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COVER-PRO APPLICATION COURT REPORTER SUPPLEMENT 2. How many (Philadelphia Insurance Companies)

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PI-PLSP-CTSUPP 04/10 Page 1 of 3
COVER-PRO
SM
APPLICATION
COURT REPORTER SUPPLEMENT
1. Full name of the Applicant Firm:
2. How many years has the Applicant been court reporting? Years
3. What forms and/or methods of court reporting does the Applicant perform?
Stenographic
Electronic
Voice Writing
Communication Access Real-Time Translation
Other (specify):
4. If the Applicant performs stenographic and/or voice writing transcriptions, have you
created and do you maintain a customized computer dictionary for keystroke code and/or
voice file translation?
Yes
No
5. If the Applicant performs voice writing transcriptions, does(do) the state(s) in which you
operate require licensure?
Yes
No
If yes, did you take and pass the state exam and/or obtain the CVR, CM and RVR
certifications required?
Yes
No
6. What is the Applicant’s annual caseload: Cases
7. Please indicate the percentage of the Applicant’s gross annual revenue from the last
fiscal period involving:
Reporting: Transcription:
Depositions % Medical %
Government Hearings % Court %
Arbitration Hearings % Technical %
Trials % Other: %
Appeals %
Sworn Statements %
Conference/Webcasts %
Other Real Time Audio Reporting %
Other (describe): %
Translation/Captioning
Document Management:
Language Interpreting Verbal % Document Copying: %
Language Interpreting Written % Document Scanning and Imaging %
Online Cart / Broadcast Captioning % Document Storage/Warehousing %
Offline Cart/Captioning %
Other: %
TOTAL MUST EQUAL
100%
8. If the Applicant performs document management services, please provide a statement of
details advising the security and privacy controls and/or procedures in place.
N/A
Clear Application
Print Application
PI-PLSP-CTSUPP 04/10 Page 2 of 3
9. Does the Applicant have any national certifications? Yes No
Please provide a list of all certifications:
10. Is the Applicant a member of any national associations? Yes No
Please provide a list of all memberships:
11. Describe the controls and procedures the Applicant uses when transcribing to ensure
proper editing, grammar, and accurate identification of names and places.
I understand that the information submitted herein becomes a part of my Philadelphia Insurance
Companies Cover-Pro
sm
application and is subject to the same conditions as stated on the application.
Name (Please Print/Type) Title (
MUST BE SIGNED BY A PRINCIPAL, PARTNER OR
OFFICER
)
_______________________________________
Signature Date
The above signed warrants that he/she is authorized and has the power to complete and execute this Application,
including the Warranty Statement on behalf of the Applicant and their respective Directors, Officers or other
insured persons.
Produced By: (Section to be completed by Producer/Broker)
Producer Agency
Producer License Number Agency Taxpayer ID or SS Number
Address (Street, City, State, Zip)
Clear Application
Print Application
PI-PLSP-CTSUPP 04/10 Page 3 of 3
ADDITIONAL INFORMATION
This page may be used to provide additional information to any question on this application. Please
identify the question number to which you are referring.
_____________________________________________
Signature Date
Clear Application
Print Application
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COVER-PRO APPLICATION COURT REPORTER SUPPLEMENT 2. How many (Philadelphia Insurance Companies)

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Completed 7 November 2020

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