Hendrickson Insurance · Sarasota, Florida

Employer liability & EPLI application.

For Gulf Coast employers in Sarasota, Bradenton, Tampa, and St. Petersburg. Employment practices liability (EPLI) covers claims by employees and applicants, wrongful termination, discrimination, harassment, and retaliation, that a general liability or workers comp policy does not touch. Underwriters price this off your headcount and your HR practices, so be straight about both. Estimates are fine where you are not sure.

A. Business Information

Legal / Named Insured *

Required.

DBA (doing business as)

Industry / what the business does *

Required.

Website

Contact name *

Required.

Phone *

Required.

Email *

Enter a valid email.

Primary location address *

Required.

City

State

ZIP

Years in business

B. Workforce

Full-time employees *

Required.

Part-time employees

Seasonal / temp

Total annual payroll

States where you have employees

C. HR Practices

This is what actually moves your EPLI price. The more of these you have documented, the better the rate.

D. Coverage Requested

Limit requested

$500,000 $1,000,000 $2,000,000 Not sure, advise me

Deductible / retention preference

E. Prior Insurance & Claims

Current EPLI carrier (if any)

Policy expiration date

If yes, list date, type, and outcome/amount

F. Acknowledgement

I certify that the information above is true and complete to the best of my knowledge. Submitting this form does not bind coverage; coverage is subject to underwriting approval and payment of premium.

Typed signature (full name) *

Required.

Date *

Required.

I agree to the statement above. *

Please confirm to submit.

Back

✓

Thank you — application received

Dennis will review it and follow up shortly with your quote. Questions? Call or text 941-952-7991.

That didn’t go through

Please try again, or call/text 941-952-7991 and we’ll take your details directly.