Market Leading, Broad Coverage Options from Lloyd's and other select markets

Professional Errors and Omissions Including Cyber, Privacy Liability, Plus Packaged General Liability and Property Options from our select underwriting partners.

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Legal Company Name

Legal Entity Type: Corp LLC Sole Proprietorship Other:

Physical Address: (Home offices are ok. Do not put in PO Box or UPS Box number)

(Mailing) if different and do you have other locations

First name

Last name

Phone

Cell Phone number:

Year Business Established (YYYY):

FEIN:

Primary Business Owner (Person most involved with the business’ daily operations)

Number of Managers, LLC Members and Executive Officers:

Number of Employees:

How did you hear about us / marketing source code if known?

Your Services and Products: (example we are an IT firm that provides managed services, value added reselling and it fix repair)

Do you provide managed services or managed security services?

Yes

Do you provide third parties with social networks, fintech, or infrastructure services?

Yes

Do you distribute Unsolicited Advertising or Content?

Yes

Does your business involve obscenity, pornography, or interactions with minors?

Yes

Do you currently maintain Errors & Omissions insurance?

Yes

If yes, what is the limit and what is the prior acts aka retroactive date?

Financials & Operations (Estimates for January 01 to December 31 of this current year ) What is your Total Gross Revenue?

What are your Total Expenses?

Most Recent completed fiscal year end (FYE) (e.g., December 2025):

Does a qualified attorney approve all of your contracts?

Yes

In your contract do you always Cap your liability for damages?

Yes

If yes, what is the amount of the Cap?

Do you require Require legal counsel review if deviating from standard contract or MSA?

Yes

What is Largest Contract $ Amount Value (annualized and this is typically the amount your largest client pays you)

What services do you provide your Largest Contract (example IT, MSP and VAR work)

Do you have a Written quality control program in place? if no, techrisks.com can provide you one.

Yes

Have you gone through any merger, acquisition, sale of any assets or other similar transaction within the past 24 months?

Yes

Do you have any subsidiaries or foreign locations?

Yes

Has the applicant been involved in any layoffs or , furloughs within the past six months or does the applicant have any plans for the same within the next six months ?

Yes

Has the applicant in the last 12 months completed or is the applicant anticipating in the next 12 months any: closings, consolidations, or divestments of any branch, location, office, chapter or Subsidiary?

Yes

Does the applicant have an employee stock ownership plan (ESOP)?

Yes

Staff & Services: Do you perform any of the following for third parties: online tracking, data aggregation, data mining, gaming or provide products or services that are specifically intended to enable others to engage in cryptocurrency mining, exchange?

Yes

Do your products or any of your services perform the following security functions for third parties? Select all that apply.

Yes

Do your products or any of your services perform the following security functions for third parties? Select all that apply.

What industries or professions do you / your company serve?

Do you have custody of Personal Health Information (PHI) of third parties?

Yes

Unknown

PHI is Any "individually identiﬁable" health data, such as medical records, lab results, insurance billing details, or even just a patient's name linked to a diagnosis.

Are you responsible for collecting, storing, processing, safeguarding, or any other activity involving the personal information of residents of foreign countries?

Yes

How many people’s non-public personal information (NPI) do you collect, store, process, or otherwise handle?

Information Security Do you back up mission critical data regularly, routinely store recent backups offline, and ensure your backups are well isolated from threats against your production systems?

Yes

Do you encrypt all electronic information that leaves your physical control (laptops, mobile devices, storage, etc.), using strong encryption and keys so that only you can decrypt it?

Yes

Unknown

Do you use technical measures, devices or tools & techniques including: firewalls, anti-virus, passwords/authentication, to preclude unauthorized corruption of your network, including endpoints & sensitive assets within the network?

Yes

Do you require multi-factor authentication for remote access to your network?

Yes

Is Remote Desktop Protocol disabled in your network? (typically, yes for MSP)

Yes

Do you use any expired or unsupported operating systems or applications?

Yes

Office / Property / Building Details Square footage of office space you occupy (this can be home office if applicable:)

Year Building was Built:

How many stories is building?

What floor is your office on?

Is this building sprinklered?

Yes

If building is owned, what is $ value of building to be insured

Business Personal Property (Equipment/Furniture / Computers) $ value to be insured:

Computer Programmers in office only (8810) what is their total annual payroll, how many are full time and how many are part-time)

Computer Programmers who travel >50% of time (8803) what is their total annual payroll, how many are full time and how many are part-time)

Computer Repair / Installation (5191 or 8859) what is their total annual payroll, how many are full time and how many are part-time)

Salespersons (8572) what is their total annual payroll, how many are full time and how many are part-time)

Clerical / Admin or Not otherwise Classified (code 8810) what is their total annual payroll, how many are full time and how many are part-time)

Other Employee Class types to be insured. Describe what they do and what is their total annual payroll, how many are full time and how many are part-time)

Do you want owner to be included in workers comp, if yes, describe what they do or spend most of their time doing and what is their annual draw or payroll $ amount:

Does this risk have only (1) one location by State? if no, please provide address of other locations, what employees do in those states , what is their payroll $ amount

Do Employees drive for work related reasons?

Yes

Does your company own any vehicles?

Yes

Have you experienced any claims, potential claims, notice of claims, or conditions that could give rise to a claim?

Yes

Prior Knowledge In the past 36 months, have you become aware of any facts, acts or circumstances that could give rise to any claim?

Yes

If in the past 36 months you have purchased insurance providing any Errors & Omissions, Cyber, or Media Liability coverage, have you reported or could you have reported any facts, acts, circumstances, claims, or loss under such insurance

Yes

Supplement & Submission Add comments, questions or additional information here: