Subsidiaries
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Subsidiary	Nature of Business	Percentage Owned	Date Acquired

Quote Questions
Does the parent organization, a subsidiary or any director or officer currently act in the capacity of general partner in a limited or general partnership?	noyes  If yes, briefly describe in box below.
Total number of U.S. employees
Total number of Fair Labor Standards Act exempt employees
Total number of Fair Labor Standards Act non-exempt employees
Total number of unionized employees in the U.S.
Is the insured organization owned by a non-U.S. parent?	noyes  If yes, please provide the name of the parent organization in box below.
Has the insured organization conducted any layoff, staff reduction or facility closing during the last 16 years?	noyes  If yes, briefly describe in box below.
Is the insured organization anticipating any layoffs or staff reductions?	noyes  If yes, briefly describe in box below.
Does the insured organization use outside employment counsel for employment advice or defense?	noyes  If yes, briefly describe in box below.
If outside employment counsel is not retained, who is responsible for employment advice and defense?
Does the insured organization have an employment-at-will statement and contract disclaimers?	noyes  If yes, briefly describe in box below.
Does the insured organization have a formal employment contract with any employee?	noyes  If yes, briefly describe in box below.
What is the total annual compensation paid pursuant to all employment contracts?
Does the insured organization provide outplacement for terminated employees?	noyes  If yes, briefly describe in box below.
Does the insured organization have an established termination procedure?	noyes  If yes, briefly describe in box below.
Does the insured organization have an established severance policy?	noyes  If yes, briefly describe in box below.

Loss History
Employment Lawsuits/Administrative Proceedings (e.g. EEOC) in last 3 years	Type of Allegation	Determination,Judgements, Defense Costs/Settlements

Is the insured organization presently subject to any judicial or administrative order, decree, judgement or conciliation agreement relating to employment?	noyes  If yes, briefly describe in box below.
Does the insured organization currenntly have Employment Practices Liability or similar insurance?	noyes If yes, please provide the following. Insurer   Limit   Deductible   Policy Period
Has the insured organization or any insured person given written notice under the provisions of any prior or current employment practices liability or similar insurance of specific facts or circumstances which might give rise to a claim being made against any insured?	noyes  If yes, briefly describe in box below.

Additional Comments

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