• Request an Executive Lines Quote

  • Complete the information to submit an Executive Lines quote request. Questions will adjust based on the coverages selected and your responses.

    Don't have everything available? That's okay. Submit the information you have and upload supportng documents when available. This form is designed to start the underwriting process. If additional information is needed, we'll follow up directly.

  • Available Coverages

    • Directors & Officers Liability (D&O)
    • Employment Practices Liability (EPL)
    • Fiduciary Liability
    • Crime

    Estimated Completion Time: 6—8 minutes

  • Agency Information

    Identify the agency submitting this request.
  • Format: (000) 000-0000.

  • Applicant Information

    Provide information about the business requesting coverage.
  • Does the applicant have operations, employees, or revenue exposure outside the United States?

  • Coverage(s) Requested

    Select all the coverages you'd like DXG to quote.
  • Coverage(s) Requested

  • Current Insurance

    A few questions to help us understand the existing program.
  • Is D&O coverage currently purchased?
  • D&O Policy Expiration Date
     - -
    2 digit month, 2 digit day, 4 digit year
  • Is EPL coverage currently purchased?
  • EPL Policy Expiration Date
     - -
    2 digit month, 2 digit day, 4 digit year
  • Is Fiduciary coverage currently purchased?
  • Fiduciary Policy Expiration Date
     - -
    2 digit month, 2 digit day, 4 digit year
  • Is Crime coverage currently purchased?
  • Crime Policy Expiration Date
     - -
    2 digit month, 2 digit day, 4 digit year

  • Claims & General Underwriting

    A few questions to help us identify anything that may require additional underwriting.
  • Has the applicant experienced any claims, lawsuits, potential claims, losses, or circumstances that may fall within the scope of the requested coverage?
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  • Company & Financial Snapshot

    A few financial figures give us enough context to begin evaluating the account.
  • Is the applicant taxed as an S corporation?
  • Does the applicant have private equity or venture capital ownership?
  • Has the applicant completed, or does it anticipate, a securities offering?
  • Is the applicant aware of any material debt covenant breach or other significant financial obligation issue?

  • Directors & Officers Liability

    A few questions help us understand ownership, governance and recent corporate activity.
  • Has there been a change in ownership during the past 18 months?
  • Are all shareholders who own more than 10% represented on the board of directors?
  • Does the applicant have an ESOP?
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  • Employment Practices Liability

    Employee counts and several HR questions help us evaluate EPL exposure.
  • Employee Count Breakdown
    Rows
  • Does the applicant provide employees with a written employee handbook?
  • Does the applicant have written policies addressing discrimination and harassment?
  • Does the applicant have written policies addressing sexual harassment?
  • Does the applicant have a dedicated Human Resources department?
  • Has the applicant experienced any employment-related complaint, charge, claim, or hearing?
  • Has the applicant had layoffs or reductions in force during the past 12 months, or does it anticipate layoffs/reductions in force during the next 12 months?

  • Fiduciary Liability

    A few questions about the applicant's benefit plans and plan assets.
  • Which types of plans does the organization sponsor?
  • Does the plan hold or offer the option to invest in the applicant's securities, including through an ESOP?
  • Has the applicant, any plan, or any plan fiduciary been investigated by the DOL, IRS, or another regulatory agency within the past 2 years?
  • Has there been litigation involving any benefit plan or plan fiduciary?
  • Does the applicant anticipate any reduction in employee benefits during the next 12 months?

  • Crime Liability

    A few questions about locations, losses and financial controls help us evaluate Crime exposure.
  • Are all locations located in the United States?
  • Has the applicant experienced a crime or fidelity loss during the past 36 months?
  • Are accounting and payment responsibilities segregated so that one individual cannot complete a transaction without another individual's involvement?
  • Is dual verification required before fund transfers are processed?
  • Are vendor banking or payment detail changes independently verified before being implemented?

  • Supporting Documents

    Upload any supporting documents you have available to help us evaluate the account.

  • Don't have everything available? That's okay. Submit what you have and DXG will follow up if additional information is needed. You may upload multiple documents at once, including current policies, declarations, applications, loss runs, financial statements, supplemental applications, or other underwriting information. 

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  • Review & Submit

    Please confirm that the information provided is accurate to the best of your knowledge.
  • Date
     / /
    2 digit month, 2 digit day, 4 digit year
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