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14, Has the Named Insured, or any current or past ornployee, partner, officer, director, owner or employed attorney of tf,,< <br />Named Insured or Predecessor Firm(s), or any attorney listed in question 11: <br />a. Ever had a claim or suit made against hirn/her in the last 5 years in respect to professional negligence <br />(irrespective of the outcome of such action)? ❑ Yes ('"OIIYI�81 <br />complete Suppl6ment #10 <br />DL l - 1 4V act <br />b, Knowledge of any circumstances, acts or omissions which could reasonably be expected to result in a claim <br />brought in respect to professional negligence (irrespective of the actual validity of such action)? Q Yes 1W No <br />Ifyes, complete Supplement #11. <br />Mth regard to question 14• abrsve, it is Understood and agreed that if any such ciairp, act, error, orriission or <br />circumstance eXists, then such Claim an,0/or any' clalm arising from such act, error, omission or circcrffe!;tance <br />is excluded from covemga that May bt prQvided under this proposed insurance and, fu thsr•, failure to <br />disclose such claim, act, error, omisslQn or circumstance re-5ult in thb proposed insurance being void, <br />ab initio and or subject to reWssion, <br />16, Do you anticipate any major change In your client base, type of specialty of work undertaken or cattier material <br />change(s) in the way you currently conduct your business? L]Yes lRio If yes, provide devils on a separate <br />attachment. <br />16_ Do any members of the entity fisvAn answer.to question 1. and/or 4. of this application share office Space or staff <br />with any other entity? 0 Yes o lfyes, complete Supplement #12. <br />17. a. Have you been continuously insured for the last six years? GA Yes IQ No <br />b. Dods your current policy have a retroactive date? JA Yes Q No If yes, date: <br />c. Provide the'following information on your coverage for the past.five years; <br />f�amd of <br />Insurer Pofly <br />Limit <br />Period <br />Ded.I <br />StR <br /># of wis— <br />Cpvared <br />P_re iurn <br />1. , � <br />5 o 0 D <br />1013 g 4 -.95 <br />25- Udp <br />5' <br />-al <br />2. i SiC <br />• <br />S DDd U00 <br />10/3 Os-qi�) <br />7 <br />1 �37s- <br />PX ►L.1 �XIh�Y i <br />bD Q <br />10/3 6gls-97 <br />`'• C(-VY1e.+ri C � � u;i � <br />5 000 0 o U <br />l D/3 g7-`l8" <br />�so� <br />1 <br />a7y�9�. ud <br />�6,v,(?l i nC- ex Gd <br />d. <br />Have you. ever purchased oxfendod discovery/reporting period coverage ("tail") from any prior insurer? <br />IQ Yes '4 No if yos, provide details on a separate attachment <br />18. DOCKET CONTROL SYSTEM <br />Yes <br />No <br />a. <br />Is the docket control system and procedure computerized? <br />b. <br />Do you maintain a docket control system and procedure with at least two <br />independent date controls' <br />z <br />0 <br />c. <br />DQer the docket control system and procedure produce a weekly calendar? <br />4 <br />i <br />d. <br />Dees the docket control systern and procedure cover ail aspects of your practice? <br />e. <br />Doos the docket control system and procedure require lawyers to both calendar <br />and remove from the calendar all filing dates? <br />f_ <br />Are open calendar entries on the docket control system and procedure circulated <br />to all lawyers or, if the firm is divided into formal departments, to all lawyers In the <br />appropriate departments? <br />S 1630-EO <(9198) page 4 of 7 <br />