2007-2008 IEEE Multiplan Brochure - (Page 48) P.C. 29224 THE INSTITUTE OF ELECTRICAL AND ELECTRONICS ENGINEERS ENGINEERS’ PROFESSIONAL LIABILITY INSURANCE APPLICATION (This is an Application for a Claims-Made Policy.) NOTE: PLEASE REVIEW A SPECIMEN EVIDENCE OF INSURANCE FOR COVERAGE PROVISIONS The limits of liability stated in the policy are reduced by costs, charges and expenses. Costs, charges and expenses also may be applied against your deductible, if applicable to the claim. Name: Address: City: State: Zip: Daytime Phone No.: ( Fax No.: ) ) ( E-Mail Address: We will use e-mail for corresponding unless otherwise requested. 1. Legal Entity: (please check one) J Individual J Professional Corporation A. Entity name (if applicable) B. Year established C. List each licensed engineer in your firm below: Name IEEE Membership I.D. Number (at least one required for acceptance) Year first licensed as an engineer J Corporation J Partnership J LLP/LLC Membership Grade Member Senior Member Fellow J J J J J D. Indicate the size of your staff (list each individual only once): Principals, Partners, Officers and Directors Engineers (other than principals) Other Technical Staff (describe position) Clerical TOTAL: J J J J J J J J J J 2. A. Please select the limits of liability for which you would like a quotation: J $100,000 each claim/$300,000 annual aggregate J $500,000 each claim/$500,000 annual aggregate J $250,000 each claim/$500,000 annual aggregate J $1,000,000 each claim/$1,000,000 annual aggregate J $1,500,000 each claim/$1,500,000 annual aggregate B. J Check if you would like to purchase an additional limit equal to the limit selected (not to exceed $1,000,000) in 2A to apply to defense costs only. 3. A. Please provide your actual gross billings for the past 12 months: $ B. Please provide an estimate of your gross billings for the next 12 months: $ “Annual Gross Billings” is defined as all amounts billed for engineering services including incidental charges and subcontractor billings excluding direct reimbursable expenses. (over, please)
Table of Contents Feed for the Digital Edition of 2007-2008 IEEE Multiplan Brochure Group Term Life Insurance Plan Group 10-Year Level Term Life Insurance Plan Group 20-Year Term Life Insurance Plan Group Disability Income Insurance Plan Professional Liability Insurance Plan Long-Term Care Plan Additional Plans & Information 2007-2008 IEEE Multiplan Brochure 2007-2008 IEEE Multiplan Brochure - (Page 1) 2007-2008 IEEE Multiplan Brochure - (Page 2) 2007-2008 IEEE Multiplan Brochure - (Page 3) 2007-2008 IEEE Multiplan Brochure - (Page 4) 2007-2008 IEEE Multiplan Brochure - Group Term Life Insurance Plan (Page 5) 2007-2008 IEEE Multiplan Brochure - Group Term Life Insurance Plan (Page 6) 2007-2008 IEEE Multiplan Brochure - Group Term Life Insurance Plan (Page 7) 2007-2008 IEEE Multiplan Brochure - Group Term Life Insurance Plan (Page 8) 2007-2008 IEEE Multiplan Brochure - Group Term Life Insurance Plan (Page 9) 2007-2008 IEEE Multiplan Brochure - Group Term Life Insurance Plan (Page 10) 2007-2008 IEEE Multiplan Brochure - Group Term Life Insurance Plan (Page 11) 2007-2008 IEEE Multiplan Brochure - Group Term Life Insurance Plan (Page 12) 2007-2008 IEEE Multiplan Brochure - Group Term Life Insurance Plan (Page 13) 2007-2008 IEEE Multiplan Brochure - Group Term Life Insurance Plan (Page 14) 2007-2008 IEEE Multiplan Brochure - Group 10-Year Level Term Life Insurance Plan (Page 15) 2007-2008 IEEE Multiplan Brochure - Group 10-Year Level Term Life Insurance Plan (Page 16) 2007-2008 IEEE Multiplan Brochure - Group 10-Year Level Term Life Insurance Plan (Page 17) 2007-2008 IEEE Multiplan Brochure - Group 10-Year Level Term Life Insurance Plan (Page 18) 2007-2008 IEEE Multiplan Brochure - Group 10-Year Level Term Life Insurance Plan (Page 19) 2007-2008 IEEE Multiplan Brochure - Group 10-Year Level Term Life Insurance Plan (Page 20) 2007-2008 IEEE Multiplan Brochure - Group 10-Year Level Term Life Insurance Plan (Page 21) 2007-2008 IEEE Multiplan Brochure - Group 10-Year Level Term Life Insurance Plan (Page 22) 2007-2008 IEEE Multiplan Brochure - Group 10-Year Level Term Life Insurance Plan (Page 23) 2007-2008 IEEE Multiplan Brochure - Group 10-Year Level Term Life Insurance Plan (Page 24) 2007-2008 IEEE Multiplan Brochure - Group 20-Year Term Life Insurance Plan (Page 25) 2007-2008 IEEE Multiplan Brochure - Group 20-Year Term Life Insurance Plan (Page 26) 2007-2008 IEEE Multiplan Brochure - Group 20-Year Term Life Insurance Plan (Page 27) 2007-2008 IEEE Multiplan Brochure - Group 20-Year Term Life Insurance Plan (Page 28) 2007-2008 IEEE Multiplan Brochure - Group 20-Year Term Life Insurance Plan (Page 29) 2007-2008 IEEE Multiplan Brochure - Group 20-Year Term Life Insurance Plan (Page 30) 2007-2008 IEEE Multiplan Brochure - Group 20-Year Term Life Insurance Plan (Page 31) 2007-2008 IEEE Multiplan Brochure - Group 20-Year Term Life Insurance Plan (Page 32) 2007-2008 IEEE Multiplan Brochure - Group 20-Year Term Life Insurance Plan (Page 33) 2007-2008 IEEE Multiplan Brochure - Group 20-Year Term Life Insurance Plan (Page 34) 2007-2008 IEEE Multiplan Brochure - Group Disability Income Insurance Plan (Page 35) 2007-2008 IEEE Multiplan Brochure - Group Disability Income Insurance Plan (Page 36) 2007-2008 IEEE Multiplan Brochure - Group Disability Income Insurance Plan (Page 37) 2007-2008 IEEE Multiplan Brochure - Group Disability Income Insurance Plan (Page 38) 2007-2008 IEEE Multiplan Brochure - Group Disability Income Insurance Plan (Page 39) 2007-2008 IEEE Multiplan Brochure - Group Disability Income Insurance Plan (Page 40) 2007-2008 IEEE Multiplan Brochure - Group Disability Income Insurance Plan (Page 41) 2007-2008 IEEE Multiplan Brochure - Group Disability Income Insurance Plan (Page 42) 2007-2008 IEEE Multiplan Brochure - Group Disability Income Insurance Plan (Page 43) 2007-2008 IEEE Multiplan Brochure - Group Disability Income Insurance Plan (Page 44) 2007-2008 IEEE Multiplan Brochure - Professional Liability Insurance Plan (Page 45) 2007-2008 IEEE Multiplan Brochure - Professional Liability Insurance Plan (Page 46) 2007-2008 IEEE Multiplan Brochure - Professional Liability Insurance Plan (Page 47) 2007-2008 IEEE Multiplan Brochure - Professional Liability Insurance Plan (Page 48) 2007-2008 IEEE Multiplan Brochure - Professional Liability Insurance Plan (Page 49) 2007-2008 IEEE Multiplan Brochure - Professional Liability Insurance Plan (Page 50) 2007-2008 IEEE Multiplan Brochure - Professional Liability Insurance Plan (Page 51) 2007-2008 IEEE Multiplan Brochure - Professional Liability Insurance Plan (Page 52) 2007-2008 IEEE Multiplan Brochure - Professional Liability Insurance Plan (Page 53) 2007-2008 IEEE Multiplan Brochure - Professional Liability Insurance Plan (Page 54) 2007-2008 IEEE Multiplan Brochure - Long-Term Care Plan (Page 55) 2007-2008 IEEE Multiplan Brochure - Long-Term Care Plan (Page 56) 2007-2008 IEEE Multiplan Brochure - Long-Term Care Plan (Page 57) 2007-2008 IEEE Multiplan Brochure - Long-Term Care Plan (Page 58) 2007-2008 IEEE Multiplan Brochure - Additional Plans & Information (Page 59) 2007-2008 IEEE Multiplan Brochure - Additional Plans & Information (Page 60) 2007-2008 IEEE Multiplan Brochure - Additional Plans & Information (Page 61) 2007-2008 IEEE Multiplan Brochure - Additional Plans & Information (Page 62) 2007-2008 IEEE Multiplan Brochure - Additional Plans & Information (Page 63) 2007-2008 IEEE Multiplan Brochure - Additional Plans & Information (Page 64) 2007-2008 IEEE Multiplan Brochure - Additional Plans & Information (Page 65) 2007-2008 IEEE Multiplan Brochure - Additional Plans & Information (Page 66) 2007-2008 IEEE Multiplan Brochure - Additional Plans & Information (Page 67) 2007-2008 IEEE Multiplan Brochure - Additional Plans & Information (Page 68) 2007-2008 IEEE Multiplan Brochure - Additional Plans & Information (Page 69) 2007-2008 IEEE Multiplan Brochure - Additional Plans & Information (Page 70)
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