Form 82: Professional Liability Insurance Application
ALLIANCE FOR CONTRACTORS
Excellence in Construction • Professional Development • Industry Leadership
FORM 82: PROFESSIONAL LIABILITY INSURANCE APPLICATION
Errors and Omissions Coverage for Design-Build Contractors and Consultants
Important: This application is for Alliance for Contractors members seeking comprehensive
professional liability coverage. Complete all sections thoroughly to ensure proper risk assessment and coverage
determination.
SECTION I: APPLICANT INFORMATION
Company/Firm Name:
Principal Contact:
Title:
Phone:
Email:
Alliance Member ID:
Years with Alliance:
Business Address:
SECTION II: BUSINESS DETAILS & PROFESSIONAL SERVICES
Business Structure & Operations
Years in Business:
Number of Employees:
Annual Revenue (Last 3 Years):
Professional Services Provided (Check all that apply)
Do you require retroactive coverage for prior work? Yes
No
If yes, desired retroactive date:
Previous professional liability carrier (if any):
Previous policy expiration date:
Reason for change in coverage:
SECTION V: PROJECT COMPLEXITY ASSESSMENT
Alliance iCOS Integration
This section leverages Alliance's integrated Construction Operations System (iCOS) for sophisticated risk
assessment based on project complexity and client requirements.
Typical Project Characteristics
Average project value:
Largest single project value (last 5 years):
Primary project types:
Project Complexity Indicators (Check all that apply)
Multi-phase projects spanning >2 years
Projects involving multiple regulatory agencies
International or multi-jurisdictional work
High-rise or complex structural systems
Environmental remediation components
Public-private partnerships
Mission-critical facilities (hospitals, data centers)
Client Profile
Government entities (federal, state, local)
Private commercial clients
Healthcare organizations
Educational institutions
Industrial/manufacturing
Residential developers
SECTION VI: CLAIMS HISTORY
Have you or your firm ever had a professional liability claim? Yes
No
Claims Detail (If applicable - use additional sheets if necessary)
Date of Claim
Nature of Claim
Amount Claimed
Amount Paid
Status
Are you aware of any circumstances that might give rise to a claim?
Yes No
If yes, please describe:
SECTION VII: RISK MANAGEMENT PRACTICES
Alliance Professional Development Resources
Access to comprehensive training programs and continuing education designed to minimize liability exposure and
enhance professional competency.
Quality Assurance Procedures
Formal project review process at key milestones
Independent peer review for complex projects
Written quality control checklists
Regular staff training and certification updates
Client communication protocols
Documentation Practices
Comprehensive project files maintained
Meeting minutes and correspondence archived
Change order documentation procedures
Digital backup and recovery systems
Professional Development & Training
Annual continuing education hours per professional staff:
Alliance training programs completed in last 12 months:
SECTION VIII: ALLIANCE INTEGRATION FEATURES
Integrated Construction Operations System (iCOS) Risk Analysis
Advanced project risk assessment utilizing Alliance's proprietary iCOS platform to evaluate project complexity,
client requirements, and potential exposure factors for optimized coverage recommendations.
Professional Development Resources
Access to Alliance's comprehensive library of risk management training, including webinars, workshops, and
certification programs specifically designed to reduce professional liability exposure.
Legal Support Network
Dedicated legal support network providing expert claims defense, risk management consultation, and proactive
legal guidance for Alliance members.
Authorize Alliance to conduct iCOS risk assessment? Yes
No
Request professional development consultation? Yes
No
Areas of professional development interest:
SECTION IX: ADDITIONAL INFORMATION
Special coverage requirements or concerns:
Additional risk management measures in place:
CERTIFICATION AND SUBMISSION
I certify that the information provided in this application is true, complete, and accurate to the best of my
knowledge. I understand that any misrepresentation or omission may void coverage. I authorize Alliance for
Contractors to verify the information provided and to conduct necessary risk assessments.
Applicant Signature:
Print Name:
Title:
Date:
SUBMISSION INSTRUCTIONS & NEXT STEPS
1. Complete Application: Ensure all sections are thoroughly completed and signed.
2. Required Documentation: Attach copies of professional licenses, certificates of insurance,
and recent financial statements.
3. Submit to Alliance: Forward completed application to your Alliance for Contractors
representative or submit through the member portal.
4. iCOS Analysis: Alliance will conduct comprehensive risk assessment using our integrated
Construction Operations System.
5. Coverage Recommendation: Receive customized coverage recommendations based on your specific
risk profile and project complexity.
6. Professional Development: Participate in recommended training programs to optimize coverage
terms and reduce premiums.
Alliance Member Advantages
• Preferred rates and terms through Alliance's group purchasing power
• Expert risk assessment via iCOS integration
• Ongoing professional development and training resources
• Dedicated claims support and legal network
• Customized coverage solutions for complex projects