
item)
Name of Primary Staff Scott R. Teach, Deputy County Attorney Phone Number (239) 252-8400
Contact
Agenda Date Item was 12/01/09 Agenda Item Number 16-K-6
Aooroved bv the BCC
Type of Document Retention Agreement - Grant, Fridkin, et aJ. Number of Original I
Attached Documents Attached
INSTRUCTIONS & CHECKLIST
Initial the Yes column or mark "N/A" in the Not Applicable column, which~v~r is appropriate.
Yes
(Initial)
SRT
N/A(Not
A licable
1.
Original document has b~en signed/initialed for legal sutl'icicncy. (All documents to be signed hy the
Chairman, with the exception of most lelters, must be reviewed and signed by the Office of the
County Attorn~y. This includes signature pages from ordinances, resolutions, etc. signed hy th~
County Attorney's Office and signature pag~s from contracts, agreements, de. that have heen fully
executed by all parties except the Bee Chairman and Clerk to the Board and possihly Slate
Officials.
All handwritten strike.through and revisions have heen initialed by tht: County Attorney's Office and
all other artics exee t the BCC Chairman and the Clerk to the Board
The Chairman's signature line dale has bet:n entered as the date orBCC approval of the document or
the final ne otiated contrad date v.'hichever is a beable.
"Sign here" labs are plact:d on the appropriate pages indicating where the Chairman's signature and
initials are re uired.
In most cases (some contracts arc an exception). the original document and this routing slip should be
provided to Sue Filson in the BCC offict: within 24 hours of Bee approval. Some documents are
time sensitive and require fon.....arding to Tallahassee \.vithin a certain time frame or the Bees actions
are nullilied. Be aware ofvour deadlines!
The document was approved by the Bee on 12/01/09 and all changes made during the meeting
have been incorporated in the attached document. The County Attorney's Office has reviewed
the chan es, if a Iicable.
Please return one executed co to Scott R. Teach, ACA
SRI'
2.
N/A
3
SRI'
4.
SRT
5.
N/A
6.
SRT
7.
l: Forms/ County Forms/ Bce Forms/ Original Documents Routing Slip WWS Origina19.03.04, Revised] .26.05, Revised 2.2405
(,mattcr._llumben>l<<document_ numbenl
MEMORANDUM
Date:
December 2, 2009
To:
Scott Teach, Deputy County Attorney
County Attorney's Office
From:
Martha Vergara, Deputy Clerk
Minutes & Records Department
Re:
Retention Agreement (Grant, Fridkin, Pearson,
Athan & Crown, P.A.)
Enclosed please find one copy of the document referenced above (Agenda
Item #16K6), approved by the Board of County Commissioners on
Tuesday, December 1, 2009.
If you should have any questions, please call me at 252-7240.
Thank you.
16K 6
16K 6
RETENTION AGREEMENT WITH
GRANT, FRIDKIN, PEARSON, ATHAN & CROWN, P.A.
This Retention Agreement is made by and between the Board of County Commissioners
of Collier County, Florida (the "County"), and the law firm of Grant, Fridkin, Pearson, Athan &
Crown, P.A. of Naples, Florida ("Grant Fridkin").
Whereas, Grant Fridkin has special expertise and resources in a wide range of legal
matters, with particular expertise in construction law, contract disputes, employment disputes,
and litigation, including related administrative, executive, and judicial hearings, appeals,
negotiations; and
Whereas, the County from time to time has a requirement and need for legal services
which are particularly within the expertise of Grant Fridkin;
Now, therefore, in consideration of the premises contained herein, the County hereby
hires and retains Grant Fridkin and Grant Fridkin hereby agrees to provide legal services to
County.
ARTICLE 1
COMPENSATION; METHOD OF PAYMENT
1.1 Compensation shall be paid to Grant Fridkin in accordance with the terms set forth in
Exhibit "A" attached hereto and made a part hereof. Requirements for reimbursable
expenses are set forth in Exhibit "B," attached hereto and made a part hereof. Expenses
other than automobile expenses must be documented by copies of paid receipts or other
evidence of payment. The Certificate contained in Exhibit "c" must be included with
every invoice submitted for payment.
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1.2 The rates set forth in Exhibit "A" shall remain in effect without change for a minimum of
two (2) years from the effective date of this Agreement. In the subsequent years of the
Agreement, upon the request of Grant Fridkin, the County Attorney is authorized to
negotiate to increase the hourly rate up to a maximum of ten (10) percent without
approval by the Board of County Commissioners. In the negotiation process, Grant
Fridkin must substantiate the reason the request is being made (i.e. market conditions,
increase in CPI, etc.)
1.3 Multiple Attorney Assignments.
The County acknowledges that, from time to time, it may be advisable for Grant Fridkin
to assign more than one attorney to a project or case. Nevertheless, in order to ensure that
such multiple attorney assignments are efficient and cost-effective for the County, Grant
Fridkin agrees to the following procedures and billing limitations for multiple attorney
assignments.
1.3.1 A primary attorney will be identified for such projects or cases and that
attorney will be the contact attorney for the County except in the case of an
emergency or the County's written pre-approval. In practice, this means that
generally only the primary attorney will meet or communicate directly with
County personnel or attend meetings, court, arbitrations, mediations or other
proceedings on behalf of the County.
1.3.2 Attorneys assigned to a project or case other than the primary attorney will be
less senior attorneys with lower billing rates unless the additional attorney(s)
has/have a demonstrated expertise that will demonstrably enhance the value
and efficiency of the legal services being provided to the County.
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1.3.3 Grant Fridkin agrees that internal or in-house conferences among multiple
attorneys assigned to a project or case shall be kept to the minimum reasonably
necessary for the provision of the legal services in question. To the extent
internal or in-house conferences among multiple attorneys assigned to a project
or case are necessary, each such attorney may bill his or her customary rate for
up to thirty (30) minutes for any such conference. To the extent such a
conference exceeds thirty (30) minutes in length, Grant Fridkin agrees that it
will discount the total billings for all attorneys involved in the conference by
forty-five (45) percent.
1.4 Grant Fridkin may submit invoices for hourly work assignments pursuant to Exhibit "A"
only after the services for which the invoices are submitted have been completed or
expenses incurred. An original invoice plus one copy is due within fifteen (15) days of
the end of the month, except the final invoice which must be received no later than sixty
(60) days after the work is completed or the expiration of this Agreement.
1.5 To be deemed proper, all invoices must comply with the requirements set forth in this
Agreement and must be submitted on the form and pursuant to the instruction prescribed
by County. Payment may be withheld for failure of Grant Fridkin to comply with a term,
condition, or requirement of this Agreement.
1.6 Payment shall be made to Grant Fridkin at:
Grant Fridkin, Pearson, Athan & Crown, P.A.
5551 Ridgewood Drive
Suite 501
Naples, FL 34108
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ARTICLE 2
INSURANCE
2.1 In order to insure the indemnification obligation contained above, Grant Fridkin shall as a
minimum, provide, pay for, and maintain in force at all times during the term of this
Agreement, professional liability insurance in an amount not less than Three Million
Dollars ($3,000,000.00) Per Occurrence, Combined Single Limits. If any liability
insurance obtained by Grant Fridkin to comply with the insurance requirements contained
herein is issued on a "claims made" form as opposed to an "occurrence" form, the
retroactive date for coverage shall be no later than the commencement date of the
assigned work to which this Agreement applies, and such insurance shall provide, in the
event of cancellation or non-renewal, that the discovery period for insurance claims (tail
coverage) shall not be less than three years following the completion of the assigned work
and acceptance by the County.
2,2 Such policy or policies shall be issued by United States Treasury approved companies
authorized to do business in the State of Florida, and having agents upon whom service of
process may be made in Collier County, Florida.
2.3 Grant Fridkin shall furnish to the Risk Management Director Certificates of Insurance or
endorsements evidencing the insurance coverages specified by this Article prior to
beginning performance of work under this Agreement.
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ARTICLE 3
TERM AND TIME OF PERFORMANCE
3.1 The term of this Agreement shall be for a period of two (2) years to begin December 10,
10,2009 and to end on December 9,2011, unless terminated earlier in accordance with
the provisions of this Agreement. Absent notice of intent to terminate, the Agreement
may be renewed upon mutual consent of the parties for three (3) additional terms of one
(1) year each. In the event the term of this Agreement extends beyond a single fiscal year
of County, the continuation of this Agreement beyond the end of any fiscal year shall be
subject to the availability of funds from County in accordance with Chapter 129, Florida
Statutes.
3.2 Time shall be deemed to be of the essence in performing the duties, obligations and
responsibilities by this Agreement.
3.3 Any amendments, alterations, variations, modifications or waivers of provisions of this
Agreement shall only be valid when they have been reduced to writing, duly signed by
both parties hereto, and attached to the original of this Agreement.
ARTICLE 4
TERMINATION
4.1 This Agreement may be terminated by either party for cause upon ten (10) days' notice or
by either party for convenience upon no less than thirty (30) days' advance written notice
in accordance with the "NOTICES" section ofthis Agreement.
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4.2 Termination of this Agreement for cause shall include, but not be limited to, failure to
suitably perform the work, failure to continuously perform the work in a manner
calculated to meet or accomplish the objectives of County as set forth in this Agreement,
or multiple breach of the provisions of this Agreement notwithstanding whether any such
breach was previously waived or cured.
4.3 In the event this Agreement is terminated for convenience, Grant Fridkin shall be paid for
any services performed to the date the Agreement is terminated; however, upon notice by
either party to terminate, Grant Fridkin shall refrain from performing further services or
incurring additional expenses under the term of this Agreement. Grant Fridkin
acknowledges and agrees that Ten Dollars ($10) of the compensation to be paid by
County, the adequacy of which is hereby acknowledged by Grant Fridkin, is given as
specific consideration to Grant Fridkin for County's right to terminate this Agreement for
convenience. Grant Fridkin' obligations to the County as provided for hereunder shall
cease upon termination, except for participating in an orderly and professional transfer of
such responsibilities and files or copies of files to the County or its designee.
ARTICLE 5
RECORD AUDIT AND INSPECTION
5.1 County shall have the right to audit the books and records of Grant Fridkin pertinent to
the funding under this Agreement. Grant Fridkin shall preserve and make available, at
reasonable times for examination and audit by County, all financial records, supporting
documents, and other documents pertinent to this Agreement for a period of three (3)
years after termination of this Agreement or, if any audit has been initiated and audit
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findings have not been resolved at the end of the three years, the books and records shall
be retained until resolution of the audit findings.
5.2 If the Florida Public Records Act (Chapter 119, Fla. Stat.) is determined by County to be
applicable to Grant Fridkin' records, Grant Fridkin shall comply with all requirements
thereof, however, no confidentiality or non-disclosure requirement of either federal or
state law shall be violated by Grant Fridkin.
ARTICLE 6
CONFLICT OF INTEREST
6.1 Grant Fridkin states that it is familiar with and will comply with the terms and conditions
of Chapter 112, Part III, Florida Statutes (Code of Ethics).
6.2 It is important that Grant Fridkin be independent and impartial in order to properly
conduct its services to the County. Grant Fridkin shall not act as counsel in any lawsuit
or other adversary proceeding in which County is named as an adversary party or in
which Grant Fridkin takes an adverse position to the County.
6.3 Neither Grant Fridkin nor its employees shall have or hold any continuing or frequently
recurring employment or contractual relationship that is substantially antagonistic or
incompatible with Grant Fridkin' loyal and conscientious exercise of judgment related to
its performance under this Agreement.
6.4 In the event Grant Fridkin is permitted to utilize subcontractors, herein, to perform any
services required by this Agreement, Grant Fridkin agrees to prohibit such subcontractors,
by written contract, from having any conflicts as within the meaning of this section.
6.5 If at any time Grant Fridkin' firm represents a client in matters having to do with the
Collier County government, be it before the Board of County Commissioners or any other
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agency or division of Collier County government, Grant Fridkin will contact the County
Attorney's Office before undertaking such representation so that it can be determined
whether a conflict of interest exists.
ARTICLE 7
INDEMNIFICATION
7.1 Grant Fridkin acknowledges and agrees that Ten Dollars ($10.00) of the compensation to
be paid by County, the adequacy of which is hereby acknowledged by Grant Fridkin, is
given as specific consideration to Grant Fridkin so that Grant Fridkin shall at all times
hereafter indemnify, hold harmless and, at County's option, defend or pay for an attorney
selected by County to defend County, its officers, agents, servants, and employees against
any and all claims, losses, liabilities, and expenditures of any kind, including attorney
fees, court costs, and expenses, caused by negligent act or omission of Grant Fridkin, its
employees, agents, servants, or officers, or accruing, resulting from, or related to the
subject matter of this Agreement including, without limitation, any and all claims,
demands or causes of action of any nature whatsoever resulting from injuries or damages
sustained by any person or property. The provisions of this section shall survive the
expiration or earlier termination of this Agreement. To the extent considered necessary
by County, any sums due Grant Fridkin under this Agreement may be retained by County
until all of County's claims for indemnification pursuant to this Agreement have been
settled or otherwise resolved; and any amount withheld shall not be subject to payment of
interest by County.
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ARTICLE 8
OWNERSHIP OF DOCUMENTS
8.1 Any and all reports, photographs, surveys, and other data and documents provided or
created in connection with this Agreement are and shall remain the property of County.
In the event of termination of this Agreement, any reports, photographs, surveys, and
other data and documents prepared by Grant Fridkin, whether finished or unfinished,
shall become the property of County and shall be delivered by Grant Fridkin to the
County within seven (7) days of termination of this Agreement by either party. Any
compensation due to Grant Fridkin shall be withheld until all documents are received as
provided herein.
ARTICLE 9
INDEPENDENT CONTRACTOR
9.1 Grant Fridkin is an independent contractor under this Agreement. Services provided by
Grant Fridkin shall be subject to the supervision of Grant Fridkin, and such services shall
not be provided by Grant Fridkin as officers, employees, or agents of the County. The
parties expressly acknowledge that it is not their intent to create any rights or obligations
in any third person or entity under this Agreement.
ARTICLE 10
NONDISCRIMINATION, EQUAL OPPORTUNITY
AND AMERICANS WITH DISABILITIES ACT
10.1 Grant Fridkin shall not unlawfully discriminate against any person in its operations and
activities in its use or expenditure of the funds or any portion of the funds provided by
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this Agreement and shall affirmatively comply with all applicable provisions of the
Americans with Disabilities Act (ADA) in the course of providing any services funded in
whole or in part by County, including Titles I and II of the ADA (regarding
nondiscrimination on the basis of disability), and all applicable regulations, guidelines,
and standards.
10.2 Grant Fridkin' decisions regarding the delivery of services under this Agreement shall be
made without regard to or consideration of race, age, religion, color, gender, sexual
orientation national origin, martial status, physical or mental disability, political
affiliation, or any other factor which cannot be lawfully or appropriately used as a basis
for service delivery.
10.3 Grant Fridkin shall comply with Title 1 of the Americans with Disabilities Act regarding
nondiscrimination on the basis of disability in employment and further shall not
discriminate against any employee or applicant for employment because of race, age,
religion, color, gender, sexual orientation, national origin, marital status, political
affiliation, or physical or mental disability. In addition, Grant Fridkin shall take
affirmative steps to ensure nondiscrimination in employment against disabled persons.
Such actions shall include, but not be limited to, the following: employment, upgrading,
demotion, transfer, recruitment or recruitment advertising, layoff, termination, rates of
pay, other forms of compensation, terms and conditions of employment, training
(including apprenticeship), and accessibility.
10.4 Grant Fridkin shall take affirmative action to ensure that applicants are employed and
employees are treated without regard to race, age, religion, color, gender, sexual
orientation, national origin, marital status, political affiliation, or physical or mental
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disability during employment. Such actions shall include, but not be limited to, the
following: employment, upgrading, demotion, transfer, recruitment or recruitment
advertising, layoff, termination, rates of pay, other forms of compensation, terms and
conditions of employment, training (including apprenticeship), and accessibility.
10.5 Grant Fridkin shall not engage in or commit any discriminatory practice in performing the
Scope of Services or any part of Scope of Services of this Agreement.
ARTICLE 11
NOTICES
11.1 Whenever either party desires to give notice to the other, such notice must be in writing,
sent by registered or certified United States Mail, postage prepaid, return receipt
requested, or by hand-delivery, addressed to the party for whom it is intended at the place
last specified. The place for giving notice shall remain the same as set forth herein until
changed in writing in the manner provided in this section. For the present, the parties
designate the following:
FOR COLLIER COUNTY:
Jeffrey A. Klatzkow, County Attorney
Government Center
3301 Tamiami Trail East
Naples, Florida 34112
FOR GRANT FRIDKIN:
GregoryN. Woods
Grant Fridkin, P.A.
5551 Ridgewood Drive, Suite 501
Naples, FL 34108
II
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ARTICLE 12
MISCELLANEOUS
8.1 WAIVER OF BREACH AND MATERIALITY
Failure by County to enforce any provision of this Agreement shall not be deemed a
waiver of the provision or modification of this Agreement. A waiver of any breach of a
provision of this Agreement shall not be deemed a waiver of any subsequent breach and
shall not be construed to be a modification of the terms of this Agreement.
8.1 COMPLIANCE WITH LAWS
Grant Fridkin shall comply with all federal, state, and local laws, codes, ordinances, rules,
and regulations in performing its duties, responsibilities, and obligations related to this
Agreement.
12.3 SEVERANCE
In the event a portion of this Agreement is found by a court of competent jurisdiction to
be invalid, the remaining provisions shall continue to be effective unless County and
Grant Fridkin elect to terminate this Agreement. The election to terminate this
Agreement based upon this provision shall be made within seven (7) days after the
finding by the court becomes final.
12.4 APPLICABLE LAW AND VENUE
This Agreement shall be interpreted and construed in accordance with and governed by
the laws of the State of Florida. Venue for litigation concerning this Agreement shall be
in Collier County, Florida.
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12.5 PRIOR AGREEMENTS
This document supercedes all pnor negotiations, correspondence, conversations,
agreements, and understandings applicable to the matters contained herein and the parties
agree that there are no commitments, agreements or understandings concerning the
subject matter of this Agreement that are not contained in this document. Accordingly,
the parties agree that no deviation from the terms hereof shall be predicated upon any
prior representations or agreements, whether oral or written. It is further agreed that no
modification, amendment or alteration in the terms or conditions contained herein shall
be effective unless contained in a written document in accordance with Article 3 above.
12.6 INCORPORA nON BY REFERENCE
The truth and accuracy of each "Whereas" clause set forth above is acknowledged by the
parties. The attached Exhibits "A," "B," and "c" are incorporated into and made a part of
this Agreement.
DATE: December 10, 2009
BOARD OF COUNTY COMMISSIONERS
OF COLLIER OOUNTY, FLORIDA
,
/:' i
ATTEST: -
DWIGHT E. BROck, CLERK
~~
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A
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\l~'(t-~,,? -~_,' l
By: I
DONNA FIALA, CHAIRMAN
Item# 1ft, \c.l"
Agenda ,~/, I oq
Date ~.
~:d ~
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By:
GRANT, FRIDKIN, PEARSON, ATHAN
& CROWN, P.A.
,4~ 41) ~~
, 1,\
"-, \"....,:J
)."....Y"f. \1\..'\' rtJ.v
Its:
STATE OF FLORIDA
COUNTY OF COLLIER
The foregoing Retention Agreement was acknowledged before me this I ~ tl'\day of
N,\'tn~ \)t\" , 200l by G Y(~)CILI lUc;'c!', as.r\(UQ htldt ( of Grant Fridkin, P.A., a
Florida Professional Association, on behalf of the professional association.G~he i(j):~~~allY
F""'='~
~~wn to ~or produced
as identification.
~"""'"t''' ~~ IOMBERL YD. SWANSON
lfi)'J,.\ MYCOMMISSION'00519153
~. .' ! EXPIRES: June 16, 2010
"~ii:,: . Bcn~~.NoIIryPubllcUnderwrlters
~ . l., r. [" e,,'ti r \1)(~7\
" .1,\1\ \/ lIVId J '. ,tli!.. . ,
Signature of Nota Public .
K \ In be '( kt\') "-, l Ut Y'L:LlY'l
Name of Notary ubhc typed, prmted or
My Commission Expires:
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EXHIBIT A
For professional services rendered, Grant Fridkin' fee shall be based on the hourly rate as
follows:
Gregory N. Woods
$300.00 per hour
All other Partners
$300.00 per hour
Associates
$200.00 per hour
Paralegals
$100.00 per hour
Grant Fridkin's fee shall not exceed $100,000.00 per new matter assigned without the approval
of the Board of County Commissioners. Any expenditure beyond the initial $100,000.00
approval by the Board of County Commissioners must have Board approval prior to work being
performed. (Where appropriate a "not to exceed" sum shall be agreed to when each assignment
is made to Grant Fridkin.)
In the event that Grant Fridkin is required or requested to perform any additional or extraordinary
services not herein contemplated, Grant Fridkin shall be entitled to apply for additional
compensation, the amount of which shall be subject to the approval of County and no such
additional compensation in excess of the amount herein stated shall be paid unless specifically
authorized in advance by County in its sole discretion.
Grant Fridkin shall provide, at no cost to County, the annual response to County's auditors
regarding pending or threatened litigation. The auditors typically request information regarding
all litigation, claims and assessments considered to be material. The response should include the
nature of the litigation, the progress of the case to date, an estimate of the amount or range of
potential loss, and any other information considered necessary to explain the case. Grant Fridkin
shall provide said response within 30 days of receipt of the request.
NOTES:
. Divisions, or departments within such divisions, shall be responsible and pay for legal
counsel services relating to litigation and outside counsel specifically for cases, matters or
issues relating to such division or department, as determined by the County Attorney in
coordination with the County Manager.
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EXHIBIT B
I. In addition to the charges for professional fees set forth in Exhibit "A," and the
Schedules attached hereto, County shall reimburse Grant Fridkin for out-of-pocket
expenses reasonably incurred in the course of rendering such legal services, including
costs of long distance calls, printing, costs of reproduction, and necessary travel
expenses incurred in accordance with the requirements of Chapter 112, F.S. Grant
Fridkin shall not charge for travel of attorneys between its offices so that it can
provide the best available and most appropriate lawyer in any of its office locations
for the issues involved.
2. Grant Fridkin shall submit invoices on a monthly basis for the payment of out-of-
pocket expenses. Each invoice shall include a signed certificate listing all costs,
expenses, vouchers, invoices and other documentary evidence that will describe in
reasonable detail the basis for expenditures for which reimbursement is sought as set
forth below.
3. REQUIREMENTS
The following represents Collier County's payment requirements for legal costs
~ Your federal employee identification number must be on all invoices submitted.
~ The applicable Purchase Order number must be on all invoices submitted.
~ No service, interest, or other charge of like nature is to be imposed with regard to
any item, invoice, or request. All firms doing business with Collier County must
have a current W-9 "Request for Taxpayer Identification Number and
Certification" on file.
~ Services rendered must be specifically and concisely identified~
~ Names of persons performing services, hourly rates, and dates must be listed. The
County agrees to reimburse Grant Fridkin for retention and utilization of
sub-consultants.
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~ Reimbursable expense must be verified by attached receipts or copies thereof.
~ Claims for mileage and meals cannot exceed statutory allowance as provided for
under Chapter 112, F.S. Meals and mileage cannot be charged unless the
professional has traveled outside the county ofthe principal business location.
~ Claims for lodging at single rate (actual cost) must be substantiated by paid bill or
charge, with a cap of no more than $150.00 per night.
~ Car rentals required for travel should include compact or standard-size vehicles
only.
~ Common carrier travel shall be reimbursable at tourist or coach class fares only.
~ Accounting Division requires original receipts, or copies of receipts which have
been individually certified to be true copies of the originals. In addition the
Certificate contained in Exhibit C must accompany each invoice. The certifYing
person must sign the Certification form and a description provided of the items,
which are certified.
~ Faxes shall not be reimbursed
~ Legal Research costs (Lexis-Nexis, Westlaw, etc.) shall not be reimbursed
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EXHIBIT C
CER TIFICA TE
IT IS HEREBY CERTIFIED that:
1. has been duly designated as special counsel to
render legal services or provider of services for or on behalf of ColIier County;
2. Each of the documents hereinafter identified and attached is a true and correct copy of the
original record;
3. Expenditure( s) enumerated represent costs necessarily incurred during the course of
official business for which payment has not been received and for which documentation is
not available or reasonably retrievable;
4. Claims are in compliance with the applicable statutes and administrative orders, and with
the express provision that all other parties are barred from entitlement to any part of these
costs.
RE:
Invoice No.
, Dated
Period Covered:
, Amount
IN-HOUSE CHARGES:
Photocopies:
copies @ $O.15/each
$
Mileage:
miles @ ~mile
$
OTHER (Copies of invoices required):
Long Distance Calls
$
Other:
$
TOTAL:
$
FOR THE FIRM
Signed:
Print Name:
Title:
Date:
04-COA-Q1158/2825
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Admiral Insurance Company
12S5cadwe1Road. ChenyHHI. NJ 08034
Declarations Page
Lawyers Professional Liability Insurance
CLAIMS MADE WARNING FOR DECLARATIONS
MOllCE: THIS POLICY PROVIDES COVERAGE ON A ClAIMS MADE AND REPORTED BAStS SUBJECT TO ITS TERMS. THIS POUCY APPUES
ONLY TO Atr( "CLAIM" fiRST MADE AGAINST THE INSUREDS AND REPORTED TO TIlE INSURER DURING THE POLICY PERIOD. THE
AUTOMATIC EXTENDED REPORllNG PERIOD, OR THE PURCIIASl!D EXTENDED REPORTING PERIOD. TIlE LIMITS OF LIABILITY AVALABlE
TO PAY DAMAGES SllALl BE REOUCfD AND MAY BE EXHAUST!D BY AIIIOUNTS INCURRED AS "ClAIMS EXPENSE" AND "ClAIMS
EXPENSE" SHALL BE APPUED TO TIlE DEDUcnBLE.
PLEASE READ AND REVIEW TIlE POLICY CAREFULLY AND DISCUSS THE COVERAGE WITH YOUR INSURANCE AGENT OR BROKER.
Whenever prI'lted in tnis Declarations Page. the boldface type terms shan have lhe same meanings as indicated irllhe Policy.
Policy form: LP 9200 (0S-1IlI) Policy Numbar: 9876690
Ileml NameandAifd...sol Namedlnoullld. ... vA289060
. SURPLUS LINES AGOOBlTc~t~~'St Pete BeId! FL 337116
Grant. Fridkin. Peerson, Athan & Crown, P,A. AGENT ADDRESS: 1 ~.., ,...,~ -l~
~~;~~~dDnve ~8mM~:~~~~lt>J t -.tJ~t x
Naples. FL 34108 .- . It.' Ao,ida surp~laWs.
lh' InsulJ:..CC':i l" . ....:; ;!Ji:.U:I;\ 10.. "' on die
Persondeslgnale<ltD receive a~lXJf_deAC8 fTDm Ihe InOUlll'I";~red by Burp:.' LillO< (;or;l~r 0 t IMI roc:' 11I0
Judy Wn9hl Inturanee G_Dly ActID tne e ent 0 y
OlflO8A<1mmlstralor ='m ~~.:rr~r.::uRE'
PoAty Period: From January 1, 2009 (incep6on date) to January 1, 2010 (expiration dale)
(80th dales at 12:01 a.m. Stant/ani Time al /he addl8SS of the Named tnsured)
Limits of Uabl~y lor the Pallcy Period Qnclusiva DI Demogeo end Claims Expense):
A. $2.000.000 eech Claim. but in no event exceeding
B. 52.000,000 In the eggregete k>r a~ Claims.
Applicable Deductible: 550,000
Plllmlum: 585.596
Endorsemenl. aneehe<l:
lIem2.
Item 3.
I\em4,
91200 (05-99)
93121 (05-99)
Administration Fee: $35.00
Surplus Lines Tax: $4.281.55
Stamping Fee: $85.63
FHCF: $856.31
Service 01 Suit
118m 5.
lI.m6.
Addition 10 SectIon III. K. Addition 01 Title Agent Covetage
Item 7. Notice to the Insurer as provided In sections VII. A. end VII. B. and any infomlatlon lumished to the InouN' as provided In section
VI. A. shall be ser.1 la: Monitor Liability Managers. LLC. Claims Deportment.
Address: 2850 Wall GoII Road. Suite 800. RoIUng Meadows. IL 600084039
Fax: (847) 806-4017
Emalt newclaim@monllorllebiity.com
AI oIher notices required to be given to the Inlure' under IhiI POlicy shall be sent ta: Moritar UabUily Managers. LlC
Addrell.: 2850 West Golf Road. Suite BOO. Ramng Me_. IL 800084039
FIX: (847) 806-62B2
These De<:laralions aIol1g with the completed and I Form and the Lawyers' Professional Uabillly Inswance Policy. shell constilule the
COOIrsCl belW88fllhe Hamod Inourtd
Aulhorized
Dele ISllJed: February 17. 2009
LP 9201 (rev. 04.(6)
9876690 Granl. Fridkin, Pearson, Alhan & C/llWn, P A
Page 1 01 1
16K
6
~,
MONITOR
SUilC 800
2850 Wetl GolrRoad
Rolling MCadowll, IL 60008-4039
847.8D6.659O
Fax: 841.806.6282
hltp:llwww.nloni1orliabilily.com
. ..
liABILITY MANACERS.INC.
February I 7, 2009
Judy Wright
Grant, Fridkin, Pearson, Athan & Crown, P.A.
Suite 501
555 I Ridgewood Drive
Naples, FL 34 J 08
Dear Judy,
Thank you for choosing Monitor Liability Managers, Inc. and the W.R. Berkley Corporation for your professional
liability insurance needs. We know that you have many choices for your insurance and we appreciate your
choosing Monitor.
Monitor and all its employees are proud of our tradition of providing an exceptional insurance facility and making
every effon to assure your satisfaction with our product and service. The people behind the promise to pay are
critical to the value of any insurance policy. Like most services, you get what you pay for - the premium is only
one part of the value ofan insurance policy.
The most important service we provide and the greatest value you receive does not come from delivering the
policy _ it comes from handling your claims. While we help our policyholders with loss control and crisis
avoidance, if the day comes when you face a claim, we will be there to help you navigate through the complexities
of a professional liability claim.
Attached is a narrative from Mr. Jason A. Fogg, Esq., Assistant Vice President- Claims, outlining claims
reporting guidelines in the event that a claim does occur, with many years of experience handling complex
professional liability claims - I am confident you will be pleased to have Monitor on your side.
Once again, thank you for choosing Monitor and the W.R. Berkley Corporation. We hope that you will see the
value in the people behind the promise and we hope to be your choice for your professional liability needs for
years to come. Please call your professional liability insurance agent if you have any questions about Monitor, or
any comments about our service to you. Your satisfaction is important to us.
Regards,
4!/L
Douglas 1. Powers, CPCU
President & CEO
16K
6
WI
MONITOR
LIABILllY MANAGERS, INC.
Claims Reporting Guidelines for the Insured
These guidelines should be followed to help Monitor Liability Managers, Inc. provide efficient claims service.
Claim Notices
All claim notices shall be sent to Monitor Liability Managers, Inc., Claims Department The notices must be
reported as required by the policy to avoid problems regarding timely notice. The address of the Monitor Claims
Department is as follows:
Monitor Liability Managers, LLC
Claims Department
2850 West Golf Road . Suite 800 . Rolling Meadows,lL 60008-4039
MI'. Jason A. Fogg, Esq., Assistant Vice President - Claims
Phone: 847.806.6590
Claims Dept. Fax: (847) 806-4017
E-mail: newclaim@monitorliability.com
Notice of claim requiring immediate action:
If immediate action on the notice is needed the Insured should express mail the notice to Monitor's Claims
Department. Situations requiring immediate action may include:
I. The Insured being served with a summons and complaint.
2. The Insured needs to provide a response to the claimant immediately.
Correspondence from the Insured
The claim notice should include a written narrative of the circumstances surrounding the claim or potential claim.
The narrative should include, but not be limited to:
I. Names of the insureds, policy number and effective dates.
2. Names and addresses of the claimant.
3. Details of the underlying claim, including its current status and the amount in controversy or relief demanded.
4. All pertinent letters or documents necessary to properly evaluate the claim.
Please provide carbon copies to your professional liability insurance agent
ofal! claim notices and correspondence scntto Monitor Liability Managers, Inc.
MIOPl2 (06-06)
16K 6
Loss Prevention Hotline
for Lawyer's Professional Liability
Commencement of Service
If you encounter circumstances which, in your opinion, expose you to potential legal
malpractice liability, you may need assistance from Monitor Liability Managers, Inc.
Lawyers' Malpractice Prevention Hotline.
I:l Send a brief, written requcst for loss prevention advisory services, along with a
current copy of your declarations page, to Hinshaw & Culbertson by facsimile:
1-877-834-3548
PI case refrain from providing Hinshaw & Culbertson with substantive information
that is confidential and which pertains to your client, until thc fino can perform a
conflict of interest check.
a If you are using the Lawyers' Malpractice Prevention Hotline for the first time,
Hinshaw & Culbertson will respond to your written request for advice by sending
you the following:
. Acknowledgement Letter
. Loss Prevention Questionnaire
Please review the Acknowledgement Letter carefully, as it sets forth the terms and
conditions of your attorney-client relationship with Hinshaw & Culbertson as hot line
counsel. Please execute the Acknowledgement Letter, and complete the Loss
Prevention Questionnaire.
I:l Return the executed Acknowledgement Letter and Loss Prevention Questionnaire
to Hinshaw & Culbertson through the hotline facsimile number. Hinshaw &
Culbertson will notify you as soon as the fino has completed a conflict search of the
name(s) provided in tbe Loss Prevention Questionnaire. This will be completed
within 4 hours of receipt of your Acknowledgement Letter.
Monitor Liability Managers, Inc. is the underwriting manager for the
Carolina Casualty Insurance Company . Admiral Insurance Company
Lawyers' Professional Liability Insurance Programs
For addilionol information on Monitor Liability Managers, Inc. and our produclS,
please visilour Web sile at www.monilorliability.com or contacl your professional/iabi/ity broker.
NI ~L8~JT2~
A BBRKLBY COMPANY.
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16K 6
Admiral Insurance Company
1255 Caldwell Road, Cherry Hili, New Jersey 08034
FLORIDA DISCLOSURE NOTICE
THIS INSURANCE IS ISSUED PURSUANT TO THE FLORIDA SURPLUS LINES LAW.
PERSONS INSURED BY SURPLUS LINES CARRIERS DO NOT HAVE THE PROTECTION
OF THE FLORIDA INSURANCE GUARANTY ACT TO THE EXTENT OF ANY RIGHT OF
RECOVERY FOR THE OBLIGATION OF AN INSOLVENT UNLICENSED INSURER.
As 01': November 20. 200'2
Page I orl
16K 6
Admiral Insurance Company
1255 Caldwell Road, Cherry Hili, NJ 08034
Page 1 of
Service of Suit
11 is understood and agreed that In the event of the failure of the Insurer hereon to pay any amount daimed to be due hereunder, the
Insurer, at the request of the Insured (or Reinsured), will submit to the jurisdiction of any court of competentjurisdldion within the United
States of America or Clll1ede and will comply with ell requirements necessary to give such Court jurisdiction end an matters arising hereunder
shan be determined in accordance with the law and practice of such Court. Nothing in this endorsement constitutes or sholld be understood
to constllute a waiver of the Insurer's rights to commence an action in any court of competent jurisdiction in the United States or Canada, to
remove an action to a United States District Court, or to seek a transfer of an action to another court as permitted by law.
It is further agreed that service of process in such suit may be made upon Daniel A. MacDonald, Senior Vice Presi~ent of Admiral Insurance
COOIparly, 1255 Caldwen Road, P.O. Box 5725, Cheny Hill, New Jersey 08034-3220, or his designee, and that in any suit Instituted against
anyone of them upon this contract, the Company will abide by the final decision of such Court or of any Appellate Court in the event of an
eppeal.
The ebove-named is authorized and directed to accept service of process on behalf of the Insurer in any such suit an~lor upon the request of
the Insured (or Reinsured) to give a written undertaking to the Insured (or Reinsured) that it or they will enler a general appearance upon lhe
Insure~s behalf in the event such a suit shall be instituted.
Further, pursuant to any statute of any state, territory or district 01 the United States of America or province of Canada, wtich makes provision
therefor, the Insurer hereby designates the Superintendent, Commissioner, Director of Insurance or other officer speclfied for that puIllOSe In
the statute, or his successor or successors in office, as its true and lawful attorney upon whom may be served any lawful process in any
action, sull or proceeding instituted by or on behalf of the Insured (or Reinsured) or any beneficiary hereunder erising out of this contract of
insurance (or reinsurance), and the Insurer hereby designates the above-named as the person to whom the said officer is authorized to mail
such process or a true copy thereof.
Whene.er prinled in lhis Endorsement, the boldface type terms shall have the same meanings as indicaled in lhe Policy F01Tl1. All other provisions of
the Pol' remain uncha ed.
Insured
Grant, Fridkln, Pearson, Alhan & Crown, P.A.
Effective Date 0 This Endorsement
0110112009
00 (05-99 - 1217
16K 6
Admiral Insurance Company
1255 Caldwe' Road. Charry HIli. NJ 08034
Paga 1 of
Addition to Section III. K.
Addition of Title Agent Coverage
In cooslderallon of Ihe premium paid for this Policy, it is undarstood and agreed that section III. Definitions K. 'Professlonal Sarvlcas' of this
Policy is amendad by the addition of the following:
III. K.: 'Professional Sarvlces' also means a tilla insurance agant, provided such services are connected with and incidenlal to the
Insurad's practice of law and are pursuant to a written agency agreement with a icensed liUe insurance company; provided,
however, the Insurer shall not be liable 10 make any payment for Damages or Claims Expense In connecIion with any Claim made
againsl an Insured based upon, arising out of, directly or indirectly resulting from or in consequence of, or in any way involving:
a. defects in tilie of which any Insured had knowledge allhe dale of issuance of such title insuranm whether or not a mailer
of public record;
b. any intentional breach of underwriting eulhority by any Insured functioning as a tiDe insurance agent;
c. any liability assumed by an Insurad under any contract or agreement whereby the Insured has agreed 10 participate in the
payment of a loss under a title insurance policy, including, attorneys' fees. coort costs and expenses, unless such tiability
would have allached 10 the Insured even in the absence of such agreement.
Whenever printed in this Endorsement, the boldface type terms shan have the same meanings as indicated in the Policy Form. All other provisions of
lhe Poli remain uncha d.
Insured Policy Number
Grant, FtldJ<in, Peerson, Athan & Crown, P A 9876690
EffectiYe Date of This Endorsement Authotlzed Representative
0110112009
9200
16K 6
THIS IS A CLAIMS MADE POLICY.
PLEASE READ IT CAREFULLY.
Lawyers' Professional
Liability Insurance Policy
Admiral Insurance Company
16K -6
Admirallnaurance Company
CLAIMS MADE WARNING FOR POLICY
NOTICE: THIS POLICY PROVIDES COVERAGE ON A CLAIMS MADE AND REPORTED BASIS SUBJECT TO ITS TERMS. THIS POUCY
APPLIES ONLY TO ANY "ClAIM" FIRST MADE AGAINST THE INSUREDS AND REPORTED TO THE INSURER DURING THE POLICY
PERIOD, THE AUTOMATIC EXTENDED REPORTING PERIOD, OR THE PURCHASED EXTENDED REPORTING PERIOD. THE LIMITS OF
LIABILITY AVAILABLE TO PAY DAMAGES SHALL. BE REDUCED AND MAY BE EXHAUSTED BY AMOUNTS INCURRED AS "CLAIMS
EXPENSE" AND "CLAIMS EXPENSE" SHALL BE APPLIED TO THE DEDUCTlBL.E.
PLEASE READ AND REVIEW THE POLICY CAREFUL.L. Y AND DISCUSS THE COVERAGE WITH YOUR INSURANCE AGENT OR BROKER.
In consKleration 01 the payment of the pramium, and in reliance on all statements flthe PropouI, and all other inIormation provided to the
Insurer, and subject to all the provisions of this Policy. the Inaul8l' and Insuredls) agree as follows:
I, Insuring Agreement
This Policy sha. pay on beIlaff of the Insured all Dsmages and Claims Expense 1I1at 1I1e lnaured shall become legally obligated to pay,
arising from any Claim first made against an Insured during the Policy Period and reported to the Insurer fl writing during the Policy
Period or within 60 days thereafter, for any Wrongful Act, provided that prior to the inception date of the firsl Lawyers' Professionall.iabUIty
Insurance Policy issued by the Insurer to 1110 Named lnaured, which has been continuously renewed and mafltained in effect to 1I1e
inception of 1I1is Policy Period, the Insured did not know, or could not reasonably foresee that such Wrongful Act might reasonably be
expected to be the basis of a Clslm.
II, Extended Reporting Period
A. If 1I1e Named Insured cancels or " the Insurer or 1I1e Nsmed Insured refuses to renew this PoflCY, then Ihe Named Insured shan
have the righ1, upon payment of the appropriate percentage of the 'ull annual premium", as provided in section II. B., to an
extension of the coverage granted by this Policy wi1h respect to any Claim first made and reported during the appropriate period of
months after the date upon which the Policy Period ends, but only with respect to any Wrongful Act fully occurring prior to the end
of the Policy Period and oth8lWise covered by 1I1is Policy. Such appropriate period 01 months shall be referred to as the Extended
Reporting Period. Ps used herein, 'full annual premium" means 1I1e premium level in effect immediately prior to the end of the
Policy Period. The rights contained in this paragraph shall terminate, however, unless wrinen notice of such election together with
Ihe additional premium due is received by the Insurer w~hin 30 days of the effective dele of cancellation or non-renewal.
B. The percentage of lhe 'ull annual premium' and period of months for the Extended Reporting Period shall be:
1. 12 months Extended Reporting Period for 100 percent of the 'uU annuai premium" of the Policy, or
2. 24 months Extended Reponing Period for 150 percent of the 'ul annual premium" of tha Policy, or
3. 36 months Extended Reporting Period for 185 percent of 1I1e 'ull annual premium" of the Policy, or
4. 60 months Extended Reporting Period for 250 percent of the 'uB annual premium" of the POlicy.
C. The additional premium for the EXlended Reporting Period shall be fully eamed at the inception of 1I1e Extended Reporting Period.
The Extended Reporting Period is not cancelable.
D. Ps a condition precedent 10 the right to purchase 1I1e Extended Reporting Period, 111. lolal premium for this Policy and all
Deductible obligations must have been paid.
E. Wrthout any additional premium being required, there shall be an automaoo extension of the coverage granted by !his Policy with
respect to any CfBim first made and reported duri1g a period of 60 days after the date upon which the Policy Period ends, but only
wi1h respect to any Wrongful Act fully occurring prior 10 1I1e end of the Policy Period and olherwise covered by this Policy and only "
there is no other policy or policies that would 01l1erwise provide ils..ence tor such Wrongful Act. This 60 day period shall be referred
to as the Automatic Extended Reporting Period.
F. The Automatic Extended Reporting Period or the Extended Reponing Period shall not be available when any Insured'. license or
right to practice law is revoked, suspended, or surrendered.
LP 9200 (05-99) Page 1 of 7
The descriotions in the heAdinn~ nf th~ Pnlir.v AM M1Atv fnr r.nnvFlniAnr.~ AM fnrm nn nArt nf tkA tlllrmq AM rnnrlifit'lnCl: I'tf I'nUArAnollo
-.16K 6
Admiral Insurance Company
III. Definitions
Whenever printed in boldface type in this Policy, the following tenns shell have the meanings indicated below.
A. 'Claim' meens a written demand for monetary or non-monetary relief including, but not limned to, a civil, criminal, administrative or
arbi1lation proceeding; provided, however, lIlal Claim shall nol include any proceedings before a state licenlling board or similar
authority, except as oth8lWlse provided in section V. Supplemental Coverages, of this Policy. A Claim shall be deemed to have
been first made at the time notice of the Claim is first received by any Insured.
a 'CIalma Expenae' means reasonable and necessary tees, costs and expellees (including premiums for any appeal bond,
attachment bond or similar bond, but without any obligation to apply for or Iumish any such bond) resulting solely from lIla
investigation, adjuslm8nt, defense and appeal of a Claim against the Insureds, but excluding salaries, wages, overl1ead or benefit
expenses associated wnh any Insured, or any amount covered by the duty to defend obligation of any other insurer.
C. 'Damages' means a monetary judgment, award or settlement, pre-judgment interest and post-judgment interest; provided,
however, Damages shall not include:
1. taxes, civil or criminal tines, or penelties imposed by law, or
2. punitive or exemplary damages, or any multiplied damages award in excess of the amount so muhiplied, or
3. any matter deemed uninsurable under the law pursuant to which this Policy shall be construed, or
4. legal fees, costs and expenses paid, incurred or charged by the Insured, whether claimed as Iorteilure, restitution of
specnic funds, financial loss, set-off or otherwise, and injuries that are a consequence of any of the foregoing, or
5. legal fees, costs, fines, penalties, sanclions, or other amounts awarded against an Insured or any client 01 an Insured
based upon the ectual or alleged filing of pleadings or other papers under sny federal or state stalute, administrative rule,
court rule or case law, including, but not limited to Aule 11, Federal Aules of CMI Procedure, any successor thereto or
state rule counterpart.
O. 'Electronic Mall' means the transmission of messages and information over a closed, private network; or a semi-public network
that provides a pLbIic access to an on.line service for a fee; or the Internet.
E. 'nsured" means:
1. the Named Insured and any Predecessor Firm;
2. any individual or professional corporation who is or becomes a partner, officer, director, stockholder, or employee of the
Named Inaured, bul solely while acting within the scope of their duties on behall 01 the Nemec! Insured;
3. any individual or professional corporation who was a partner, officer, director, stockhoider, or employee 01 the Named
Insured or Predecsssor Firm, but solely while acting within the scope of their duties on behalf of the Named Insured or
Predecessor Firm;
4, any individual or professional corporation designated "counser or 'of counsel' to the Nemed Inlured, but solely while
acting within the scope of their duties on behaW of the Named In8UllKt for which a fee inured to the Nemec! Insured:
5. the heirs, executors, administrators, and legal representatives of each Insured in the event of death, incapacity or
bankruptcy, but solely with respecl to the liability of each Inaured as otherwise covered by this Policy.
F. 'nlul'el'" means the entity issuing this Policy as listed on the Declarations Page.
G. ,..med Insured" means the individual, partnership, professional association, limited liability partnership, limited liability
corporallon, or corporation named in Item 1. of the Declarations.
H. "ersonallnJury" means invasion of privacy, wrongful entry, evicIIon, false arrest false Imprisonment malicious prosecution, libel,
slander, mental anguish, humiliation, or emotional distress, orel or written publication of defamatory or disparaging material, or the
inadvertent disclosure 01 confidential or privileged information communicated by Electronic Mall.
I. 'Policy Period' means the period of time from the inception date shown in Item 2. of the Declarations to the earlier of the
expiration date shown in Item 2. of the Declarations or the effective date of cancellation of this Policy; however, to the exlentthat
coverage under this Policy replaces coverage in other policies tenninating at noon standard lime on the inception date of such
coverage hereunder, then such coverage as is provided by this Policy shall not become effective until such other coverage has
terminated.
LP 9200 (05-991 Pege 2 of 7
The descriptions in the headings of this Policy are solely for convenience, and form no part of the tenns and condnions 01 coverage.
16K 6
Admiral Insurance Company
J. 'PndenAOr FInn' means an individual, partnership, professional association, lim~ed liabilily partnership, limited liability
corporation, or corporation to whose financial assets and liabilities the Named Insured is lhe majority successor in interest,
Pred_ Firm does not include an individual, partnership, prolessional association, limited liability pa~nership, limited lability
corporation, or corporation to whose financial assets and liabilities lhe Named Insured becomes the majority successor in interest
during lhe Policy Period 1I11ess 1I1e Insurer, in its sole discretion, and 1I1e Named Insured agrees to include such individual,
partnership, professional association, lim~ed liability partnersh~, limited lability corporation, or corporation as a PnlcIecelBor
Finn. The Named Insured shall accept any premium adjustment or coverage revisions which lhe Insum may require.
K. 'Proleaalonal Services" means services:
1. rendered by an Insured solely as a lawyer, mediator, arbllrator, or notary public for others, or
2. performed by an Insured as an administrator, conservator, receiver, executor, guardian, trustee, or in any olher fiduciary
capacity, but only ij the act or omission in dispute is in the rendering of services ordinarily pertormed as a lawyer and
then only to the extent 01 such services.
L. 'Propotal" means 1I1e Proposal Form and any materiai submined therewith.
M. 'Related Wrongful Acr means Wrongful Ac:l1I v.tJich are logically or causally connected by reason of any common fact,
cifctJmstance, s~uation, transaction, casuaily, event or decision.
N, 'Wrongful Act" means any actual or aUeged act, omission, or Personal Injury arising out of Professional ServIces rendered by
an Insured or by any person for whose act or omission the Insured is legally responsible..
IV. Exclusions
The Insurer shall not be liable to make any payment for Damag.. or Claims Expenle in connection with any Clsim made against an
Insured: .
A. based upon, arising out of, directly or indirectly resulting from or in consequence of, or in any way invoMng a dishonest, fraudulenl,
criminal, or malicious act or omission committed by or at 1I1e direction of, or ratified by any Insured; provided, however, lhe Insum
will provide a defense for any such Claiml, wi1l10ut any liability by the lnaunr to pay such sums that any Insured shal become
legally obligated to pay as Damages;
[INNOCENT INSURED PROVISION: Whenever coverage under this Policy would be excluded, suspended, or lost because of
Exclusion A, the Insurer agrees that such insurance, as would 01l1erwise be aIforded under this Policy, shaU be applicable with
respect to an lnaured, other 1I1an the Named Insured and any PnlcIecel80r Firm, who did not personally pa~icipate or personally
acquiesce in or remain passive after having knowledge 01 such conduct.]
B. by any Insured;
C. as 1I1e beneficial)' or distributee of any trust or estate;
D. for bodily injury, sickness, disease, death, assau~, or baftary 01 any person, or damage to, or destruction of any tangible properly,
including loss of use thereof;
E. based upon, arising out of, directly or indireclly resulting from or in consequence of, or in any way involving any IllIured's activities
or their capacity as:
1. an officer, director, partner, trustee, or employee of a business enterprise, not named in Item 1. 01 1I1e Declarations, a
non-profR organization, or a pension, welfare, profit sharing, mutual or invesbnent trust or IIlnd, or
2. a public officiaJ, employee, or agent 01 a govemmental body, subdivision, or agency, unless the Insured is deemed to be
a public official, employee, or agent of such entily solely by virtue of rendering Profession" ServIces to ft, or
3. a fiducial)' under the Employee Retirement Income Security Act of 1974 as amendsd or any regulations promulgated
thereunder or any similar provisions of any state or federal common law or statute;
F. by or in connection with any business enterprise, not named in Item 1. of 1I1e Declarations, in which the Insured owns more than a
10 percent interes~ or in v.tJich any Insured is an owner, partner, or employee, or v.t\ich is directly or indirectly controUed,
operated, or managed by any Insured, other Ihan soleiy in a fiduciary capacity, but only ij the act or omission in dispute is in the
rendering of services ordinarily pertormed as a lawyer, and then only to lhe extent of such services;
G. wf1ich is insured in v.t\ole or in pa~ by ano1l1er valid policy, except wi1l1 respect to any excess beyond the amount or amounls 01
coverage under such other policy whether such other policy is Slated to be primary, contrlbutol)', excess, contingent, or otherwise;
LP 9200 (05-99) Page 3 of 7
The descriptions in 1I1e headinas of this PolicY are solelv for convenience, and form no Dart of the terms and conditions of coveraoe.
16K
6
Admiral Insurance Company
H. based upon, arising out of, directly or indirectly resuhing from or in consequence 01, or In any W8!f involving any nuclear reaction,
radiation 01 contamination, regardless of cause;
for actual or alleged seepage, pollution or contamnation of any kind;
based upon, arising out of, directly or indirectly resuUing kom or in consequence of, or In any way involving the Securities Act of
1933, the Securities Exchange Act of 1934, rules or regulations promulgated lf1ereunder or any simAar state statutes, rules,
regulations, or common law;
based upon, arising out 01, directly or indirectly resulting from or in consequence of, 01 in any way involving:
1. any Wrongful Act alleged in any claim which has been reported, or in any circumstance of which notice has been given,
prior to the Policy Period under any other policy, 01
any other Wrongful Act whenever occurring, which together with a Wrongful Act l'tt1;ch has been tile .ooject of such
claim or notice, would conslttute Related Wrongful Acta;
for discrimination or harassmoot because of race, color, religion, age, sex, disability, pregnancy, national ongin, sexual orientation,
marllal status, or any other basis prohibited by law.
I.
J.
K.
2.
L.
V. Umils of Liability and Deductible
A, The Limits of liability stated in Item 3. of the Declarations are lf1e Umits of the Inllllm's liability for all Oems... and ClaIms
Expense arising out of all Claims first made against lf1e Inllllllds during lf1e Policy PerIod, the Automatic Extended Reporting
Period, and the Extended Reporting Period (II applicable). The Limits of Liability for lf1e Automatic Extooded Reporting Period and
the Extended Reporting Period shall be part of, and not in addition to, the Limits 01 Liability for the Policy Period. Further, any
Claim mede subsequent to the Policy Period, the Automatic Extended Reportng Period, OIlf1e Extended Reporting Period (if
applicable) l'tt1ich pursuant to section VII. B. or VII. C. Is deemed first made during the Policy Period, lf1e Automatic Extended
Reporting Period, 01 the Extended Reporting Period shell also be subject to lf1e applicable Limits of Liability stated in Oem 3. 01 the
Declarations. In the event lf1e Limits of Liability stated n item 3. of the Declarations are exhausted by payment of Oamagee andlor
Claims Expense, or the Limits of Liability heve been tendered to or on behell of the Insured, Ihen any and all obligations of the
Insurer hereunder shall be deemed 10 be completely Iulfilled and extinguished.
B. The maximum Limit of Liability for all Claims under Ihis Policy shall not exceed the aggregate Limit of Liability stated in Item 3. B.
of the Declarations.
C. ClaIm. Expense shall first be applied against the Deductible and shaH be part of and not In addition to Ihe applicable limits of
liability slated in Item 3. of the Declarations. Payment of Claim. Expenae shall reduce the applicable Limits of liability stated in
Item 3, of the Declarations.
D. The Deductible amount slated in Item 4. of the Declarations shall be paid by the Named Insured and shall apply to each and every
Claim. The Insurer shall only be liable for the amount of 08l1l8getl and/or Claim. Expense arising from a Claim l'tt1ich Is in
excess of the Deductible amount stated in Item 4. 01 the Declarations.
Such amolllts shan, upon written demand by the Insurer, be paid by Ihe Named Insured withn 30 days. If the N8m8d Insured
fails to pay Ihe Deductible, then all the Insureds shall be jointly and severally obligated to pay the Deductible. Any funds advanced
by Ihe Insurer shall serve to reduce the Linits 01 liability. If the InlUlllr brings suit to collectlhe Deductible, Ihen Ihe Insured
responsible to pay the Deductible also shall pay the legal fees, costs and expenses incurred by Ihe Insurer 10 coIlecllhe
Deductible.
Supplemental Coverages
The Insurer will pay:
E. up to a maximum aggregate Iimll 01 $7,500 per Policy Period for aillnsured8 for reasonable legal fees, COSls and expenses
resulli1g from the investigation or defense of an Insured in a proceeding before a state licensing board or similar authonty arisilg
out of any Wrongful Act by such Insured, but only if such legal fees, costs, Of expenses ale incurred after notice is first received
by tha Insured during the Policy Period and reported to the Insurer in writing during the Policy PerIod. The 0educItl1e shall not
apply to lf1is coverage and any payments made heraunder shall not reduce ths Limits of LiabiHty stated in Item 3. of the
Declarations.
F. up to $250 for actual loss of earnings to each Insured for each day or part 01 a day 01 such Insured's attendance, at the Insurer's
written request, at a trial, hearing, or arbllration proceeding involving a Claim against an Insured, up to a maximum aggregate limit
01 $1 0,000 per Policy PerIod for alllnlllreds. The Deductible shan not apply to this coverage and any payments made hereunder
shall not reduce lf1e Limits 01 Liability stated in Item 3. of the Declarations.
lP 9200 (05-99) Page 4 of 7
The descriptions in the headh'\Qs of Ihis Policv are solely lor convenience. and Ionn no oart of the terms and conditions ot CQveraae.
Admiral Insurance Company
G. an add~ional 10 percent of the Limit of Liability stated in Item 3. A, of the Declarations up to a maximum aggregate lim~ of
$100,000 per Policy Period for Claims Expenll, but only for a single Claim occurring alter the aggregate Limit of Liability stated
in Item 3. B. of the Declarations is exhausted by payment under this Policy. The Deductible shall not apply to this coverage.
lbt<
6
VI. Defense, Cooperation and Settlements
A. An InsUJed shall not admit liability for, enter into any settlement agreement, stipulate to any judgment, agree to arbitration, or incur
Claims Expense without the Insurer's prior wrinen consent. The Insurer's consent shall not be unreasonably withheld, provided
that the Insurer shall be entitled to full information and all particulars it may request in order to reach a decision regarding such
consent Any Damages and/or Claims Expense incurred and settlements agreed to prior to the Insurer giving its consent shaH not
be covered hereunder.
B. The Insurer shall have the rIght and the duty to defend any Claim \0 which this insurance applies, even ~ eny allegations of the
Claim are groundless, false, or fraudulent. The Inaurer's right and duty \0 defend any Claim shall end when the IneUl8r's
applicable Limit of liability has been exhausted by payment of Onaga and/or Claims Expense, or has been tendered to, or on
bella" of, the Insured, or to a court of competent jurisdiction.
C. Each Insured shall cooperate wi1h the Insurer in the defense and settlement of any Claim, and in enfolcing any right of
contribution or indemnity against any person or organization that may be liable to the Insured, at no cosl to the Insurer. Upon the
request of the Insurer, the Insured shall submit to exeminatlon end interrogation, under oath II required by e representative of the
IlI$urer, and shall attend hearings, depositions and trials, assist in effecting settlement securing and giving evidence, obtaining the
attendance of witnesses, as well as giving written statement(s) to the Insurer's representatives, and meeting with such
representatives for purposes of investigation or defense, all without charge to the Insurer.
D. The Inaurer shaft not settle any Claim wi1hout the Named Insured's written consent It, however, the Nsmed Insured shaft refuse
to consent to any settlement recommended by the Insurer, wIllch is acceptable to the claimant, and shall elect to contest the
Claim, or continue any legal, administrative, or arbitration proceedings in connection with such Clsim, then the Insurer's liability
for the Claim shall not exceed the emount for which the Claim could have been settled, including Claims Expense incurred up to
the dale of such refusal. Such amounts are subject to the provisions of section V.
VII. Notice of Claim and Multiple Claims
A. As a condition precedent to their rights under this Policy, an Insured shall give the Insurer written notice of any Claim as soon as
practiceble.
B. If during the Policy Period an Insured becomes aware 01 any fact, circumstance 01 situation wIlich may reasonably be expected
to give rise to a Claim being made against any Insured end shall give written notice to the Insurer, as soon IS practicable (but
prior to the expiration of 01 cancellation of the Policy), of:
f . the specific fact, circumstance or situation, wi1h full details as to dates, persons, and entities involved; and
2. the injury or damages which may resulltherefrom; and
3. the circumstances by wIlich the Insured first became aware thereof;
then any Claim subsequentty made arising out of such fact, circumstance or situation shall be deemed to have been made wilen
notice was first ~en to the Insurer.
C. All Cleima based upon or arising out of the same Wrongful Act or any Related Wrongful Acts, or one or more series of any
similar, repeated or continuous Wrongful Act or Relsted Wrongful Acta, shaR be considered e single Claim. Each Claim shan be
deemed to be first made at the eariiest of the following times:
1. when the earliest Claim ar~ng out of such Wrongful Act or Related Wrongful Acts i6 first made, 01
2. wilen notice pursuant to section VII. B. of a fact, circumstance or slluation giving rise to such Claim is given.
D. In addition to fumishing the nollce as provided in sections VII. A. and VII. B., the Insureds shal give the Insurer such infonnation
and cooperation as it may reasonably require and shall, as soon as practicable, fumish the Insurer wi1h copies of reporl8,
investigations, pleadings and other papers in connection therewith.
LP 9200 (05-99) Pege 5 01 7
The descfiplions in the headings of this Policy are solely tor convenience. and form no oart oltha IannI and oond~inn. nf ""v...",,
16K
6
AdmlrBllnsurance Company
VIII. Generel Conditions
A. Termination of Policy end Non-Renewal
1. This Policy shall terminate at the earliest of the Iollowing times:
a. upon the receipt by the Insu..r of wrillen notice 01 cancellation from the Named Insured;
b. upon expiration of the Policy Period as set forltl in ttem 2. of the Declarations;
c. at such othef time as may be agreed between the Named Insured arnj the Insu..r; or
d. 20 days alter receipt by the Named Inaured 01 the Insurer's written notice of cancellation lor nOll-payment of
premium.
2. The Insurer may not cancel this Policy except lor non-payment of any premium when due.
3. If this Policy is canceUed by the Named Insured, the Insum shall relaln the customary short rate proportion of the
premilJm herein. Payment or tender of any unearned premium by the Insurer sha. not be a condition precedent to the
elfectiveness of cancellation, but such payment shall be made as soon as practiceble.
4. If the Insurer decides not to renew this Policy, the Insurer shall provide written notice to the N8I1Ied IlIIured etleast 60
days prior to the end of the Policy Period. The notice shall Include the resson for such non-renewal.
5. Any notices 10 be given to the Named Insured under this seclion shall be provided 10 the N8I1Ied Insured at the last
known principal address and to its insurance agent or broker. The meiling by certified mail of such notice shall be
suffic;;enl.
B. Proposal
The Propoeal is the basis 01 this Policy and is incorporated in and constitutes a part of this Policy, A copy of the Proposal FORn is
anached hereto. MY materials submitted with the Proposal Form shall be maintained on file w"h the Insurer and shall be deemed to
be alleched hereto, as ij physically attached. It is agreed by the Insur8d tIlat tile statements in the Proposal are their
represenlations, that they are material and lhatthis Policy is issued in reliance upon the trutll of such representations.
C. Action Against the Insurer
No action shall lie against the Insurer unless, as a condition precedenttherelO, there shall have been full compliance with all of the
tefms of this Policy, nor until tile amount of tile Insureds' obligetion to pay shall have been finally determined eitller by judgment
against tile Insureda alter actual trial or by written agreement of the Insureds, tile claimant and the Insu..r.
My person or organization or tile legal representative tIlereof who has secured such judgment or written agreemenl w1t1l the Insurer
shalltherealter be en1itled to recoVef under this Policy to the extent 01 the inSlllSnce afforded by this Policy. No person or organization
shall have any right under this Policy to join the Insurer as party to any action against the Insureds 10 determine the Insu..ds'
liability, nor shall the Insurer be impleaded by the Insureds or their legal representatives, Bankruptcy or insolvency of the Insureds
or of their estates shall not retieve the Insurer of any o. "s obligations hereunder.
D. Firm Changes
If Wing the Policy Ferioclthere is a 50 percent or greater change in the Named IlllIured's total lawyer population, then the Named
Insured shall give the Insurer written notice of such changes, as soon as practicable, but in no event later than 60 deys alter the
effective date of such change; provided, however, thai this provision shall not apply K the Named Insured had less than 6 lawyers
who met the definition oIllllIured at the Policy inception date. The Insured shall accept any premium adjustmeot or coverege revisions
which the Insurer may require.
E. Subrogation
In the event 01 any payment under this Policy, the Inaurer shall be subrogated to tile extent of such payment to a1lthelnsul'lds'
rights of recovery thereof. and the Insu..ds shall execute all papBfs required arnj shall do everything thet may be necessary to
secure such rights including the execution of such documents necessary to enable the Insurer to effectively bring su~ In the name of
the Insureds,
LP 9200 (05-99) Page 6 o. 7
The descriotions in the headinos of this PoIicv are solelv for convenience. and fORn no Dart of the terms and conditions of coveraqe.
16K 6
Admiral Insurance Company
F. Assignment
This Policy and any and all rights hereunder are not assignable without the written consent of the Insurer.
G. Entire Agreement
By acceptance of this Policy, the Insured. and the Insurer agree that 1I1is Policy (including the Proposal) and any written
endorsements an&ched hereto constitute the entire agreement between the parties.
H. Representation by Named Insured
II is agreed thai the Nemed InlUred shall acl on behall of alllnSUM. with respect to the giving of any notices under sections VII. A.
and VII. B., or giving and receiving any notices under section VIII. A., the payment of premiums and the receiving 01 any return
premiums that may become due under this Policy, 1I1e receipt and acceptance of any endorsements issued to form a part of this
Policy and the exercising or declining to exercis& any right to an Extended Reporting Period.
I. Coverage Territory
This Policy only applies to a Wrongful Act taking place anywhere in 1I1e wofId, but only II the Claim is made and su~ is brought
against the Insured within the United States of America, lis terrllorles or possessions.
In wibless whereof, the Insurer has caused this Policy to be signed by its President and Chief Executive Onicer and Secretary, but this
Policy aha' nol be valid unless countersigned on the Declarations Page by a duly authorized representative of 1I1e Insurer.
~s.~
~ ~~#~
President and Chief Ex""utive Officer
S"",""'I)'
LP 9200 (05-99) Page 7 of 7
The descriptions in 1I1e headinas of 1I1is Policv are solelv lor convenience. and form no no" of 1M IArmA .nd r.nnd~;"n. nf mII...n.
11/21/2008 15:54 Lutgert InSurance
(FAX)2392625360
16K
P~~17
6
,t
,
. ~ ~.
Admiral Insurance Company
1256 CaIdMll Road, Ch8ny HW, NJ 08034 Proposal Form
Lawyers' Professional Liability Insurance
CLAIMS MADE WARNING FOR APPUCATION
THIS PROPOSAL FORM IS FOR A CLAIMS MADE AND REPORTED POLICY, RELATING TO CLAIMS MADE AGAINST
THE INSUREDS DURING THE POLICY PERIOD, THE AUTOMATIC EXTENDED REPORTING PERIOD OR THE
PURCHASED EXTENDED REPORTING PERIOD. IF APPUCABLE.
Whenever printed In this Proposal Form, the terms In boldlaolllype shan ha.e the same meanillgs as indicated Ir1lhe Policy. ThIs P!Ilposal Fonn is
10 bs completed wiIh respect to the!l!!l!!! Appl1conl Finn.
NameolNJpUcantFum &r~j;ll;lt 'Pf-~~ 8 trDI.(})\.,1>.~,
Addle.. &5'~1 1] j,lIl'~',!,tvD Dv, Js'0I . .
City ~'Mx'~~~ rlfrt7flt, Ci'.:i'atL ZlpCtlde;lJAOPJ
Phone: ~,... _ FIX: PtM, 5j~ ,..
TIle ponon designated as agent of !he Applicant Fim and of ai Insureds 10 receive any and all notlc:es loin the In...rer or their suthorize<l
rePlllsen~~Tml';!'~'F.~ce: ofl.t QMII\Y1-l.~ jlOl~~' Cl1t\\..
Neme ~ TIUe E-m AdillUs
General Information
2.
3,
ChecII the box Ihal describes the above AppIieont FInn, [J liTited U8bl1lly CorporeUon [J LImited Uabllly P_hlp
o Par1nershlp CJ Professional AsscclaJion If ProfesSIOnal CorporatIon 0 Sole P!IlpMlor
If you are a soIe proprietor, provide !he name 01 the Iawyer(s) who would bs responsible for your aftalrs If you
""Ill abSent for an extended period of Ume ~.e" vocation, mne,s, ole).
Name:
Address (City, Slate, ZIp):
Telephone Number.
Date Commented Business: ---rr;t;lIlS
Ust the namea ol all Predeceesor Flrma to whose assets and liabilities the Appllcanl Firm Is the majorlty successo~ Indudo!he
d redtc Fi
1.
allllho P essor Irma were established and Ihe date, of ..-ner,
Name of Predel*lor Firm Date Establs~ed IlaIe of Moraer
'.
Princinal orrICO Bronch Office ral Branch 0IIic0 !ill Branell Office leI
Total numbet 0118WVOlll I,
Peral....a1. or low c1erl<s
Other rJericaUsuooort ..e" . 1'3
4.
Indicele Ihelol8l number of "",,,onnel by locallon
Ctlmplele!he Indlvlduallnsured Supplemental Fonn ILPL 9600).
5. Does ony lawyer In !he AppRcant Firm seMI e. a director, officer, tcu,1oe or partner of, or e..rd.e any fiduciary control
over,"'y organ1zalton other than the Applicant Firm?
~I' [J No
It "Yes", comolete the following.
Is Organlzallon I,!h. Parcenlage of
Name of Lawyer Name of Organization For Profit or Qrgan\Zstion posiUon Held Percentage of Tol8I Fum
Non-Prolit? a Finn CUenl? bv La- Eftultv Held Bill.....
-~. .. .J j. , OVesONo
CJ Ves [J No
[J V.. 0 No
Page 1 of5
LPL 95115 (rev. 05-(4)
11/21/2008 15:55 Lutgert Insurance
(FAX)2392825360
Admiral Insurance Company
Nature of Practice
16K
P ,003101 7
6
6. Inlic8lB the gIIlIls Income Icr the applicable fisCal year (grass income means all sums billed lD clIenb forservlClll
101lCIered, or II your /l4lPIlc8nt FInn deals prtmer1ly with conllngency 100 COllIS, your average annuel g..... nlVOnue):
AclUslforlmmsdlalepBSlfiscalyear. ~I fitb~'r,{(.,(1-~- u;"'n~#.h.
7, IndlcalO the peroentage 01 gRl" income for the posl fist:lll year derived tmm the Icllowlng areas 01 prectlce: ,;<ut- ~
Area of Pnctlce l Area 01 PToctlce . y.
AdmInlslra1ive Law. General _% Insurance Coverage . _%
Adm1rallylMaritlme _'II IlISUrance Delense UUgal10n _%
AntilruslfTradeRegulalion _'II Inlemaliol1slLBw _%
ArllItra1IonIMedlation _'AI LBbor ReloUon.. Labor _%
BanlallptGy _% Labor RellllIon.. Management _%
B8I1kBlSaving. end Loana _% Utigation (Clvi~ _%
CM! RIghts and DIscI1mination _% Local Government Law - without bonda _%
CoIlactionlRepo&Sll6s1on _ _ % MOI!JIlra end Acqul.lllona _%
CommtltlalLaw _'II on and Gas _%
Comm.n:lal L1Ugallon _ Delense . _""Pension end Employee Benefits - _%
Commen:leIUllgallon. Plaintiff _"" PersonallnjJTy and NogIlgenc;e LlIgIlllon. OIlfenae --'"
Communlca1lon. (FCC) ~% P....nallnjury and Negl1gence UUgalIon - PIaIntift _%
eonstnn:llonLaw _% PubKeContracll.BW _%
CopytigtM'lIanlITrademerk _ _ % Pubic UUlIti.. - %
CorporalcOfllanlzatlonlFonnation _. ,_% Real Property-Con'/llY8l1ce -""
ClImlnal Law _ % Real Properly. oOV81opmenl -""
Entertalnment/Spoltl- with Money Management _II Real Property - l1lla examination -""
EnlollelnmenUSports _ without Money Man"llement _'II Soou~UOB Law -Indueling municipal bondS - %
EnvilOOmental Law _"" Taxation. OpinionS _%
Estale. Trosland Probale _ _ % Taxation - Prep8llllion - %
Family Law _% Workera' Compensallon UtIgallon. Plalntftl -'"
General Corporate/Busness _ % Workers' Compensation U\lgation . Defense -'"
Healll":",,, _" Olher(lisl); _%
ImmIgratkln and NaIunIIIzation _'" _'10
TOTAL ,..., 100""
8. Indicate the perI:8Iltage of the Applcan\ FI!1T1'1l plaintlfl cases that sre dass ac;tlons sulls. .J...!'"
General Policy and Procedures
g. O<x:l<e\ and Calendar ProcedUlSS;
lal Does the ApprlC8nt Finn maintain a planned dockol conllOl.ysleln and procedUre with atlo..t2lndopllndent dale
conllO~?
(b) No the docket conlrol.ystem(.) and the Pl"cedure compulertzed?
10. Buslnoss Proceduras:
(a) 00..1110 Applicant Finn use engagemanlldlsengagemonUOOlHlll!logement leU....?
(b) Does the App1loant FInn mairrtain a system lD avoid conll1cls of Inleresl?
(e) Isll1a conflicts syotem compuleflZlld?
(d) How many suI\s for coDection of toes havo been filed by the AppI1canl Film dUring tIIo past 2 yea",?
[e) How many lawyera of the Applicant FIrm have partldpaled In fo!m81 conllnulng legal oduca1lOn programa. of !It
least 7 hours. duIing theles! year? .
(~ Does !he Applicant Finn sIlare oftlce space, elCJl8nsos, c...., or I9t1llrhaed with any other lnd1vldu'" 01 counael.
partnerslllp. firm, or organIZatIon? II "Yos', pmIde. on saparate attachment, Ihe nama 01 the enlily(las).
LPL 9505 (rev. 05-04)
m'YIISOI'lo
tEl Yos ONa
'YeslJNo
I!{yes ONo
IitYaslJ No
o
I&!-
eyes IZf No
Page 2 015
16K
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12J0912008 08:45 Lutgert Irmrance
(FAX)2392625360
P.002I006
Admiral Insurance Company
Prior Insurance Information
11. HIS lhe Applicllnt Finn or Bny pledoces.or in bu.l..... _ had lIIIlnSUlllr dedln., cancel, refuse III renew, rescind. or
8Cll1l!l1 only an speclellerms, lilY f...ienal Uablnty lo_? (Nal appllcabl. In Muauri)
I ~es',pIlI\Ildell\ld.taIIs. . .
vi
121 '1..0 No
12. Has the Applic:lml Film or any predecessor In business ever puR:h..ad an 'Exlended Reparllng PerIOd" or 'DIscovery
POIiad' under. prior poney which exl8nded 111. cI&ImS repOl1lng ported of Ill. poUcy following cancelleUon Dr non-
/lIf18WIlI?
If 'Y.s', pl\lVlde iuD d.taIs.
tJ v..1Zf No
, 3. US! the pralessianBlDebDlty Insurence plIldulsed by the AppUcant FIrm far .ach of the pest 5 years.
InsUI8I liml of Uablllly Deducllble PremIum
II
.,
..
..
F""" To
M f(r r
r ,
,
. , , ,
l.r .r r
.. ' , .
Ij(YeslJ No
,I
.'
"
14. Daes Ule AppIC;JI\I Finn's "l'"'rt Dr, 'Jr~,...ntly expired poley contain a relllledivB date?
. If"'(....Indic:al8th.dale:~(MoIOaYf(rl
Utigalion and Claim Information
15. Has lilY lawyer In the Appncant Arm ever been refused admIsSIon 10 prac1lCe, disbarred, or ,",.panded from prectice,
reprtmlllded. sanctioned. or dlsc:iplln.d by any ccurt or adrmnlslralive ageney'l
If 'V.!t, provide lun details.
CYostiNo
16. During lhe I.., 5 ye8lS. has any profussIonal IIabllty el8ln1 or sui been m.de ageln$t the AppIIcalIt Finn. or any
predeceSSOr In busilees, or any pest or pr_nt liMy." in the ApplIcant Finn?
K "'(os', provId.IuU delaJls an the CI.im Ilncid.nI Supplemental Fonn (lPl9610).
17. Is the Applcanl FI1l1 or.ny lawyer In the Applicant Finn aware of any fact. cIrcUmstance, oralluatk>n thel might resu~ In
any pmleaslonalllablllty claim or suit "!lail}~~ Applcant Finn, or eny pre~ecassor in busln.ss. or any pest or present 0 Y Il!I" N
lawyell In theApplcsnt Firm? ~(~~ c-(ttf(t,?L\4\V~~~ ~ T.~J~il.d IS 0
W'Y.s', provide ruR d.tan. on the ClaIm IInddenl Supplemenlal Form (lPl9B10). rJY.. ~ ~ .
IT IS UNDERSTOOD AND AGREED THAT THE INSURER SHAl.L NOT BE LIABLE TO MAKE AIf'( pAltMENT FOR
DAMAGES OR CLAIMS EXPENSE IN CONNECTION WITH ANY CLAIM MADE AGAINST Atf( INSURED BASED
UPON, ARISING OUT OF, DIRECTLY OR INDIRECTLY RESULTING FROM OR IN CONSEQUENCE OF, OR IN ANY
WAY INVOLVING ANY PROFESSIONAl. LIABILITY CLAIM OR SUIT, FACT, CIRCUMSTANCE,OR SITUATlON SET
FORTH IN RESPONSE TO QUESTIONS 16. OR 17.
~YesONo
pag.3af5
LPl9505 (rev. 05-04)
11/2112006 15:56 Lutgert Insuranc:e
(FAX)2392625360
16K
P.0051017
6
Admlralll1llurance Company
Please Read Carefully
The undmlgn8d ecling on behalf of the Applcanl Finn BIld ell pelSOns pIOpDlled for II1s InllUrance dBdlll1ls that Ihe llaIemenls set forth heteln are
tNe snd CO"ed and ilia! tnorough ellorts have been made 10 obtain suflIclsnllnlormdon to ladlltale the PTOPsr and accuJlIle complellon of this
Proposal Form.
The undersigned agrees that llIe par1lculalS IlI1d stalements COfltalned In the Proposal Foml and IlI1Y matellaI suIlmItted he~ are their
repreaenlBtlons end lhal \hey 8IIl mal8riBl end IIIlI the bBSls ollhe In&llrance oontrad. The undll1fgned Ivrlher agree that the Proposal Form shaH
be considered ettachBd to and a part 01 the Polley. Any matelialsubmlltBd with the Proposal Form shall be malntsinod onll1e with Il1llnsurer and
shall be deemed to be attached hIlreto as If physically altached.
ttlstul1harapedlllal:
. W any signlftcant chlll9a In tho condition 01 the applicant Is dlscovel8d batwoen the date of this Proposal Fonn and the Policy Incepllon dale.
..alch would nmderlhls Proposel Form Inaa:uralll or IncOmplale. notice oIsuell changa wig belllported In 'lIIttIng to Ihe Insurer Immediately;
. any Policy, If loSuad. wiD be In rellence upon the IlUth of &lid! repr88ontallcn.:
. this Proposal Fonn haS been allnpleled as mpeds thl!!!llil! Applicant Firm:
. IIlld lIle signing of this Proposal Form _ not bind the unde!SlgnBd to purchase the 111&II18008.
~ . TIlIa: e...t'i~
L Partner,OWnar~orPJincill8l
I R\_.....CS ,. c;...."I.:O"-'" IDaIBd: \)-"lo-C::>"-
Print Nams
This AdrnlrallnsWllllC8 Company Proposal Fonn, Including any mste~alsubmlned herawlth, shall be hald In slrtct8Sl conlilance.
A. POLICY CA.NNOT BE ISSUED UNLESS THE PROPOSA.L FORM 15 PROPERLY SIGNED AND DA.TED.
P1aasa aubm1l this Proposal Form Including approprlale dacumenla\iOn to:
~ MonItor LIability Managers, Inc., 2650 West Golf Road, SUIte BOO, Rol1lng Maadows. IL 60008-4039
~~dv' IOated: ~
.~
~~) .~NSENUMBER
I
I
Page 4 015
LPL 9505 (rev. 0&-04)
.-...,.,,-~._-~....._--~--
11/21/2008 15:57 Lutgert InSUrance
(FAl()2392825360
16K
P.OO6I017
6
Admlrallnsuranoe Company
!lWICE TO COLORADO APPLICANTS: rr IS UNLAWFUL TO IOIOWINGL Y PROVIDE FALSE, INCOIIPIm. OR MISLEADING FACTS OR
INFORMATION TO AN INSURANCE COMPANY FOR THE PURPOse OF DEFRAUDING OR ATTEMPTING TO DIfRAUD 'llIE COMPANY,
PENAlTIES MAY INCLUDE IMPRISONMENT, FINES, DENIAL OF INSURANCE. AND CML DAMAGES. NfY INSURANCE COIlPANY OR
AGENT OF AN INSURANCE COMPANY WHO KNOWlNGL Y PROVIDES fALSE, INCOMPLETE, OR MISLEADING FACTS OR INFORMAllON
TO A POLICY HOLDER OR CLAIMANT fOR THE P\JRPOSE OF DEFRAUDING OR ATTEMPTING TO DEFRAUD 'llIE POLICY HOLDER OR
CLAlMAK1' WITH REGARD TO A SETTLEMENT OR AWARD PAYABLE FROM INSURANCE PROCEEDS SHALL BE REPORTBl TO THE
COLORADO DIVISION OF INSURANCE WITHIN THE DEPARTMENT OF REGULATORY AGENCIES.
NOTICE TO NEW YORl( APPLICANTS: AllY PERSON WHO KNOWINGLY AND WITH INTENT TO DEFRAUD ANY INSURANCE COMPANY
OR OTHER PERSON FUS AN APPLICATION FOR INSURANCE OR STATEMENT OF CLAIM CONTAINING ANY MATERIALLY FALSE
INFORMATlON. OR CONCEALS FOR THE PURPOSE OF MISLEADING, INFORMATION CONCERNING ANY FACT IIATERIAL TIlERETO,
COMMITS A FRAUDULENT INSURANCE ACT, WHICH IS A CRIME, AND SHALL ALSO BE SUBJECT TO A CIVIL PENALTY NOT TO
exCEED FIVE THOUSAND DOLLARS AND THE STATED VALUE OF THE CLAIM FOR EACH SUCH VIOLATION.
NOTICE TO NeW MEXICO. PENNSYLVANIA APPLICANTS: ANY PERSON WHO KNOWINGLY AIID WITH INTENT TO DEFRAUD ANY
INSURANCE COMPANY OR OTHER PERSON FILES AN APPLICATION FOR INSURANCE OR STATEMENT OF CLAIIII CONTAINING ANY
MATERIALLY FALSE INFORMAllON OR CONCEALS FOR THE PURPose OF MlSLEAOING, INFORMAllON CONCERIING ANY FACT
MATERIAL THERETO COMMITS A FRAUDULENT INSURANCE ACT, WHICH IS A CRINE AND SUBJECTS SUCH PERSON TO CRIMINAL
AND CIVIL PENALTIES.
NOllCE TO APPLICANTS OF KENTUCKY: ANY PERSON WHO KNOWINGLY, AlID Wl'lllINTENT TO 1ltJURE, DEFRAUDS OR DECEIVES
ANY INSURER OR OTHER PERSON FLES AN APPLlCAllON FOR INSURANCE OR STATEMENT OF CLAIM FOR THE PROCEEDS OF AN
INSllRANCE POLICY CONTAINING AllY FALSE, INCOMPLETE. OR MISLEADING INFORMATIOll OR CONCEALS FOR THE PURPOSE OF
MISLEADING INFORMATION CONCERIING ANY FACT MATERIAL THERETO, IS GUILTY OF A CRIME AND IS SUBJECT TO CRIM\NAL
AlID CML PENALTIES.
NOTICE TO APPLICANTS OF FLORIDA. MINNeSOTA NEW JERSEY. OHIO. AND OKLAHOMA: NfY PI!RSON WHO KtlOWINGLY, AlID
WITH INTENT TO INJURE, DEFRAUDS OR DECEIVES ANY INSURER OR OTHER PERSON FILES All APPLICATION FOR INSURANCI: OR
STATEMI!NT Of CLAIM fOR THE PROCEEDS OF AN INSURANCE POLICY CONTAINING ANY FALSE, INCOMPLErE. OR MISLEADtlG
INFORMATION OR CONCEALS FOR'llIE PURPOSE OF MISLEADING INFORMATION CONCERN1IlG ANY FACT MATERIAL THERETO,IS
GUILTY OF A FELONY AlID IS SUBJECT TO CRIMINAL AND CIVIL PENALTIES.
NOTICE TO DISTRICT OF COLUMBIA. MASSACHUSETTS. TENNESSEe. AND VIRGINIA APPLICANTS: IT IS A CRIME TO I<NOWIIGL Y
PROVIDE FALSE, INCOMPLETE OR MISLEADING INFORMATION TO AN INSURANCE COMPANY FOR THE puRl'OSl: OF OEFllAlIDlNO
THE COMPANY. PENALTIES INCLUDE IMPRISONMENT, FINES AND DENIAL OF INSURANCE BENEFllS.
NOTICE TO MAiNe APPLICANTS: rr IS A CRIME TO KIlOWINGL Y PROVIOE fALSE, INCOMPLETE OR MISLEADING INFORMATIllN TO AN
INSURANCE COMPANY FOR THE PURPOSE OF DefRAUDING THE COMPAlIY. PENALTIES INCLUDE IMPR1S~, FINES OR DENIAL
OF INSURANCE BENEFITS,
Page 5 of 5
LPL 9505 (rev, 05-04)
16K
6
11/21/2008 15:58 Lutgert Insurance
(FAX)2392625360
P,0071017
Admiral Insurance Company
1255 Caldwell Road. chtmy HI8. NJ 08034
LawYers' Professional liability Insurance
CLAIMS MADE WARNING FOR APPLICATION
THIS PROPOSAL FORM IS FOR A CLAIMS MADE AND REPORTED POLICY, RElATING TO CLAIMS MADE AGAINST
THE INSUREDS DURING THE POLICY PERIOD, THE AUTOMATIC EXTENDED REPORTING PERIOD OR THE
PURCHASED EXTENDED REPORiING PERIOD, IF APPliCABLE.
Indlvldualln8ured
supplemental Form
Name of Applicant FIrm
NANEALLOWNERS. PARTNERS, OFFlCERS,DIRECTORS. STOCKHOUlER EMPLOYEE&, AND EMPLOYED IAW'tER8.ATTACHAN
ADDITIllNALINIlMDUAL INSURED SUPPLEMENTAL FORM 1F1llEFIRM SIZE ~ 20,
DesigIWIIons: "0' Qftk;ers. Directors, lit Sh...holdel1 of 1Il0 Applicant Finn who are 1Ice"&8d I'"
"Po Partne" of a pOr1nO"hIp
"S" Sole I'1optlotor A.u.. IAJ
"E" Employed lawyers (must be empoyee 01 Applicant Fm) e'er; K1Wl
"C' 'Of Co\lllller attomoys for whom coverego i. desired ,J:-t-
,,.' Asooc\ate tor whom wverege Is desired
Do.lgno1lon lawyer'o
O,P.S.E,C AdmiRed 10 Yaarsl" Individual Member il Good S\lIldIng ~s':
lawVa(s Nome orA Bar MoIYr PractiCe Snocl01lv fol\oWlno Bar Assod8Iion s
1.
2-
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
lB.
11.
16.
19.
20.
I understand lIlat \he Informallon submKlad hareIn becomes e pert of the Appicant Flrm's Lawyers' professional UabI1l1y I'1oposal Form and Is
subjoot to 1I1a somo =tetlonO and condlllon..
I '50._ _ I ,011.: :;,.....~.....~.
S' naWl. of par1nor. Ownar. Dfllcer or Pnm:l I
~.. c",..r~ c:: ~ 1"...",,:)-- Doted: I) - 'i.o- 0,
Print Namo Pl.... submit \hla Propooal Form including approprlall! documenllltion 10:
Monl1or UabUly Man 0", Ine.. 2850 Well GonRDad, Suile 800, Roling MeadoWS, IL 60008-4039
Dated:
submIllad by (PRODUCER)
I
AGENT'S NAME (Please pmt Name H<<e)
LPl9600 (rev. 05-99)
I
AGENrS UCENSE NUMBER
Page 1 012
11/21/2008 15:58 Lutgert Insurance
(FAX)2392625360
lQJ(
6
Admlrallnsuranc;e Company
NOT~ TO cnt.llRADO APPLICANTS: IT IS UNLAWfUL TO KNOWINGLY PROVIDE FALSE, INCOMPLETE, OR MISLEADING FACTS OR
INFORMATION TO AN IN8URANCE COMPANY FOR THE PURPOSE OF DEfRAUDING OR AneMPTING TO IlEFRAlID THE COMPANY.
PEMALT1ES MAY INCLUDE IMPRISONMENT, FINES, DENIAL OF INSURANCE, AND CML DAMAGES. ANY INSURANCE COMPANY OR
AGENT OF AN INSURANCE COMPANY WHO KNOWING!. Y PRovnres FALSE, INCOMPLETE, OR MISLeADING FACml OR INFORllA11ON
TO A POLICY HOLDER OR CLAIMANT FOR THE PURPose OF DEFRAUDING OR AneMl'TlNtl TO Ill!FRAUD lHE POLICY HOlDER OR
CLAIMANT WITH REGARD TO A SETT\.EMENT OR AWARD PAYABLE FROM INSURANCE PROCEEDS SHALL BE REPORTED TO THE
COLORADO DMSlON OF INSURANCE WITHIN THE DEPARTMENT OF REOULATORY AGENCIES.
~OTlCE TO NEW YORK APPLICANTS: ANY PERSON WHO KNOWIKGL Y AND WITH INTENT TO DEFRAUD ANY INSURANCE COMPANY
OR OTHER PERSON FILES AN APPLICATION FOR INSURANCE OR STATEMENT OF CLAIM CONTAINING ANY MATERIALLY FALSE
INFORMATION, OR CONCEALS FOR THE PURPOSE OF MISLEADING. INFORtAATION CONCERNING ANY FACT MATERIAL THEREfO,
COMMITS A FRAUDUl.ENT INSURANCE ACT, WHICH IS A CRIME, AND SHALL ALSO BE SUBJECTTO A CIVn. PENALTY NOT TO EXCEED
FIVE THOUSAND DOLLARS AIID THE STATED VALUE OF THE CLAIM FOR ~CH SUCH VIOLATION.
1I0TlCE TO NEW MEXICO PENNSYLVANIA APFUCANTS: ANY PERSON WHO KNOWINGLY AND WITH INl'ENT 10 DEfRAUD ANY
INSURANCE COMPANY OR OTHER PERSON l'1LES AN APPLICATION FOR INSURANCE OR STATEMENT OF CLAIM CONTAINING ANY
MATERIALLY FALSE INFORMATION OR CONCEALS FOR 1llE PURPOSE OF IlISLEADING, INFORMATION CONCERNING ANY FACT
UATEJlIAL THEREfO COMMITS A FRAUDULENT INSURANCE ACT, WHICH IS A CRIME AND SUBJECTS SUCH PERSON TO CRlIlINAL
AND CML PENALTIES.
IlOTlCE TO APPUCANTS OF KENTUCKY: ANY PERSON WHO KNOWlNGL Y, AND WITH INTENT TO INJURI!, DEFRAUDS OR DECEIVES
ANY INSURER OR OTHER PERSON FILES AN APPLICATION FOR INSURANCE OR STATEMENT OF CLAIM FOR THE PROCEEDS OF AN
INSURANCE POLICY CONTAINING ANY FALSE, INCOMPLETE. OR MISL~D1NG INFORMATION OR CONCeALS FOR THE PURPOSE OF
MISLEADING INFORMATION CONCERIlING Atrf FACT MATERIAL llIERETO, IS GUILTY OF A CRIME AND IS SUBJECT TO CRNINAL AND
CML PENALTIES.
NOTICE 10 APPLICANTS OF FLORIDA. MiNNeSOTA. NEW JERSEY. 0111O. AND nKLAHOMA: ANY pERSON WHO KNOWINGLY, AND
WITH INTENT TO INJURE, DEFRAUDS OR DECEIVES ANY INSURER OR OTHER PERSON FlLES AN APPUCATION FOR IISU!WlCE OR
STATENENT OF CLAIM FOR THE PROCEEDS OF AN INSURANCE FOUCY CONTAININCl Attf FALSE, INCOMPLETE, OR MISI.I!ADIIG
INFORMATION OR CONCEALS FOR THE PURPOSE OF MISLEADING INFORMATION CONCERNIIlCl ANY FACT MATERIAL llIERETO,1S
GUILTY OF A FElONY AND IS SUBJECT TO CR1M1NAL AND CML PENALTIES.
NOTICE TO DISTRICT OF COLUMBIA. MASSACHusms, AND VIRGINIA APPLICANTS: IT IS A CRIME TO KNOWINGLY PROVIDE FALSE.
INCOMPLETE OR MISLEADING INFORMATION TO AN IIlSURANCE COMPANY FOR THE PURPOSE OF DEFRAUDING TItE COMPANY.
PENALTIES INCLUDE IMPRISONMENT, FINES AND DENIAL OF INSURANCE BENEFITS.
flOTICE TO MAINE APPUCANTS: IT IS A CRIME TO KllOWlNGL Y PROVIDE FALSE, INCOMPLETE OR M1SLEADINClINFORMATlON TO AN
INSURANCE COMPANY FOR THE PURPOSE OF DEFRAUDING THE COMPANY, PENALTIES INCLUDE IMPRISONMENT, FINES OR DENIAL
OF INSURANCE BENEFITS.
IPL 9600 (rev. OS.99)
Psge 2of2
16K 6
11/21/2008 15:59 Lutgert Insurance
(FAX)2392625360
P.OOBI017
Firm Name: Graol, Fridkio, Peanoo, Atbao & Crown, P.A.
Application Date: November 20, 2008
Addendum to Admlrallnsuraoce Company
Lawyers' Professional L1abUlty Iulurance AppJicatioo
Question 5: Attorneys who serve as a director, officer, employee, or other management capacity
for a past or present client:
For- or %
Non- FinD EqullY
Attornev O",Name Profit Client'l Position Held in On!:
Alban I. Education Foundation of Collier NP No I. Board Member N/A
County
2. Drug Free Collier NP No 2. Board Member 8<
Socrctarv
Budd Soo attached list.
Crown I. Sanlka Harbrecht Insurance Trust FP Yes l. Trustee N1A
2. GalY McFarlane Insurance Trost FP Yes 2. Trustee
3. Don Dian Insurance Trust FP Yes 3. Trustee
Fridkin 1. NapleS Area Chamber of NP No 1. Immediate put chalr N/A
Commm:e
2. Leadership CoDier Foundation NP No 2. Chair Bleet
3. PGCU Foundation NP No 3. Chalnnan Emeritus
4. PGCU Financing Corp. NP No 4. Secretary
5, Lee County Port Authority Special NP No S. Member
Management Comm.
Grant l. Economic Developmant Council of NP No 1. Board Member N/A
Collier Coonly, Inc. .
2. Southwest Florida Land NP No 2, Board Member
Preservation Trust Inc.
Pearson I, BstofLeoD'Andre. N/A All arc l. Curator N/A
2. Est of MBJjorie Lane linn 2. Per.onol Rep
3. Leroy 8< Helen Appellrrcv Trost clients 3. Trustee
dated 7123/97
4, Leroy L. Appel 8< Helen L. Appel 4. Trustee
IlTOv Trust Agt for the benclit of
Jessica Lee Cohco dated 11130198
S. !:.eroy L, Appel 8< Holco L. Appel S. Trust""
IITev Trust Agt for the benefit of
Nathan Felix Cobon dated 9/28/99
6. LIUT)' A. Thomas IlTev Trust Agt 6. Trustee
dated 10/26/00
7. Scott A. Ross Irrcv Trust Agt dBted 7. TI1lSlCe
4fl7/99
Strauss I. Est &; Trust of Joseph Fanok NIA I, Yes I. Co-PR &; Co-TrustIle N/A
2. ESt of James Wllliamson NIA 2. Yes 2, Trust Protector
3. Est of June Fanok NIA 3. Yes 3, Co-Pr'" Co-Trustee
4. Est of Jerry Verplank N/A 4. Yes 4. Co-PR
S. Est '" Trust of Phyllis Kay Hardy N/A S. Yes S. Co-Fiduciary
6. Est &. Trust of J. Ouy HOOVOl NIA 6. Yes 6. Co-fiduciary
7. Indiana Society of Soutbwcst FL NP 7. No 7, Board Member
8. McEachern Foundation (a private 8. No 8. Board Mamber
familv foundBtion)
11/21/2008 16:00 Lutgert Insurance
(FAX)2392625360
16K
P.Ol0/017
6
Errors & Omissions: David G. Budd
~me of Organization
Profit Status
Position Held
North Americe Investments, Inc. For.Profit Ives Asst Secretarv 0%
Flflh Avenue of NeDI.... Inc. For.Profit Ives Assl SecretarY 0%
Rlmaco Corn. dba Veraine For-Profit Ives Assl Secr&iliN- 0%
Gulf Enterori88S of Naoles, Inc, For-Profit Ives V1ce President 0%
GuW Horizon Investment Inc. For-Profit Ives V1cePresldenl 0%
Gulfsun Entemrises Inc. For.Profit Ives VP/Seci'et8N 0%
Home Port Revocable Trust u/a 12/17101 For-Profit es Trustee 0%
Mother Shlo, LLC For-Profit es Assl Meneaer 0%
KW pronertles LLC For.Pra11l es Assl Mana""r 0%
Mulrlands ProDSrties LLC For.prof~ es Ass!. Manaiiili 0%
Transaorter, LLC For-Proflt es Ass!. Manaaer 0%
West Coest Hanaan;, Inc. For -Profit ves VP/Secretarv 0%
Ubllam Pronmtles, Inc. For-Profit es VP/Secret8N 0%
Mammoth Mountain Prnnarlies, Inc. For-Profit as VP/Secretarv 0%
Piuta Procerlv. Inc. For.Profit ves VP/Secretarv 0%
Saba Avletion Inc. For-Profit ves VP/Secretarv 0%
Asoen Aviation, LLC For-Profit ves Assl Menaner 0%
Asoen HellcOriiers LLC For.Profit ves Ass!. Manaoer 0%
Snow mass Creek Ranch LlC For-Profit ves Ass!. Manener 0%
Low Tida Docklna, LLC For-Profit ves Assl Manaoer 0%
Hiah lide Oockina Com. For-Profit ves VP/Seerelarv 0%
Sea Coro. For-Profit ves VP/SecrelarV 0%
Rimaco Corn. For-Profit ves Assl SecretaN 0%
Erika Inc. For-Profit vas VP/Secretarv 0%
BS&T Ine: For-Profit vas Ass!. Secreterv 0%
Trover Brothers, Inc. For-Profit ves Assl SecretaiV 0%
Trover Brolhers Florida, Inc. For-Profit ves Assl Secretarv 0%
Volma, Inc. For-Profit Ives Initial Director 0%
Veroina, Inc. For-Proftl Ives Initial Director 0%
Dakota Blues, LLC For-Profit Ives Assl Secrela,rV 0%
Pull Moon Inc. For-Profit Ives VP/Secrelarv . 0%
Knew Moon, Inc. For-Profit Ives VP/Secrelarv 0%
Jobox LLC For-Profit Ives Assl Manaaer 0%
Shelslar LLC For-Profit Ives AsSl Manirier 0%
Dabudd, LLC For-Profit Ives Assl Mananer 0%
Seekv. LLC For-Profit Ives Ass!. Manaaer 0%
Rlckvmar LLC For-Profit Ives Assl Manaaer 0%
Delao, LLC For-Profit Ives Assl. Manaoer 0'10
JanDa, LLC For-Profit Ives Assl Meneaar 0%
Jewald, LLC For-Profit as Asst. Manaaar 0%
Kumon LLC For-Profit as Asst. Mananer 0'10
Kumoff, LLC For-Profit es Aset Manll~r 0%
W. Cross & Associates. LLC For-Profit es Assl SecretarY 0'10
G & M Avlalion LLC For-Profil ves Secretarv 0'10
Aarlcullural Risk Maniiiilment, LLC For-Profit es Asst. SecretarY 0'10
11/21/2008 16:00 Lutgert Inuance
(F AlO23926Z5360
16K
P.011/017
6
Question 7: Areas of Practice
,
Please be advised Ihat we do not maintain our billing and a\lcolUlting systems in a manner that
pemlltll us to Precisely break our billings down in the manner that you ~uire. Our definitions
of practice areas also do not exactly match yours. Some of the areas on your form are undefined
or not. included in your definitions. We have made subjective judgments in a way that is
designed: to conform to your criteria as much as possible given these limits,
Our practice areas as defined by our billing system are set out below.
Area of Practice Percent
BusmesslCOlllorate Transactions - Commercial Law 4.5
Estate PlllIIIIinll , Estate Administration' Trust' Probate 100ardianshin 32
General Renresentation 6
Litil!ation - Commercial/Civil 40
Real Estate - General' Transactional 15
Real Estate - Loans 2.5
TOTAL 100
QUestion 16: Claims or suits arising out of the rendition of legal services made against
attorney(s) during the past 5 years:
WiUiam Pearson - Sposit/Esta.te of Shirley Pearson
William Pearson - McNeillKauftnan
Jacqueline J. Buyze - Bevan vs. (not legal malpractice)
G. Helen Athan - Smal/wood v. Athan
RicharCl Grant - Signature Communities, Inc.
Richard Grant - Emergency Physicians of Naples
See attached summary of CItors and omission issues. We will provide a more detailed
explanation of these matters during the week ofNovernber 24,2008.
Question 17: Fact, circumstances, or situations that might result in any professional liability
claim or suit against the Firm, or any predecessor in business, or any past or present lawyers:
Richard C. Grant - Basil Street Partners. LLC
. Jeffrey D, Fridkin - Jacqueline BBr.lumian
Jerome M. Strauss - Trust of Phyllis Kay Hardy (not legal malpractice)
11/21/2008 16:01 Lutgert Insurance
(FAX)2392625360
16K
P.012/017
6
Firm Name: Grant, Frldkin, Pcarson, Atban & CroWD, P.A.
Application Date: November 200S
Admiral Insurance Company
Lawyers' Profe8Sional LIabIlIty Iosurance Application
IndivIdual Insured SlIpplemental Form
2008 List of Attorneys
-- D.";' Adml8Bd lD PIWdJ<e L'w,efl individual SpeclaJl)' .,."ber In GaocJ 811.ndIng
nl1ill<l FL.., VI> ofe. AIIOC(t)
fvy,W.1tIl1IeI1 A 11/96 21.1!1 UIIgOUDn FL,!-' TX, III
A'tIM, G. Helen 0 1118. 20 Rnl EIII1. LN, R1eIldrtg FL, GA, ABA
8ucId,DM'IcIG. C 12J1O '0 Co<po- FL, OH, ABA
CRMl1. Howard L. 0 11no '2 Ealalo PIe"''''' FL,MA
PfIdk1n:Jtffr1yD. 0 BI.. " Bullns.. Utlgeuon, Civil TliIl FL, MO, ABA.
OnNtt."k:hardC. 0 BIT, .. Real Estate, Corporato FL,ABA
Hllti'lgl. Cheryl L - 0 412000 0 Real !alate, CantnJeI n,MA
Loukonen, RtcMeI S. A 8/83 , UUgluon FL.MA
Penon. V\IiIIIIm M. 0 12186 2' WUa, TruSll & Est_. Fl, TX,ABA
SlRtUaa. Jerome M- e - 60 WIts, irusl3 a ElIaSd FI.,IN,AM
Tranc:ante, MJchUI T. A 0100 . ConvnIrdII LllIgatlon. Real Ellate/Tl1lntllCtfGnll n,MA
Wk:kendlln, D. Klllh 0 ,.., 17 Utfl'llUon FL.MA
WoocfI, Ctlrtstlll8 S. E 10101 ,. B\.CIIne.. & Tax PllMlng FL, 'IX
'(\'oQd1. Greoory N. 0 11/9. 23 COJrIrMIdaI UlIgedon FL, 'IX
lbt\ 6
11/2112008 16:01 Lutgert Insurance
(FAX)2392625360
P .0131017
"...", --'E" ,..'-,
1 I' ','
l,'1 to, , "'j\. t
._...1L ... olo..-..-.J
RICHARD C, GRANT
Boar<l Ccrtllled Rcall!sta1c Atlcmcy
239.51 U 000 ExI. 2002
rgrant@lfpec.eom
...... ..9Rf.>:l'IT, mD~!.~.~J'l!.~~ &. CR.Q~&.~:
5551lUdpwaod Drift, Sui,. ~1
NopIco, FIoricIa 34108-2719
Tcl239.SI4.1000
FIX 239~14.0377
www.JIPoc.com
ATTOFlNIYS AT LAW
November 3. 2008
Huntley A. Hornbeck, President
LUlgert Insurance
139S Panther Lane, Suite 100
Naples, FL 34109
R.: Grant, FrIdkln, Pearson, Athan & Crown, P.A.
Professional Liability Il18uranca
Dear Bud:
Attached is a summary of pending matters that have been or will be reported to our
current cmier Zurich Insurance Company. It may be provided to other pcitential carriers to
evaluate our furn. It bas been prepared in mostly generic terms to preserve confidentiality. It
should be treated as confidential.
Let me or JcffFridkin know if you need more information or if questions exist.
Very truly yours,
~
Richard C. Grant
RCGljw
Enclosure
00: Jeffrey D, Fridkin, Esq,
16K 6
11/21/2008 16:02 Lutgert InslI'ance
(F AK)2392625360
P.014/017
Grant, Frldkin, Pearson, Athan & CroWD, P.A. - Errors and Omission Issues
This summarizes and explains the claim reports we have made to our OE carrier, Zurich
Insurance, that an: now pending and other matters that could be the basis for future claims. This
summary explains the background and the status of all the matters involved. These matters are
quite untypica1. They have regrettably occurred in a short period of time. The matters involve
three of our shareholders: Richard C. Grant, Jeffrey D. Fridkin, and O. Helen Athan. They are
explained below,
SmaUwood LaDdscaping, IDe.
Smallwood Landscaping, Inc. and its sole shareholder, Joanne Smallwood, were clients of our
firm although not for general corporate matters ongoing. Rather we had periodically provided
counsel to her on disputed matters. III 2006 Ms. Smallwood found a buyer for the assets of the
company. Helen Athan in oW' finD was engaged to review, advise, and negotiate a letter of
intent, asset sale agreement and handle the closing, Ms. Smallwood claims that Ms. Atban failed
to take steps to protect her from these losses and to guard against the buyer closing down the
business thus depriving her of these benefits. She has sued our firm and Ms. Alban.
Shortly after the sale was closed Ms. Smallwood became embroiled in a dispute with the buyer
of the . business over her own performance and claims that she had misrepresented material
matters. As a result the buyer terminated her continued services and liquidated the business thus
deprivirig her of future compensation and an eamOlit payment for the business. That dispute
resulted in litigation between Ms. Smallwood and her buyer. It was settled between them a few
months ago. Ms, Smallwood contends that Ms. Athan failed to take steps to protect her from
this. We dispute this. It is our belief that her losses primarily resulted from her own failure of
perfonnance under continuing agreements she had with her buyer and! or misrepresentations she
made to her buyer.
In oui case a non binding court ordered arbitration was held in June 2008, This is standard
procedure. The proceedings were disorganized and the arbitrator appears to have become
confused.' The attorney assigned by Zurich to represent us in this matter had not expected to have
the arbitration occur at this time as he had filed a motion asking the court to defer it. The court
denied the motion. Po:; a consequence our attorney was not as well prepared for the arbitration as
hecouid or should have been, Ms. Smallwood's attorney presented an expert witness who had
reviewed the files and who testified in some detail why it was his opinion that Ms, Athan had
failed to properly represent Ms. SmaJIwood. Our attorney did not refute this as wen as it could
have been, The arbitrator ruled against us and entered an award of over $1,000,000 against our
finn and Ms. Atltan. We have determined to proceed to a full1riaI.
We lUld our counsel believe that it can be shown that the buyer's action was taken, and was
pelhaps justified, by our client's own action and the misrepresentations she made. We also
believe it can be shown that our client had adequate legal recourse to recover anything to which
sbe was entitled based on the docwuents executed at the closing other than the recovery of an
eamout payment since there was no later performance on which to base it. Curiously the
1112112008 16:03 Lutgen Inuance
(FAX)2392625380
16K 6
P.0151017
arbitrator rnIed that we were not liable for the loss of the earnout, but were liable for the loss of
salary as CEO.
We may bave'some exposure to the claim that we should have taken steps to insure payment of
the unpaid account payables, but those are in the $150,000 range.
Employment Contract Dispute
This client is a professional practice group. In 2007 it entered into negotiations with three
owner-members to withdraw from the group. Richard C. Grant acted as its counsel in drafting
and negctiating the terms of the documentation. There is a problem with the way in which a
clause in one of the documents is drafted that has resulted in our client being sued as a result. It
did not accurately state what was intended, The client representatives bad ample opportunity to
review. it and note the problem before it was executed, The client acknowledges that it shares
responsibility for the problem. A suit tiled by one of the withdrawing members bas recently
resulted in a judgment against our client. The basis for the judgment is the clause in question.
We have reached agreement with the client to share not more than fifty percent of any loss it
sustains.
Two other fonner members entered into similar contracts soon after the first one. The client
handled these itself, but used the same set of documents. It even made some revisions to the
clause in question. We continue to represent this client and have its confidence.
Condominium Warranty Case
This client owned a residential condominium unit which she bad purchased from a developer.
She encountered a serious blown insulation infestation that was as a result of construction defects
and engaged Jeffrey Fridkin In our firm to sue the developer for damages based on the provisions
of the Florida Condominium Act which mandate that all condominium units sold include certain
statutory warranties that a developer and the contractor are deemed to provide, The applicable
statute dOes not provide for the recovery of attorney fees by the prevailing parties.
The developer defended the suit aggressively. In its pleadings it demanded attorney fees if it
were the prevailing party. We did not move to strike this demand, but we did file an answer that
denied entitlement to attorney fees. The purchase contract for the unit contained a provision that
the prevailing party in any action "arising under" the contract would be entitled to recover
attorneys' fees. The contract expressly disclaimed any walTanties except those arising under
statute. The lawsuit we filed expressly claimed to be brought solely under the !llatute, and did
not mention or rely upon the contrllct,
As the suit progressed the court ordered non binding mandatory arbitration. The arbitrator ruled
against our client. As a result the client determined not to proceed with the case and to dismiss
it. Based on the theory of thc case, and the absence of statutory attorney fees to the prevailing
party, Mr. Fridkin advised the client that she would not be liable for the developer's attomeys'
fees. We dismissed the suit as desired by the client, with her decision to do so being in reliance
on our advice that she would not bear the burden of the developer's legal fees.
2
11/2112008 16:03 Lutgen Inuance
(fAX)23B2625360
16K 6
P.o161017
The developer then filed a motion to recover its and the contractor's attorneys fees. Both argued
that because the contract by which the client purchased the condominium uhit from it confirmed
the existence C?f the statutorily mandated wmanties and provided for recovery of attorney fees in
the event of a contractual dispute, that the dispute arose uncler the contract, not just based on a
statutory warranty, and that as a result both were entitled to recover attorney fees. Mr. Fridkin
has been told that the attorneys' fees being sought total about $250,000. However at this time no
bearing has been set to establisb an award of fees. The developer bas filed for bankruptcy, and
its attorneys have indicated that it is unsure if it will proceed with its claim for fees.
We believe the court erred in its ruling and that substantial authority and the theory of the case
will support a reversal on appeal. With Zuricb's concurrence, we have informed the client that a
bond will be posted pending appeal,' at no cost to the client, in the event a judgment for
attorneys' fees is entered in the case. We are defending our client against the fee claim at no cost
to the client. No formal claim by the client bas been made.
Developer IUlIQ and Claims
Our finn bas a substantial practice involving the provision of legal services to real estate
developers. Ia the past two years, as the real estate market has deteriorated, buyers of property
under construction have increasingly looked for ways to avoid closing on contraCts and ways in
which .to recover earnest money deposits. Generally this involves trying to find fault with th~
content, form, or substance of a real estate purc!tase agreement or with the process by which the
developer has engaged in selling its product. A common method of finding relief exists if the
developer has failed to comply with the Interstate Land Sales Full Disclosure Act (ILSA), If
applicable ILSA requires either federal registration or satisfying the requirements of one of many
exemptions. Failure to comply with ILSA rendm 1111 contracts voidable. We have one client
who has sustained some deposit losses because of ILSA issues that exist with the documents that
wo drafted and! or advice we gave.
We have another client who has encountered some legal issues with some legal documents that
we prepared for a mixed use condominium project including residential, marina and hotel
condominium units that could be a basis for a loss. The issues result because of the inclusion of
provisions in the documents that erroneously describe the size of certain condominium units and
that provide for limitations on the use of certain units by their owners. The unit size issues bear
on the vlllue of the units. The use limitations bear on whether the client can be said to have
imPosed such restrictions on its own or whether the restrictions can be said to be merely
implementing mechanisms to insure compliance with existing govommental use restrictions. If
found to.be the former it can be argued that the sale of the botel units is not in compliance with
existing guidelines for the sale of hotel condominium units and might be found to be a security
that would have required registration. We beHove that we properly advised the client on the
required content. There is an issue over our responsibility to insure that the client provided the
proper information.
3
-"-'--'~----"-"-'.."'''''''''''--
16K 6
11/21/2008 16:04 Lutgert Insurance
(fAX)2392625360
P.0171017
The iSSl!e for our firm is whether will focus on the reasonableness of our reliance on information
provided to us by the client and its other professionals that was included in the documents that
We drafted. These developer matters involve potentially substantial dollar sums.
Richard C, Grant is primarily responsible for our services tll these clients.
Summ.ary
As can be seen the Smallwood matter and the developer issues bave the potential to be large
exposures. Tbe convergence of all these matters at once is unfortwlate, but not indicative of an
underlying failure or systematic problem with our law firm competently practicing law.
Certainly the developer matters would not likely have arisen but for the deteriomed real estate
mllIket and the problems of the financial markets. But that is not relevant. Nonetheless we do
not believe any of these matters, or the convergence of them, is an indiClltion that our law firm is
a bad insurance risk, We maintain and manage a good practice. We do it carefully,
The three lawyers involved in these matters have practiced respectively for 35. 25, and 20 years.
None bas ever had a malpractice claim prior to these matters. All three enjoy A V ratings from
Martindale Hubbell and have been recognized by peers by inclusion in Best Lawyers of
America. Mr. Fridkin and Mr. Grant have been listed as Super Lawyers and Mr. Orant has been
listed among the Florida Legal Elite. Mr, Orant was recently advised that he has been selected as
the singulllI best lawyer real estate lawyer of the year for 2009 in the Ft, Myers- Naples area.
We have been insured by Zurich since OUI inception on January 1. 1995. Zurich bas never been
required to pay any claim or expense on OUI behalf until we exceeded our fifty thousand dollar
(S50,000) deductible for 2008 on the Smallwood matter in the summer of 2008.
We practice law in a collaborative and team approach. Most advice, counsel, and decision
making concemmg the handling of legal matters is done collaboratively involving more than one
lawyer to guard against oversights or error. The issues presented by each of these matters are
different. They represent isolated situations. They are not repetitive, nor indicative that they are
likely to be repeated.
Our firm enjoys a very good reputation for results, quality legal work, and client service. That
reputation has been earned and is deserved as is indicated by the accolades described above. It
should also ~ noted that, except for Ms. Smallwood, all clients involved in these matters
continue to have confidence in and use our law finn.
Grant, Fridkin, Pearson, Athan & Crown, P.A.
November 3, 2008
4
16K 6
12/17/2008 10:37 Lutgert Insurance
(FAX)2392625360
P.0041017
Agency Marketing Services
December 16,2008
Page 2
other statutory requirements simply require that we better scrutinize documents
that we draft and pay better attention to the application of applicable laws that
bear on those documents and contracts. All atlomeYs involved'in the firm are
painfully aware of the problems that exist in not doing so. I believe adequate
procedures and steps exist to guard against tbis occurring in the future, Lawyers
in our firm work with other lawyers in our finD on most matters, consult
regularly, and ask each other to review the other's work where there an:
significant issues and concenis. We use this process to guard against errors and
oversights,
With respect to the matter in which our fmn is involved in litigation with a fonner
client, a good'dea1 ofwbat has resulted from it could have been avoided by having
prepared an engagement letter with that client, baving better documented advice
that was given to that client, and confmning in writing information that the client
gave us and risks that the client accepted and of which the client was aware. I do
not believe something like this will reoccur.
If you have further questions or need more information please let me know.
Very truly yours,
~
Ricbard C, Grant
For the Firm
RCO/jw
EnclostueS
1211712008 10:44 \.utgert Insurance
(FAX)239262S360
1.QJ\
6
Lawyers ProCessional Liability Insurance Policy
Dedantlon
Tb!s II I CIIiaI!I Made IIId Reported Policy. PIo... ",vl.w tho Polley cuotUIly.
Tho policy iI IIIlIi10cI '" liability for only tho.. c...... thaI.... ftrot IDlde llaiast tho lnlIured llIId reporll:d '" the C.IDJIUJ duriIIa tho
PDIIcy Period,
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PoIicyNUlIIbcr. r..r. 1.74&10-12
~.fNUnUxr. LPL 1674'60-11
1_1. hIIurc4 by tbo IIA>Ck c:ompoay below aud ImeIuofter ClI10cI the COlllplUl)'
AllBlt%CWI lIVUAII'nIB . I.:ru:D.I'ft' D1SV11A11C1l CQHP~
I..... 2. Named lOIlIIOd IIld Mailing Addzess:
GJIAII'r, ramJtnt, JDRSCH'.
A~ . CIOMR. P.A.
5551 llDlClBllOOD DIUVB
IVn'Il 501
IrA1'LJI8 CO:r.L%B1l
'L 34101
Producer:
AGIIlIICY IIIUlD'1'DlllI URVZCJl8. DlI: . II'L
P.o. _ .7211
St. peee ....b. .L 3373'-7211
1_3. PoIlcyPorlod: JI'ruu 01-07..2008 To. 01.07...-200'
12:01 IIDlS-.m 'TIme at tho.- of tho NAMED lNllUlU!D.........lbeVC.
II.... 4. LImIt.f LlablIity
!!lob C1Jim
AgIcpIll
1_ 5. Deductible
S 5,000,000
. S 5.000.000
S 50,000
Item'- PRmium S 89. COP . 00 I'lIc.
aOGe 'lOA lIIuq...cy 1.041.1C 200. nGA Re!ll11u
IlelD 7. 1'000000AllIChod Illssua'ncc
SEa A TIACllED SCIII!DULl! OF FORMS AND I!NDORSI!MIlNTS
.,C.O,
1.110.54
T.lephone Rep01'liDg far All Claims
Clllto Report. Claim
1-800-987-3373
By ICCllpllllCO ol'lhiI polIcy lb. ....ured agn:c:a dlallllc IlItemcD1s in lb. docIanIlcmo lUId th. "I'P1i..ti08 aad IUl)' .~ boRlo
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CoanIlllllpd at:
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12/28/07
Issue Dato
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Date
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FLORIDA-EXCESS LIABILITY POLICY
DECLARATIONS
Landmark American Insurance Company
(All OtdahomB Stodf Co.)
(hereinafter called "the Company')
EXECUTIVE OFFICES: 945 East Paces Ferry Road, Sufte 1800, Atlanta, GA 30326-1160
Policy Number; LHZ720235 RENEWAL OF: NEW
Named Insured and Mailing Address: Producer Name;
GRANT FRIDKIN PEARSON ATHAN AND CROWN PA
5551 RIDGEWOOD DRIVE
SUITE 501
NAPLES, FL 34108
Polley Period; From; 01101109 To; 01/01110 "12:01 A.M.Stl.d.-dTIm..,.h.Nomod I..u"'dedd"'........edherel..
IN CONSIDERATION OF THE PAYMENT OF THE PREMIUM, IN RELIANCE UPON THE STATEMENTS HEREIN OR
ATTACHED HERETO, AND SUBJECT TO ALL TERMS OF THIS POLICY, THE COMPANY AGREES WITH THE NAMED
INSURED AS FOLLOWS:
1. PROFESSIONAL SERVICES: Law Firm
2, PRIMARY INSURANCE:
PrlmaN Carrieres}
Admiral Insurance Company
Pollcv Number's'
LPL 1674660-12
Policv Period(al
0110112009 - 01/01/2010
3. DESCRIPTION OF PRIMARY INSURANCE:
Limits of L1abllltv
$2,000,000 per claim and aggregate
Retroactive Oat.
TBD
TVMA of CoveraOG
Lawyers Professional Liability
4. DESCRIPTION OF EXCESS INSURANCE;
Llml.s of Liabilitv
Retroactive Date
$ 3,000,000.00
$ 3,000,000,00
5. PREMIUM;
$ 45,000.00
Each Claim
Aggregate LImit
01/01/1995
TVDaS of Coveraae
Excess Professional Liability
Coverage Form Claims Mada Basis
Not Subject to Audit
Filing Fee: $35.00
Surplus Lines Tax: $2,251.75
Stamping Fee: $45.04
FHCF: $450.35
A Hurricane CAT Fund Emergency Assessment equal to 1% of the Florida premium is applicable.
FORM(S) AND ENDORSEMENT(S) MADE A PART OF THIS POLICY AT TIME OF ISSUE:
See attached forms list.
RSG 50018 0607
THESE DECLARATIONS TOGETHER WITH A SIGNED COPY OF THE NAMED INSURED'S APPLICATION FOR THIS
POLICY, COVERAGE FORM(S), FORMS AND ENDORSEMENTS, ISSUED TO FORM A PART THEREOF, COMPLETE THE
ABOVE NUMBERED POLICY.
01105/2009 By: ;/-."alJ.,;..
Date llllllPW3 LiNes MeNl. ~d fl. Wull A26~ Authorized Representative
~bW~WF'I~~t~e, 9t.~. e.j~ ~":':.,
ADDRESS: :)/'),. qo,"" '!e' :'i,;~ ~ -,:5 Irf,^;,}.-
Thl~ lnsurarn::e is tss!J8d pursU811t 10 11'::". A.Orida sur~UIIJnella"~n~
I......tt by Surplus Lines Carrl.ro do n.~. 111. PI_ ~ the Floricf\l.
Inlurl..e GUllloty Act 10 111. extent Of"'!l wry tor ytt '~IlI~lon 'if)r
=to==URE; J<C)P-J# ~ /
16K 6
LANDMARK AMERICAN INSURANCE COMPANY
SCHEDULE OF POLICY ATTACHMENTS AND FORMS
RSG 510261103
Excess Professional Liability Coverage Form Claims Made Basis - RSG 51026
1103
Employment Practices Liability Exclusion - RSG 560270903
Florida - State Fraud Statement - RSG 99022 0908
Florida Changes - Cancellation and Nonrenewal - RSG 53007 0108
Florida Important Notice to Policyholders - RSG 99003 0803
Florida Surplus Lines Disclosure Notice - RSG 99064 0106
Infringement Exclusion Endorsement - RSG 56041 0903
Lateral Hire Exclusion - Excess - RSG 56045 0903
Minimum Retained Premium - RSG 54025 0405
Nuclear Energy Liability Exclusion - RSG 56058 0903
Prior and Pending Litigation Exclusion - RSG 56069 0104
Prior Knowledge Endorsement - RSG 560700903
R.I.C.O. Exclusion - RSG 56074 0903
Service Of Suit - RSG 94022 0407
ENDT-01
ENDT-02
ENDT-03
ENDT-04
ENDT-05
ENDT-06
ENDT-07
ENDT-08
ENDT-09
ENDT-10
ENDT-11
ENDT-12
ENDT-13
Policy Number: LHZ720235
RSG 14054 0903
16K 6
LANDMARK AMERICAN INSURANCE COMPANY
This Form Provides Claims-Made Coverage.
Please Read The Entire Form Completely.
EXCESS PROFESSIONAL LIABILITY COVERAGE FORM
CLAIMS MADE BASIS
The word "Company" refers to the Company providing the insurance shown on the Declarations. Throughout this
document, words and phrases that appear in bold have special meaning. Refer to Part II. Definitions.
I. Coverage - Insuring Agreements
A. Covered Services
Pay on behalf of the Insured all sums that the Insured becomes legally obligated to pay as Damages and
associated Claims and Claims Expenses for loss in excess of Underlying Insurance as described in
the Declarations provided that the:
1. Claim is first made against the Insured during the Policy Period, and reported to the Company no
later than thirty (30) days after the end of the Policy Period;
2. Negligent act, error or omission took place after the Retroactive Date shown in the Declarations.
B. Following Form Policy
This excess insurance policy shall follow the insuring agreements, exclusions, definitions, conditions,
warranties, representations, and endorsement of the controlling Underlying Insurance policy except for:
1. the Limits of Liability under this policy;
2. the Policy Period;
3. any provisions which are inconsistent with this policy;
4. the Retroactive Date;
5. any provisions of any Extended Reporting Period option of any Underlying Insurance;
6. premium;
7. any renewal agreement;
8. any loss settlement by any underlying insurer or by any Insured without the Company's prior written
consent;
9. the cancellation provisions.
C. Policy Limits
Regardless of the number of Claims, persons or entities Insured or included in the definition of Insured,
or the number of claimants or Claims made against the Insured:
1. The maximum liability of the Company for Damages and Claims Expense from each Claim made
against the Insured during the Policy Period and the Extended Reporting Period option, if
purchased, shall not exceed the amount as shown in the Declarations as each Claim.
2. The maximum liability of the Company for all Damages and Claims Expense as a result of all
Claims first made against the Insured during the Policy Period and the Extended Reporting Period
option, if purchased, shall not exceed the amount shown in the Declarations as Aggregate.
RSG 51026 1103
Page 1 of 5
16K 6
If the Limits of Liability as shown in the Declarations are on an excess of loss basis, the limits of the
Company's liability shall be the amount of all Damages or Claims Expenses to which this policy applies
which is in excess of Underlying Insurance up to the limits stated in the Declarations.
If the aggregate Limit of Liability of the Underlying Insurance should be reduced or exhausted by reason
of payment of Damages or Claims Expenses, then:
a. in the event of reduction, the Limits of liability applies in excess of the applicable reduced
Underlying Insurance aggregate Limit of Liability; or
b. in the event of exhaustion, the Limits of Liability continue in force as the applicable Underlying
Insurance subject to all the terms and conditions of the Underlying Insurance and the terms
and conditions of this policy.
The Company shall not be obligated to pay any Claim or judgment or defend any suit after the applicable
Limit of Liability has been exhausted by payment of judgments, settlements, or Claims Expenses or any
combination thereof.
Claims Expenses shall be part of and not in addition to the applicable Limits of Liability. Payment of
Claims Expenses by the Company shall reduce and exhaust the applicable Limits of Liability.
D, Extended Reporting Period
If the policy is not renewed for any reason, or is cancelled for any reason other than for non payment of
premium or deductible (whether cancelled by the Company or by the Named Insured), the Named
Insured as shown on the Declarations, has the right to purchase, within thirty (30) days of policy
termination, an extension of the coverage granted by this policy. This reporting period extension shall
remain in force for a period of twelve (12) months after the policy terminates, but only for Claims resulting
from negligent acts, errors or omissions committed before the effective date of the cancellation or non
renewal, and otherwise covered by this policy. Increased premiums or deductibles or modifications of
coverage terms or conditions upon renewal do not constitute cancellation or non renewal.
The premium for this Extended Reporting Period will not exceed two hundred percent (200%) of the full
annual premium set forth in the Declarations and any attached endorsements, and must be elected and
paid within thirty (30) days after the effective date of the policy's termination. Such additional premium is
deemed fully earned immediately upon the inception of the Extended Reporting Period.
The Extended Reporting Period is added by endorsement and, once endorsed, cannot be cancelled. The
Extended Reporting Period does not reinstate or increase the Limits of Liabiiity. The Company's Limits of
Liability during the Extended Reporting Period are a part of, and not in addition to, the Company's Limits
of Liability stated in the Declarations.
II. Definitions
A. Claim means a written or verbal demand received by the Insured for money or services, including service
of suit or institution of arbitration proceeding against the Insured.
B. Claim Expense means expenses incurred by the Company or the Insured with the Company's Consent
in the investigation, adjustment, negotiation, arbitration, mediation and defense of covered Claims,
whether paid by the Company or the Insured with the Company's consent, including:
1. Expenses the Company incurs including such as but not limited to independent adjusting 1
investigative expenses;
2. Attorney's fees;
3. Costs taxed against the Insured in any suit defended by the Company;
4. Interest on the full amount of any judgment that accrues after entry of the judgment and before the
Company has paid, offered to payor deposited in court the part of the judgment that is within the
applicable Limit of Liability;
5. The cost of appeal bonds or bonds to release attachments, but only for bond amounts within the
available applicable policy limit and only if said Claims are covered by the policy;
6. Reasonable expenses incurred by the Insured at the Company's request other than:
RSG 510261103
Page 2 of 5
16K ~6
a. Loss of earnings; and
b. Salaries or other compensation paid to the Insured or any employee of the Insured.
C. Primary Insurance means the underlying policy as shown in the Declarations and includes any
additional exclusions, endorsements or limitations contained within the Primary Insurance and any other
policies in excess of the Primary Insurance and underlying this policy.
D. Damages mean monetary judgment, award or settlement, except those for which insurance is prohibited
by law. Damages does not include punitive or exemplary Damages, fines, penalties, sanctions, taxes,
awards or Damages that are multiples of any covered Damages, disputes over fees, deposits,
commissions or charges for goods or services.
E, Policy Period means the period of time stated in the Declarations or any shorter period resulting from
policy cancellation or amendment to the policy.
F. Retroactive Date means the date stated in the Declarations on or after which any alleged or actual
negligent act, error or omission must have first taken place in order to be considered for coverage under
this policy.
G. Underlying Insurance means the Primary Insurance policy and any other primary or excess insurance
policies contributing to the Limit of Liability as shown in the Declarations, including any deductible
amount, the insured's participation or self-insurance retention of any policy.
III. General Conditions
A. Maintenance of Underlying Insurance
The Underlying Insurance shall be maintained in full effect during the period of this policy except for
reduction of the Underlying Insurance limits or exhaustion of such limits due solely because of Claims
made during the Policy Period or any Extended Reporting Period Option, if any. If the Underlying
Insurance is not maintained in full force and effect, the Insured will become self insured for Ihe amount
stated in the Declarations and will assume all the obligations of the underlying insurer.
The Company's obligation under this policy shall not be increased, expanded or otherwise changed as a
result of:
a. any position taken by the underlying insurer with respect to coverage;
b. the Insured's failure to comply with any condition of any such policy; or
c. the receivership, insolvency, or the inability or refusal to pay of any underlying insurer or the
cancellation of the Underlying Insurance.
B. Notice of Claim
The Insured must notify the Company as soon as practicable of an incidenl, occurrence or offense which
may reasonably be expected to result in a Claim. The Insured must immediately send copies of any
demands, notices, summonses or legal papers received in connection with any Claim or suit and provide
authorization to the Company to obtain records and other information. Notice to any underlying insurer
shall not constitute notice to the Company under this policy. Please send all claim information to:
Attention: Claims Dept.
RSUI Group, Inc.
945 East Paces Ferry Road, Suite 1800
Atlanta, Georgia 30326-1160
C. Prohibition of Voluntary Payments and Settlements
The Insured shall not, with respect to any Claim covered under this policy, except at the Insured's cost,
make any payment, admit liability, settle Claims, assume any obligation, agree to arbitration or any other
means of resolution of any dispute, waive any rights or incur Claim Expenses without prior written
Company approval.
RSG510261103
Page 3 of 5
16K 6
D. Cooperation
The Insured shall cooperate with the Company and, upon the Company's request, submit to examination
and interrogation by Company representative, under oath if required, and shall attend hearings and trials
and assist in effecting settlements, securing and giving evidence, obtaining the attendance of witnesses
and in the conduct of suits.
E. Notice of Cancellation and Non Renewal
The Named Insured may cancel this policy by mailing or delivering to the Company written notice of
cancellation. For other then non payment of premium, the Company will provide the Named Insured sixty
(60) days written notice prior to cancellation or non renewal of this policy by mailing or delivering the
notice to the first Named Insured's last known mailing address.
If the Company cancels the policy because the Named Insured failed to pay a premium or deductible
amounts when due, this policy may be cancelled by the Company by giving not less then 10 days written
notice of cancellation. The cancellation will state the effective date of the cancellation and the Policy
Period will end on that date.
If cancelled by the Company, the earned premium shall be computed pro-rata. If cancelled by the
Insured, the earned premium shall be computed short rate.
F. Premium and Audit
Premiums for this coverage are computed in accordance with the Company's rules and rates. Any
premium shown as advance premium may be a deposit premium only. If the premium is a deposit
premium, at the close of each audit period, the Company will compute the earned premium for that
period. Audit premiums are due and payable upon notice.
The Company may examine and audit the Insured's books and records at any time during the Policy
Period and within three years alter the final termination of the policy, as far as they relate to the subject
matter of this policy. The first Named Insured as shown in the Declarations must keep records of
information the Company will need for premium computation and, upon request must send the Company
copies of the information.
G. Authorization
The first person or entity named in the Declarations agrees to act as the Named Insured with respect to
the giving and receiving of all notices, the exercising of Extended Reporting Period option, the
cancellation of the policy, the payment of premiums and deductibles and receiving of any return
premiums that may become due.
H. Change
This policy contains all of the agreement concerning the insurance provided. The first Named Insured as
shown in the Declarations is authorized to make changes in the terms of this policy with the Company's
consent. The policy terms can be amended or waived only by endorsement issued by the Company and
made a part of this policy.
I. Subrogation
In the event of any Claim under this policy, the Company shall be subrogated to all Insured's rights of
recovery against any person or organization and the Insured shall execute and deliver instruments and
papers and do whatever else is necessary to secure such rights. The Insured shall do nothing alter the
loss to prejudice such rights.
J. Other Insurance
This policy shall be excess over, and shall not contribute with, any other existing insurance unless such
other insurance is specifically written to be excess of this policy.
RSG 510261103
Page 4 of 5
16K 6
If it is determined that both this insurance and other insurance or self insurance apply to any Claim on the
same basis, whether primary, excess or contingent, the Company shall not be liable under this policy for
a greater proportion of the Damages or Claim Expenses than the applicable Limit of Liability under the
policy for such Damages bears to the total applicable Limit of Liability of all valid insurance whether or
not collectible against such Claims.
K. Actions Against the Insurer
No action shall lie against the Company unless as a condition precedent, there shall have been full
compliance with all of the terms of this policy, and until the amount of the Insured's obligations to pay
shall have been finally determined either by judgment against the Insured after actual trial or by written
agreement of the Insured, the claimant and the Company.
L. Non-Transferability
The Insured's rights and duties under this policy may not be transferred without the written consent of the
Company.
M. Coverage in Bankruptcy
Bankruptcy or insolvency of the Insured or of the Insured's estate shall not relieve the Company of their
obligations under this policy.
N. False or Fraudulent Claims
If an Insured makes any Claim that is faise or fraudulent, this insurance shall become void and
entitlement to coverage for all Claims hereunder shall be forfeited.
O. Application
The Insured agrees that the statements in the application are personal representations, that they shall be
deemed material and that this policy is issued in reliance upon the truth of such representations and that
this policy embodies all agreements existing between the Insured and the Company, or any of its agents,
relating to this insurance.
RSG 510261103
Page 5 of 5
16K 6
LANDMARK AMERICAN INSURANCE COMPANY
This Endorsement Changes The Policy. Please Read It Carefully.
EMPLOYMENT PRACTICES LIABILITY EXCLUSION
This endorsement modifies insurance provided under the following:
EXCESS PROFESSIONAL LIABILITY COVERAGE FORM CLAIMS MADE BASIS
In consideration of the premium charged, it is agreed that no coverage shall apply to any Claims arising out of or
in anyway related to:
1. Refusal to employ;
2. Termination of employment;
3. Coercion, demotion, performance evaluation, reassignment, discipline, defamation, harassment,
humiliation, discrimination or other employment related practices, procedures, policies, acts or omissions;
or
4. Consequentiai Bodily Injury or Personal Injury as a result of (1) through (3) above.
This exclusion applies whether the Insured may be held liable as an employer or in any other capacity and to
any obligation to share Damages with or to repay someone else who must pay Damages because of the
injury.
It is further agreed that no coverage shall apply under this policy to any Claim brought by or against any
spouse, child, parent, brother or sister of the Insured or any other person.
The Company shall not have a duty to defend any Claim, suit, arbitration or any other form of a trial court
proceedi ng.
All other terms and conditions of this policy remain unchanged.
This endorsement effective 01/01/2009
Forms part of Policy Number LHZ720235
Issued to GRANT FRIDKIN PEARSON ATHAN AND CROWN PA
by Landmark American Insurance Company
Endorsement No.: 01
RSG 56027 0903
16K 6
LANDMARK AMERICAN INSURANCE COMPANY
State Fraud Statements
Fraud Statements - Signature Required for New York Only
ARKANSAS, LOUISIANA, RHODE ISLAND, TEXAS AND WEST VIRGINIA FRAUD STATEMENT
Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or knowingly
presents false information in an application for insurance is guilty of a crime and may be subject to fines and
confinement in prison.
ALASKA FRAUD STATEMENT
A person who knowingly and with intent to injure, defraud, or deceive an insurance company files a claim
containing false, incomplete, or misleading information may be prosecuted under state law.
ARIZONA FRAUD STATEMENT
For your protection Arizona law requires the following statement to appear on this form. Any person who
knowingly presents a false or fraudulent claim for payment of a loss is subject to criminal and civil penalties.
CALIFORNIA FRAUD ST A TEM ENT
For your protection, California law requires that you be made aware of the following: Any person who knowingly
presents false or fraudulent claim for the payment of a loss is guilty of a crime and may be subject to fines and
confinement in state prison.
COLORADO FRAUD STATEMENT
It is unlawful to knowingly provide false, incomplete, or misleading facts or information to an insurance company
for the purpose of defrauding or attempting to defraud the company. Penalties may include imprisonment, fines,
denial of insurance, and civil damages. Any insurance company or agent of an insurance company who knowingly
provides false, incomplete, or misleading facts or information to a policyholder or claimant for the purpose of
defrauding or attempting to defraud the policyholder or claimant with regard to a settlement or award payable from
insurance proceeds shall be reported to the Colorado division of insurance within the department of regulatory
agencies.
DISTRICT OF COLUMBIA FRAUD STATEMENT
WARNING: It is a crime to provide false, or misleading information to an insurer for the purpose of defrauding the
insurer or any other person. Penalties include imprisonment andlor fines. In addition, an insurer may deny
insurance benefits if false information materially related to a claim was provided by the applicant.
FLORIDA FRAUD STATEMENT
Any person who knowingly and with intent to injure, defraud or deceive any insurer, files a statement of claim or
an application containing any false, incomplete, or misleading information is guilty of a felony of the third degree.
HAWAII FRAUD STATEMENT
For your protection, Hawaii law requires you to be informed that any person who presents a fraudulent claim for
payment of a loss or benefit is guilty of a crime punishable by fines or imprisonment, or both.
IDAHO FRAUD STATEMENT
Any person who knowingly, and with intent to defraud or deceive any insurance company, files a statement of
claim containing any false, incomplete or misleading information is guilty of a felony.
INDIANA FRAUD STATEMENT
Any person who knowingly and with intent to defraud an insurer files a statement of claim containing any false,
incomplete, or misleading information commits a felony.
RSG 99022 0908
A ml"nrner of AJleghal1Y Insurance Holdings LLC
16K 6
KENTUCKY FRAUD STATEMENT
Any person who knowingly and with intent to defraud any insurance company or other person files an application
for insurance containing any materially false information or conceals, for the purpose of misleading, information
concerning any fact material thereto commits a fraudulent insurance act, which is a crime.
MAINE FRAUD STATEMENT
It is a crime to knowingly provide faise, incomplete or misleading information to an insurance company for the
purpose of defrauding the company. Penalties may include imprisonment, fines or a denial of insurance benefits.
MARYLAND FRAUD STATEMENT
Any person who knowingly and willfully presents a false or fraudulent claim for payment of a loss or benefit or who
knowingly and willfully presents false information in an application for insurance is guilty of a crime and may be
subject to fines and confinement in prison.
MINNESOTA FRAUD STATEMENT
Any person who files a claim with intent to defraud or helps commit a fraud against an insurer is guilty of a crime.
NEW HAMPSHIRE FRAUD STATEMENT
Any person who, with a purpose to injure, defraud or deceive any insurance company, files a statement of claim
containing any false, incomplete or misleading information is subject to prosecution and punishment for insurance
fraud, as provided in RSA 638:20.
NEW JERSEY FRAUD STATEMENT
Any person who includes any false or misleading information on an application for an insurance policy is subject
to criminal and civil penalties.
NEW MEXICO FRAUD STATEMENT
Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or knowingly
presents false information in an application for insurance is guilty of a crime and may be subject to civil fines and
criminal penalties.
OHIO FRAUD STATEMENT
Any person who, with intent to defraud or knowing that he is facilitating a fraud against an insurer, submits an
application or files a claim containing a false or deceptive statement is guilty of insurance fraud.
OKLAHOMA FRAUD STATEMENT
WARNING: Any person who knowingly and with intent to injure, defraud, or deceive any insurer, makes any claim
for the proceeds of an insurance policy containing any false, incomplete or misleading information is guilty of a
felony.
OREGON FRAUD STATEMENT
Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or knowingly
presents materially false information in an application for insurance may be guilty of a crime and may be subject
to fines and confinement in prison.
PENNSYLVANIA FRAUD STATEMENT
Any person who knowingly and with intent to defraud any insurance company or other person files an application
for insurance or statement of claim containing any materially false information, or conceals for the purpose of
misleading, information concerning any fact material thereto commits a fraudulent insurance act, which is a crime
and subjects such person to criminal and civil penalties.
TENNESSEE, VIRGINIA, AND WASHINGTON FRAUD STATEMENT
It is a crime to knowingly provide false, incomplete or misleading information to an insurance company for the
purpose of defrauding the company. Penalties include imprisonment, fines and denial of insurance benefits.
RSG 99022 0908
A marmerof i\lleghany Insurance Holdings 11C
SIGNATURE REQUIRED
NEW YORK FRAUD STATEMENT
16K
6
Any person who knowingly and with intent to defraud any insurance company or other person files an application
for insurance or statement of claim containing any materially false information, or conceals for the purpose of
misleading, information concerning any fact material thereto, commits a fraudulent insurance act, which is a
crime, and shall also be subject to a civil penalty not to exceed five thousand dollars and the stated value of the
claim for each such violation.
I nsuredl Applica nVelai mant
By (Authorized Representative)
Title
Date
RSG 99022 0908
A merrtler of Alleghany Insumnce Holdings LtC
16K 6
LANDMARK AMERICAN INSURANCE COMPANY
This Endorsement Changes The Policy. Please Read It Carefully.
FLORIDA CHANGES-CANCELLATION AND NONRENEWAL
This endorsement modifies insurance provided under the following:
EXCESS PROFESSIONAL LIABILITY COVERAGE FORM CLAIMS MADE BASIS
The Notice of Cancellation and Nonrenewal section of this coverage form is replaced by the following:
A. Notice of Cancellation
1. The first Named Insured shown in the Declarations may cancel this policy by mailing or delivering
to us advance written notice of cancellation.
2. Cancellation of Policies in Effect 90 Days or Less
If this policy has been in effect for 90 days or less, we may cancel this policy by mailing or
delivering to the first Named Insured written notice of cancellation, accompanied by the reasons for
cancellation, at least:
a. 10 days before the effective date of cancellation, if we cancel for nonpayment of premium; or
b. 20 days before the effective date of cancellation, if we cancel for any other reason, except we
may cancel immediately if there has been:
(1) A material misstatement or misrepresentation; or
(2) A failure to comply with underwriting requirements established by the insurer.
3. We will mail or deliver our notice to the first Named Insured's last mailing address known to us.
4. Notice of cancellation will state the effective date of cancellation. The policy period will end on that
date.
5. If this policy is cancelled, we will send the first Named Insured any premium refund due. If we
cancel, the refund will be pro rata. If the first Named Insured cancels, the refund may be less than
pro rata. If the return premium is not refunded with the notice of cancellation or when this policy is
returned to us, we will mail the refund within 15 working days after the date cancellation takes
effect, unless this is an audit policy.
If this is an audit policy, then, subject to your full cooperation with us or our agent in securing the
necessary data for audit, we will return any premium refund due within 90 days of the date
cancellation takes effect. If our audit is not completed within this time limitation, then we shall
accept your own audit, and any premium refund due shall be mailed within 10 working days of
receipt of your audit.
The cancellation will be effective even if we have not made or offered a refund.
6. If notice is mailed, proof of mailing will be sufficient proof of notice.
7. Cancellation of Policies in Effect for More Than 90 Days
a. If this policy has been in effect for more than 90 days, we may cancel this policy only for one or
more of the following reasons:
(1) Nonpayment of premium;
(2) The policy was obtained by a material misstatement;
(3) Failure to comply with underwriting requirements within 90 days of the effective date of
This endorsement effective 01/01/2009
Forms part of Policy Number LHZ720235
Issued to GRANT FRIDKIN PEARSON ATHAN AND CROWN PA
by Landmark American Insurance Company
Endorsement No.: 03
RSG 53007 0108 Includes copyrighted material of Insurance Services Office, Inc., with its permission.
@ ISO Properties Inc., 2006
Page 1 of2
ill 6
coverage;
(4) A substantial change in the risk covered by the policy; or
(5) The cancellation is for all insureds under such policies for a given class of insureds.
b. If we cancel this policy for any of these reasons, we will mail or deliver to the first Named
Insured written notice of cancellation, accompanied by the reasons for cancellation, at least:
(1) 10 days before the effective date of cancellation if cancellation is for nonpayment of
premium; or
(2) 45 days before the effective date of cancellation if cancellation is for one or more of the
reasons stated in 7.a.(2) through 7.a.(5) above.
B. Nonrenewal
1. If we decide not to renew this policy, we will mail or deliver to the first Named Insured written notice
of nonrenewal, accompanied by the reason for nonrenewal, at least:
a. 10 days prior to the expiration of this policy, if we non renew for nonpayment of premium; or
b. 45 days prior to the expiration of this policy, if we non renew for any other reason.
2. Any notice of non renewal will be mailed or delivered to the first Named Insured's last mailing
address known to us. If notice is mailed, proof of mailing will be sufficient proof of notice.
All other terms and conditions of this policy remain unchanged.
RSG 53007 0108 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 2 of 2
@ ISO Properties Inc., 2006
16K 6
LANDMARK AMERICAN INSURANCE COMPANY
IMPORTANT NOTICE
IMPORTANT INFORMATION TO FLORIDA POLICYHOLDERS
KEEP THIS NOTICE WITH YOUR INSURANCE PAPERS
QUESTIONS ABOUT YOUR INSURANCE? - If you have any inquiries, need to obtain coverage information or
need assistance in resolving complaints, please do not hesitate to contact your insurance company or
agent.
FOR COMMERCIAL INSURANCE CONTACT:
RSUI Group, Inc.
945 East Paces Ferry Road
Su ite 1800
Atlanta, GA 30326
Call Collect
(404) 231-2366
RSG 99003 0803
16K 6
LANDMARK AMERICAN INSURANCE COMPANY
IMPORTANT NOTICE
FLORIDA SURPLUS LINES DISCLOSURE NOTICE
THIS INSURANCE IS ISSUED PURSUANT TO THE FLORIDA SURPLUS LINES LAW.
PERSONS INSURED BY SURPLUS LINES CARRIERS DO NOT HAVE THE PROTECTION
OF THE FLORIDA INSURANCE GUARANTY ACT TO THE EXTENT OF ANY RIGHT OF
RECOVERY FOR THE OBLIGATION OF AN INSOLVENT UNLICENSED INSURER.
RSG 99064 0106
16K 6
lANDMARK AMERICAN INSURANCE COMPANY
This Endorsement Changes The Policy. Please Read It Carefully.
INFRINGEMENT EXCLUSION ENDORSEMENT
This endorsement modifies insurance provided under the following:
EXCESS PROFESSIONAL LIABILITY COVERAGE FORM CLAIMS MADE BASIS
In consideration of the premium charged, it is understood that this policy does not apply to any Claim or Claim
Expenses based upon or arising out of infringement of copyright, patent, trademark, trade name, trade dress,
service mark, title or slogan.
All other terms and conditions of this policy remain unchanged.
This endorsement effective 01/01/2009
Forms part of Policy Number LHZ720235
Issued to GRANT FRIDKIN PEARSON ATHAN AND CROWN PA
by landmark American Insurance Company
Endorsement No.: 06
RSG 56041 0903
16K 6
LANDMARK AMERICAN INSURANCE COMPANY
This Endorsement Changes The Policy. Please Read It Carefully.
LATERAL HIRE EXCLUSION (EXCESS)
This endorsement modifies insurance provided under the following:
EXCESS PROFESSIONAL LIABILITY COVERAGE FORM CLAIMS MADE BASIS
In consideration of the premium charged, it is understood and agreed that the following Exclusion is added to
the policy:
This policy does not apply to any Claim or Claim Expenses based upon or arising out of:
Any Claim resulting from any act, error, omission, or Personal Injury which occurred prior to the date when an
Insured became an employee, partner, member, of counsel, or shareholder, of the Named Insured Law Firm.
All other terms and conditions of this policy remain unchanged.
This endorsement effective 01/01/2009
Forms part of Policy Number LHZ720235
Issued to GRANT FRIDKIN PEARSON ATHAN AND CROWN PA
by Landmark American Insurance Company
Endorsement No.: 07
RSG 56045 0903
16K 6
LANDMARK AMERICAN INSURANCE COMPANY
This Endorsement Changes The Policy. Please Read It Carefully.
MINIMUM RETAINED PREMIUM
This endorsement modifies insurance provided under the following:
EXCESS PROFESSIONAL LIABILITY COVERAGE FORM CLAIMS MADE BASIS
In the event of cancellation of this policy by the Insured, return premium shall be computed at .90 of the
pro rata unearned policy premium, subject however to a retention by the company of not less than
$11,250.00.
Nothing in this endorsement is deemed to affect the Company's cancellation rights which remain as
indicated in the coverage form.
It is further agreed that return premium may be allowed on a pro rata basis if cancelled for non payment of
premium or deductible, subject however to retention by the company of the minimum retained premium as
shown above.
All other terms and conditions of this policy remain unchanged.
This endorsement effective 01/01/2009
Forms part of Policy Number lHZ720235
Issued to GRANT FRIDKIN PEARSON ATHAN AND CROWN PA
by landmark American Insurance Company
Endorsement No.: 08
RSG 54025 0405
16K 6
lANDMARK AMERICAN INSURANCE COMPANY
This Endorsement Changes The Policy. Please Read It Carefully.
NUCLEAR ENERGY LIABILITY EXCLUSION
This endorsement modifies insurance provided under the following:
EXCESS PROFESSIONAL liABILITY COVERAGE FORM CLAIMS MADE BASIS
This policy does not apply;
a. Under any Liability Coverage, to bodily injury or property damage;
(1) with respect to which an Insured under the policy is also an Insured under a nuclear energy liability
policy issued by Nuclear Energy Liability Insurance Association, Mutual Atomic Energy Liability
Underwriters, or Nuclear Insurance Associates of Canada, or would be an Insured under any such
policy but for its termination upon exhaustion of its limit of liability; or
(2) resulting from the hazardous properties of nuclear material and with respect to which (a) any person or
organization is required to maintain financial protection pursuant to the Atomic Energy Act of 1954, or any
law amendatory thereof, or (b) the Insured is, or had this policy not been issued would be, entitled to
indemnity from the United States of America, or any agency thereof, under any agreement entered into by
the United States of America, or any agency thereof, with any person or organization;
b, Under any Medical Payments Coverage or any Supplemental Payments provision relating to first aid, to
expenses incurred with respect to bodily injury resulting from the hazardous properties of nuclear material and
arising out of the operation of a nuclear facility by any person or organization;
c. Under any Liability Coverage to bodily injury or property damage resulting from the hazardous properties of
nuclear material, if:
(1) the nuclear material (a) is at any nuclear facility owned by, or operated by or on behalf of, an insured,
or (b) has been discharged or dispersed therefrom;
(2) the nuclear material is contained in spent fuel or waste at any time possessed, handled, used, processed,
stored, transported or disposed of by or on behalf of an insured; or
(3) the bodily injury or property damage arises out of the furnishing by an Insured of services, materials, parts
or equipment in connection with the planning, construction, maintenance, operation or use of any nuclear
facility but if such facility is located within the United States of America, its territories or possessions, or
Canada, this exclusion (3) applies only to property damage to such nuclear facility and any property
thereat;
d. As used in this Endorsement:
(1) "Hazardous properties" include radioactive, toxic, or explosive properties;
(2) "Nuclear material" means source material, special nuclear material or byproduct material;
(3) "Source material", "special nuclear material", and "byproduct material" have the meanings given them in
the Atomic Energy Act of 1954 or in any law amendatory thereof;
(4) "Spent fuel" means any fuel element or fuel component, solid or liquid, which has been used or exposed
to radiation in a nuclear reactor,
(5) "Waste" means any waste material (a) containing byproduct material and (b) resulting from the operation
by any person or organization of any nuclear facility included within the definition of nuclear facility under
paragraph (6). (a) or (b) thereof;
This endorsement effective 01101/2009
Forms part of Policy Number LHZ720235
Issued to GRANT FRIDKIN PEARSON ATHAN AND CROWN PA
by landmark American Insurance Company
Endorsement No.:
09
RSG 56058 0903
Page 1 of2
.16K 6
(6) "Nuclear facility" means;
(a) any nuclear reactor;
(b) any equipment or device designed or used for (i) separating the isotopes of uranium or plutonium, (ii)
processing or utilizing spent fuel, or (iii) handling, processing, or packaging waste;
(c) any equipment or device used for the processing, fabricating or alloying of special nuclear material if
at any time the total amount of such material in the custody of the insured at the premises where
such equipment or device is located consists of or conIains more than 25 grams of plutonium or
uranium 233 or any combination thereof, or more than 250 grams of uranium 235;
(d) any structure, basin, excavation, premises or place prepared or used for the storage or disposal of
waste; and includes the site on which any of the foregoing is located, all operations conducted on
such site, and all premises used for such operations;
(7) "Nuclear reactor" means any apparatus designed or used to sustain nuclear fission in a self-supporting
chain reaction or to contain a critical mass of fissionable material;
(8) "Property damage" includes all forms of radioactive contamination of property.
All other terms and conditions of this policy remain unchanged.
RSG 56058 0903
Page 2 of2
16K 6
lANDMARK AMERICAN INSURANCE COMPANY
This Endorsement Changes The Policy. Please Read It Carefully.
PRIOR AND PENDING LITIGATION EXCLUSION ENDORSEMENT
This endorsement modifies insurance provided under the following:
EXCESS PROFESSIONAL LIABILITY COVERAGE FORM CLAIMS MADE BASIS
In consideration of the premium charged, it is agreed that this policy does not apply to any Claim(s) arising from:
1. any Claim or litigation against any Insured occurring prior to, or pending as of January 01,2009 including
(but not limited to) Claims, demands, causes of actions, legal or quasi-legal proceedings, decrees, or
judgments;
2. any subsequent litigation or Claims arising from, or based on substantially the same matters as alleged in
the pleadings of such prior or pending litigation;
3. any act, error, omission, Personal Injury or Advertising Liability of any insured(s) which gave rise to
such prior or pending litigation or Claims.
All other terms and conditions of this policy remain unchanged.
This endorsement effective 01/01/2009
Forms part of Policy Number lHZ720235
Issued to GRANT FRIDKIN PEARSON ATHAN AND CROWN PA
by landmark American Insurance Company
Endorsement No.: 10
RSG 56069 0104
16K 6
LANDMARK AMERICAN INSURANCE COMPANY
This Endorsement Changes The Policy. Please Read It Carefully.
PRIOR KNOWLEDGE ENDORSEMENT
This endorsement modifies insurance provided under the following:
EXCESS PROFESSIONAL LIABILITY COVERAGE FORM CLAIMS MADE BASIS
In consideration of the premium charged, it is agreed that the following exclusion is added to the policy:
Any alleged act, error, omission, or circumstance likely to give rise to a Claim that an Insured had knowledge
of prior to the effective date of this policy. This exclusion includes, but is not limited to any prior Claim or
possible Claim referenced in the Insured's application.
All other terms and conditions of this policy remain unchanged.
This endorsement effective 01/01/2009
Forms part of Policy Number LHZ720235
Issued to GRANT FRIDKIN PEARSON ATHAN AND CROWN PA
by Landmark American Insurance Company
Endorsement No.: 11
RSG 56070 0903
16K 6
LANDMARK AMERICAN INSURANCE COMPANY
This Endorsement Changes The Policy. Please Read It Carefully.
R.I.C.O EXCLUSION
This endorsement modifies insurance provided under the following:
EXCESS PROFESSIONAL LIABILITY COVERAGE FORM CLAIMS MADE BASIS
The following additional Exclusion is added to the policy.
"This policy does not apply to any Claim or Claim Expenses based upon, arising out of in any way connected
with any actual or alleged violation of the Racketeer Influenced and Corruption Organization Act, 18 USC
Sections 1961 et seq., and any and all amendments thereto, and any rule, regulation, or order issued
pursuant thereto."
All other terms and conditions of this policy remain unchanged.
This endorsement effective 01/01/2009
Forms part of Policy Number LHZ720235
Issued to GRANT FRIDKIN PEARSON ATHAN AND CROWN PA
by Landmark American Insurance Company
Endorsement No.: 12
RSG 56074 0903
16K 6
lANDMARK AMERICAN INSURANCE COMPANY
This Endorsement Changes The Policy. Please Read It Carefully.
SERVICE OF SUIT
This endorsement modifies insurance provided under the following:
All COVERAGE PARTS
In the event of our failure to pay any amount claimed to be due, we, at your request, will submit to the jurisdiction
of any court of competent jurisdiction within the United States of America. Nothing in this condition constitutes or
should be understood to constitute a waiver of our rights to commence an action in any Court of competent
jurisdiction in the United States, to remove an action to a United States District Court or seek a transfer of a case
to another Court as permitted by the laws of the United States or of any state in the United States, moreover, this
endorsement is not an agreement that the law of a particular jurisdiction applies to any dispute under the policy.
Service of process in such suit may be made upon the Senior Claims Officer of RSUI Group, Inc. 945 East
Paces Ferry Road, Suite 1800, Atlanta, GA 30326-1160, or his designee. In any suit instituted against any
one of them upon this contract, we will abide by the final decision of such Court or of any Appellate Court
in the event of an appeal.
The above named is authorized and directed to accept service of process on our behalf in any such suit
andlor upon your request to give a written undertaking to you that we will enter a general appearance upon
our behalf in the event such a suit shall be instituted.
Further, pursuant to any statute of any state, territory or district of the United States of America, which
makes provision therefore, we hereby designate the Superintendent, Commissioner or Director of
Insurance or other officer specified for the purpose in the statute, or his successor or successors in office,
as our true and lawful attorney upon whom may be served any lawful process in any action, suit or
proceeding instituted by you or on your behalf or any beneficiary hereunder arising out of this contract of
insurance, and we hereby desi9nate the above named as the person to whom the said officer is authorized
to mail such process or a true copy thereof.
All other terms and conditions of the policy remain unchanged
This endorsement effective 01/01/2009
Forms part of Policy Number lHZ720235
Issued to GRANT FRIDKIN PEARSON ATHAN AND CROWN PA
by landmark American Insurance Company
Endorsement No.: 13
RSG 94022 0407
Lawyers Professional Liability Insurance
Application
16K 6
~
ZURICH
AMERICAN GUARANTEE AND UABIUTY INSURANCE COMPANY
THIS APPLICATION IS FOR A CLAIMS-MADE AND REPORTED POLICY.
IF ISSUED, PLEASE READ YOUR POLICY CAREFULLY.
Please type or print clearly In Ink. Answer all questions. If space is lnsufflchmt to answer any question lully, attach a separate
sheet- Complete all required supplements..
GENERAL INFORMATION
Appllcanl's (Firm) Name: Grant, Fridkin, Pearson, Athan & Crown, P.A.
Street Address: 5551 Ridg~wodd Drive. Suite 50'
(P 0 Box not acceplable)
Cily: Naples Slale: Florida Zip Code: 34108
Phone: ( 239) 514 1000 Fax: ( 7,q) ')14 O~77
Applicants Contact E.Mali: ~Wright~Ar..rnm Website Address: WWW.2fpac.com
Please attach a list of all branch and secondary locations and a copy at the Applicants letterhead.
Form of Business: o Sole PracHtioner o Partnership o Prolesslonal Assoc
o limited Uabilily Partnership/Corp o Professional Corporation 6il Corporation
DESIRED COVERAGE DESIRED DEDUCTIBLE
0$100,000/$300,000 o $2MI$2M 0$0 o $15,000
o $200.0001$600,000 o $3M/$3M 0$1,000 o $20.000
o $500,000/$1 M o $4M/$4M o $5,000 o $25,000
O$1M1$1M [jl $5M/$5M 0$10,000
OOlher: .,. .. Ij(IOlher: $50,000
ATTORNEY/FIRM INFORMATION
1. Total Number of Atlorneys: ---~--
2. Please list all Attorneys working lor Applicant (include you,."it ~ you are a sole practitioner), In the chart below. II necessery,
,J~laase continu.Il.Ql]~.p_~!.ate sheet. O~tu of airth . Years In --~, AUU'I~V ear II ,~
Attorney Nama D,C! Stlclnl SocLltity Oale of Hire " Df Hours
Number (ononlddlYYI Praclicc (mm/ddlW Worked!
~. ..- .-...--- f-_. _n_._ -- "..." ....-- Wllek ,-
-,",.
559 2 t t <;1clllau. -.....- _.~.'- ._,._-~- ~.w_...... --- -_.--",-
-.-- 1---' ..--- ~,.'~--,... ..,," -,_...._--~
" -.-.--. ..- -..-
--.- -.-, ., ...--...-...-' ..-.....-".
'Oftsignatlon Codoc - .--
0- DlIlears. Diroctor&, Shareholut:'!'s of thf"l r,nrporallon who ~ra licensed atlorllt:!yS 6 - SOlo Practitioner
P . Partner, If a Partnership E - i:mpioyed Attorney
C . Of Counsel Attorney Ie .. Independent Contractor
PT . Part.Time Altorney (must practice law fewer than twenty-six (26 ) hours per week solely for applicant firm)
3. Have all 01 the Attorneys listed in Question 2 taken Continuing Legal Educalion (CLE) course(s) in the past [lYes 0 No
Iweive (12) months?
4. If the Applicant is a sole practitioner, who is the Attorney that will handle the Applicants cases in the Applicants
absence?
Name: D08s he/she maintain professionalliabUity coverage? DYes ONo
Address: City/SlalelZip:
5. Does the Applicant share an olflce or suite with attorneys other than those listed in Question 2 above? DYes IlO No
11 yes. does the Applicant share slafl or Isner head? DYes ONo
6. What date was the Applicanl established? AGENCY MARKETINIlSERVICES, INC, (mm/dd/yyyy) 01/01/199
P.O. BOX 67218
ST, PETE BEACH, Fl 33736.7218
U.PL.966-C CW (01/07)
Page 1 01 5
16K 6
ATTORNEV/FIRM INFORMATION cont'd...
7.
How many non.Altorney employees does the Applicant have?
-~--
8.
Provide the date that the Applicant has been continuously insured for lsy.,yers professional
liability claims: (mm/dd/yyyy) 0 1/ 0 1/ 199
Does the Applicant's current professional liability polley conlain a limitation on prior acts coverage (i e., OCI Yes 0 No
relroactive date, prior acls exclusion, elc)? 01/01/1995
II Yes, please provide the date: (mm/dd/yyyy)
9.
10.
Does any Attorney in Question 2 above have a limitation on prior acts coverage (I 8., retroactive dale, prior acts ij{l Yes [1 No
exclusion. ate) thai is differenllrom thai of the Applicant?
If YES. please Iisllhe name 01 the AlIomey(s) and the prior acts exclusion dale on a separate sheet New attorneys as
of date ~ oined.
Is any Attorney in Question 2 above not currently covered by lawyers professional liability insurance? 0 Yes K1 No
II YES, please HSlthe name of the AUorney(s} and the reason he/she is nol covered by insurance on a
separate sheet
List the Aoolicanls law ers orotessional iabiiilv insurance inlormatlon lor the Dasl live '5\ "ears below
Policy Period Limit of Llabllltv De~le Insurer
0' -17/01 <'M""M <50J,!l.!lL Zuri.h-^merican
~ .1? 11'1. ,.n nnn q.. ., -,,-^=~-, ---
~-17/n1 5.ML'"'' ," 'nnn q, -,.".
ln1'i'O'Z_lO In^ "n' nnn q,,_'.h
Inlin7.1? ,on'nnn 7,,_'-'_
11.
12.
Premium
"1,471
67 973
^^~
~'", i,"
<68 056
13. Has any Attorney in Quesllan 2 above had his/her lawyers profess;analliabillty insurance declined, canceled,
non-renewed or reduced by any prolessionalllablllty insurer during the past five (5) years? (question nol
applicable in the State of Missouri)
If YES, please provide Ihe name 01 the AUorney and explanation on a separate sheet
o Ves Ii(] No
AREAS OF PRACTICE SEE ATTACHED.
14. Inslructlons for completing this secUon
a. Based upon the last fiscal year, please provide the percentage 01 lima devoted (number of hours actually
worked) to each area of practice listed In the chari below.
b. " the Appllcanll',oles work for any arBas of practice in CAPS, piease complele the applicable
supplomental application larms Included with the application
c. Does tile Applicant's practice involve any Atlorney acUng In the capacity of a mediator or arbitrator?
II YES, indioate the percentage of lima devoted to acting as a medlalor or arbitrator
o VBS tiiJ No
%
-,,, Area of Practice -,,'~ ---'4" -,. Area o(Prpoti(lA -, . .,4
~Fdmiral!Y.rMiritime ,_,_.,......_~~_~ ~~"': % Govemment (E~,~_etaIlStat~,-~ocal/LobbYina) .._'- %
~~~~;:,~\rr~de ne~ul!~lon ~, --. "" ~ -.r::i~r~~;:~' ~- -.'''........ ~
Sonl"uotov -. -'=~, ..lnsUrance Dolenn LIIIgation .... ~- ,_....:::- __.'!J>_
~!~~ TrBnsBOt!QD1.L {,,;omm-orOlal LElW _.,,~.". l')~.. lnsuranc!l (}Ihtllf (Goveraac, Rcaulatorv, SvltrVlI_t1onL_ Y,:,-_
Civil Rlgllt!> -Iii' lnlernaliultdl Law %
Collectlono .... . . --=..___._ % Invc"tmont coun6iiWnal Money M.,!!'gemenl ___ %
Comm,ur.lal Practice ~uSlncGG Lll1a3tlon _ 35 ~~. Laoor- lIninn l'lelsted wori<, -.,---- "'~,
COllulluni(;atiOl1s/ Ml":rlln % Medical Mi:lh~l'actic.e - Dl":frmdanl .k
Construction Law t:.. Clio ""MedicarMaloraclice - Plaintiff %
Consumer Claims % 011 f Gas %
COPVRIGHTITRADEMARK % PATENT %
Camerate Business Formation/Alteration 'l % Personallnlurv. Defendant %
Comarate _ Business Transactions/Advice 2 % Personalln1urv - Plaintllf %
Criminal Law % Public UtUities %
Disabilitv I Social Securitu % Real Estate Commercial 7 %
Elder Law % Real Estate - Residential j~
Enmlovmenl % SECURITIES LAW (excent comoralelormalionl %
ENTERTAINMENT % Secured Transaction IUCC - Commercial poner' %
ENVIRONMENTAL % Texation %
Eslates I Wills I Trust J Probate 2 % Tax Shelters %
Familv Law % Workers' ComnensaUon - Defendant %
Financiallnstltutions-ReQ. Compliance % Workers' ComoensaUon - Plalntuf %
TOTAL (must equal 1 00%) 100 %
U-PL-96a.c CW (01/07)
Page 2 015
16K 6
AREAS OF PRACTICE conl'd..,
15. If the Applicant has stated any percentage 01 Medical Malpractice' Plaintllf work in the area of practice char1 above, please
indicate in percentages the amount of work allocated to the following areas:
I Nursing Homes % I OBlGYN % I OncoloaL- % Pediatrics %
I Permanent Olsabllilv % I Wronoful Death % I Other. %
.11 the Applicanl stated a percentage of work for "other," please explain the type at work performed on a separate sheel
16. Does the Applicant engage in any Class AcUen I Mass Tort work? DYes (ZNo
If YES. please complete the applicable Supplemental AppHcation
17. Does the Applicant expect any changes \0 its areas 01 practice in Ihe next twelve (12) months? DYes BNo
II YES, please explain on a separate sheet and speclfically indicate the new areas of practice to be handled
by Ihe Applicant
DOCKET/CALENDAR CONTROL
18. a. Does the Applicant's docket/calendar control system include the following? (Please check all that apply)
n Single Calendar JO[Dual Calendar [l Ticlder Cards 01 Master Listing [I Computer
o Other (please describe):
b. Indicate how frequently the time deadlines are cross. checked: ji;l Daily 0 Weekly 0 Monthly 0 Never
RISK MANAGEMENT
19. Does the Applicant require the use of engagement lelters including lee agreements on all new matters KJYes ONo
undertaken by the firm?
20. Does the Applicant issue declination letters or non-engagement lelters lor aU matters it declines? KiYes DNa
21. 0085 the Applicant outline and reduce to writing its billing policy and procedures when agreeing to represent a [I Yes 0 No
new clienl?
22. D08s the Applicant have a procedure for evaluatlng prospective clients, including such factors as the DYes DlNo
prospective clienls' financial strength, management expertise, rcpulation or history of changing attorneys?
23. Does the Applicant reduce to writing the scope 01 ils services when taking on new matters for existing clients? BYes 0 No
24. ooe& the Applicant have formal wrinen procedures regarding the maintenance and review 01 custodial DYes KI No
accounts and CGcrow funds 7
25. Does the Applicant have a computer back-up system Of sorno other form of emergency back-up system In 1he iO Yes 0 No
event of a disruption or interruplion 01 busIness?
26. Does any AlIornoy in Question 2 above have any law partners, associates, of counselor employed attorneys o Ves ji;l No
other ltlan those listed In auestioll 2 above or IS any AUorncy li&ted In auestlcn 2 abc;lVp. employed by or
perform legRI work fOT an entily olher than the Applicant? II YES, please explain on a separate sheet
27. 0000. the AppliCilint or any Allornoy in Question:2 4illJlIve,'irm stuve 8S a dircator. officer, ern~\uyee, or olher IaYco 0 No
m:mo.nement capacity for ~ put or ptr;$cm cl1enl1 If ye-S,pllolase p.xphtin on a 3f1pOro.to sneQ\,
d;erih""Al1 ~~p '~I:1"~hee Tr~'l AdV~\i,or ~ull,,,lian Ad. l,~te~ WV.s ~Nn
28. . ot!':s 1 e ppll dr a y p~!;i ur ~resen ja;1 orney 0 0 A'pP oant own iln eqUIty tn crM In arw paDt 0'
l:llrrenl rJte:nt of the Applicant? If YES, pll!Me. nomolotc the controllinq hltl:tresls SllPplementa.l Form,
20. t.,l"Ilw8nly-live percenl (2h'1oj ci moro of the Applk:ant's revenues"'nnrr,c.fr'om any form 01 l~liJ sharmO. ~utJ- o YeS III No
contracting 01 lel!lrral wnrk? 11 n:~. plC3ce e:.:plain 011 i:!l:)aparAlp. ~heet
30. Does the Applicant have anyone cllenl that represents ten percent (10%) or mare of the Applican1's bllllngs? o Ves S No
If YES, please explaIn and specify the area of practice and type 01 work perlormed for that client on a
separate sheet Provide c6enl name andJor nature of business enlity
31. Does the Applicant have procedures lor identifying and resolving potential or actual conflicls of interest, !!J Yes 0 No
including cross checking of former. exIsting or potenllal clients? ~Yes 0 No
II YES, is the procedure computerized?
32. Has the Applicant initiated lawsuits or arbitration procedures during the past five (5) years to enforce coHeetlon DYes ID No
of unpaid fees for the Applicant?
a. If YES, how many matters?
b. How may of these matters have been resolved successlully?
c. How many or these matters are still unresolved?
U.Pl.96S.C CW (01/07)
Page 3 015
16K 6
LOSS HISTORV
If the answer is YES to any 01 the following Questions, complete the Notice 01 Circumstance /Claim Reporting Form included
with the application and attach add~ional sheets as necessary
33. During Ihe pasl ten (101 years has any Allornej in Queslion 2 above or employee 01 the Applicant been Ihe 0 Ves IXI No
subject of a criminal action. reprimand, disciplinary action, bar complaint, investigation, or olher ethics
proceeding?
34. During the pasl fiVe (5) years has any claim or suit arising out 01 the rendition of legal services been made
againsl any Attorney in Question 2 above or employee of the Appliean!?
35. Is any Attorney in Question 2 above or employee 01 the Applicanl aware of any circumstance, incident, act,
erTor or omission thai could result in a claim Of suit against Ihe applicant or any predecessor or any or the
lormar or current Attornevs or emnlovees of the Applea"t?
RJ Yes 0 No
I!!lVes ONo
IT IS AGREED THAT tF THE RESPONSE TO QUESTIONS 33, 34 AND 35 ARE IN THE AFFIRMATIVE, ANY CLAIM OR
CIRCUMSTANCE THAT COULD RESULT IN A CLAIM WILL BE EXCLUDED FROM THE PROPOSED COVERAGE.
There are many faclors used by the Company to evaluate an Application for Lawyers Professional liability insurance Such factors
may include a law firm's areas of practice, loss history, risk management and an insurance score
An insurance score is developed from a mathematical model that weighs and measures credit information such as payment history, the
number of collections. bankruptcies, outstanding debt.lenglh at credit history, types 01 credit in use and the number of new applications
lor credit These lactors have been shown to correlate with insurance loss activity
You may be eligible for a premium discount based upon your insurance score, An Insurance score will not result In a premium
increase The insurance score is also never the basis on which the company will accept or reject an application for an insurance poticy
If you do nol wish 10 have your insurance score computed, please check the box 0
By signing this appllcation on the lollowing page the applicant agrees that after inquiry of all prospective insureds, no person proposed
for coverage is aware 01 any fact or circumstance which reasonably might give rise to a future claim that would fall within the scope of
the proposed coverage
Receipt and review of this application does nol bind the insurer to provide this insurance
It is agreed by Ihe applicant and the insurer that the particulars and slatements made in this application, together with all attachments 10
this applicallon and any other materials submitted 10 the insurer (all 01 which attachments and materials shall be deemed attached to
the policy as if physically aUached thereto) shall be the representations of the applicant and lhe prospective Insureds, It is further
agreed by the applicant and the prospective insuredslhal tllis pollcYt if Issued,ls issued in reliance upon the truth of such
representaHons thai are incorporated into and made part 01 this policy, Arter inquiry of all prospectlvelnsufedst the undersigned
authorized officer of the applicant represents that Ihe slalements sot forth in this application and its attachments and other materials
submitted to us are true and correct Signing 01 this applicalfon does n01 bind the applicant or the insurer
The undersigned lurther declares that any event taking place between the date this appllcatlon was signed and the effective date of the
In:.umnce applied for which may ran del' inaccurate, untrue. or incomplete any information In thl!'l. Rpplication, will immediately be
reponed in writing to U5 and we may withdraw or modify any outstanding Quotations and10r authoritation or agreement to bind the
insurance
The applicent repre5clll3 thnl the: abovo nto.tomonte ore true and correct 10 thQ be~t of his I;H her klluwlmJgg and that no material or
relevant locl:5 hEl1J1:l botn $UpprC55Dd or mlMtl1lecf 3nd aqreB that the polley, if i~~uefj.. wi1ll;1~ i~l>ul.'tl on the relianCe of such
represenli'llinn:<>
Nnl;c~ In Nebraska Appllcan!: NO mlsreprescnl.allana or warranty mad$ by lhQ lmourud or on hi!i behalf in the negutlallon or
appliclItlol'\ of this; r"Jolicy nr nnntrnnt of insuranoe shall dofo~n or void tne policy or contrilCt or effect the cornpiiltlyls ubllg8Uull
under tilt: I)ollcy or contrAct unlr.5!'i 5uch misrepresenlatlon or wprrpnw W<.1G m~nerI31, W3& made knowingly with the Intent to
deceive, was relied and ac.ted upon by the company and deceivod the oompiJny to he InJury. The breach of a warranty or
condition In any conlract or policy of Insurance shall not void the policy or allow the company to avoid liability unless such
breach exists at the time of the loss and contributes to the loss.
Reaulred Stale Fraud Notices
Nolice to Arkansas Applicant: Any person who knowingly presents a false or fraudulen' claim for payment of a loss or benefit or
knowingly presents false informatlon in any application for Insurance Is gulRy of a crime and moy be sublectto fines and
confinement in prison.
Nollce to Colorado Applicant: 1\ Is unlewful to knowingly provide false, Incomplete, or misleading facts or information to an
Insurance company for the purpose 0' defrauding or attempting to defraud the company. Penalties may Include
Imprisonment, tines, denial of Insurance, and civil damages. Any Insurance company or agent of an Insurance who knowIngly
prOVides talse. Incomplete, or misleading facts or Information to B policyholder or claImant tor the purpose of defrauding or
attempting to defraud the policyholder or claimant with regard to a settlement or award payable from Insurance proceeds
shall be reported 10 the Colorado Division of Insurance within the department of regulatory agencies.
U.PL.966.C CW (01/071
Page4015
16K 6
Notice to Districlof Columbia Applicant It Is a crime 10 provide lalse or misleading Inlormallon 10 an Insurer lor the purpose 01
defrauding the Insurer or any other person. Penalties Include Imprisonment andlar fine. In addition, an (nsurer may deny
Insurance benefits If false Information related to a claim was provided by the applicant.
NOllce to Florida Applicant: Any person who knowingly and with Intent to InJure, defraud, or deceive any Insurer fUes a
statement of claim or an application containing any falsB, incomplete. or misleading infonnation Is guilty of a felony of the
third degree.
Notice to Kenlucky Applicant: Any person who knowingly and with Intent to defraud any insurance company Of other person
files an appllcallon for insurance containing any materlallv false Information or conceals, for the purpose of misleading,
information concerning any fact material thereto commits a fraudulent insurance act, which Is a crime.
Notice to Louisiana Applicant Any person whet knowingly presents a false or fraudulent claim for payment of a loss or benefit or
knowingly presents false information In an application for Insurance is guilty of a crime and may be sublect 10 nnes and
confinement In prison.
Notice to Maine Applicant: It is a crime to knowingly provide false, Incomplete or misleading Information to an insurance
company for the purpose of defrauding the company. Penalties may Include imprisonment, fines or a denial of insurance
bene/lIs.
Notice to New Jersey Applicant: Any person who includes any false or misleading information on an applleatlon for an
Insurance policy Is sublect to criminal and civil penalties.
Nolice to New Mexico Applicant: ANY PERSON WHO KNOWINGLY PRESENTS A FALSE OR FRAUDULENT CLAIM FOR
PAYMENT OF A LOSS OR BENEFIT OR KNOWINGLY PRESENTS FALSE INFORMATION IN AN APPLICATION FOR
INSURANCE IS GUILTY OF A CRIME AND MAY BE SUBJECT TO CIVIL AND CRIMINAL PENALTIES_
Notice of Ohio Applicant: Any person who, wllh Inlenlto defraud or knowingly Ihal helsha Is faclAlallng a Iraud against any
Insurer, submits an application or files a claim containing a false or deceptive statement Is guilty of Insurance fraud.
Notice to Oklahoma Appiicant: WARNING: Any person who knowingly, and with Inlenllo Injure, delraud or deceive any Insurer,
makes any claim for the proceeds of an insurance policy containing any 1alse, Incomplete or misleading Information Is guilty
of a felony_
Notice 10 Pennsylvania Applicant: Any person who knowingly and with Intent to defraud any Insurance company or other person
fIles !In application for Insuratlce or statement of claim containing any materially false Information or conceals for the
purpose Of misleading, infonnation concerning any fact materlallhereto commits a fraudulent Insurance act, which is a crime
and subJects such person to criminal and civil penallles.
Notice to Vermool Applicant: Any petson who knowingly and with intent 10 defraud any insurance company or other person
flies an ~pplicatlon for Insurance or statement of claim containing any false Information or conce~19 for the purpose of
misleading, Information concerning any fact material thereto, may have committed a fr~udulent Insurance set.
Completion of this form does not bind coverage. Applicant's acceptance of company's quotation is required prior to binding coverage
and policy issuance. Ills agreed lhat this application shall be the basi5 of the contract of Insurance should a policy be issued and it will
be attached to the policy
Signature ~
p~part~( Prell~ldenl"-.-..
O.'e:_._~~:_ \ ""2. - O-L___.__
Print Name: Ridli;iL_d.._C... Cra.nl-
Tltl~ Prp.r.1de11t.
NQTE: TlilS APPLICATION MUST Bf SIGNHJ UY A f'rIINGIPAL, PARTNER OR PRESIDENT OF THE FIRM ACTING AS TI Ie
AUTHORIZED AGENT OF THF APPIIr:ANT
U-PL-966.c CW (01107)
Page 5 of 5