IT Professional Insurance Quote Step 1 of 5 20% Applicant Name(s)Email Phone NumberOperating NameRisk Location Addresse.g. 10 Water Street, Somecity, ON. A1A 1A1 Does the Applicant work solely from a home office location? Yes No Year Established:YYYYHow many years of experience does the Applicant have?EmployeesNumber of employees located in Canada:Does the Applicant have any employees outside of Canada? Yes No Number of Employees located in US:Number of Employees located in other Countries:If there are employees located in US or Other Countries, please list the countries, number of employees and describe the situation: Risk InfoTypes of Services ProvidedPlease selectApplication Service Provider (SAAS)Business Management ConsultingComputer Consultants - FeesData Processing / OutsourcingData Storage / RetrievalGraphic DesignHardware Installations and SupportHardware SalesI.T. Consulting ServicesInternet Service ProvidersInternet/Electronic Marketing/AdvertisingManaged Security Service Provider (MSSP)Managed Security Service (MSP)Mobile App DevelopmentNetwork Support ServicesSales of Pre-Packaged SoftwareSoftware / App DevelopmentTraining and EducationWeb-HostingWebsite Design and DevelopmentRevenue Breakdown by Service (%)Do you wish to add a 2nd service? Yes No 2nd Type of Services ProvidedPlease selectApplication Service Provider (SAAS)Business Management ConsultingComputer Consultants - FeesData Processing / OutsourcingData Storage / RetrievalGraphic DesignHardware Installations and SupportHardware SalesI.T. Consulting ServicesInternet Service ProvidersInternet/Electronic Marketing/AdvertisingManaged Security Service Provider (MSSP)Managed Security Service (MSP)Mobile App DevelopmentNetwork Support ServicesSales of Pre-Packaged SoftwareSoftware / App DevelopmentTraining and EducationWeb-HostingWebsite Design and DevelopmentRevenue Breakdown of 2nd Service (%)Do you wish to add a 3rd service? Yes No 3rd Type of Services ProvidedPlease selectApplication Service Provider (SAAS)Business Management ConsultingComputer Consultants - FeesData Processing / OutsourcingData Storage / RetrievalGraphic DesignHardware Installations and SupportHardware SalesI.T. Consulting ServicesInternet Service ProvidersInternet/Electronic Marketing/AdvertisingManaged Security Service Provider (MSSP)Managed Security Service (MSP)Mobile App DevelopmentNetwork Support ServicesSales of Pre-Packaged SoftwareSoftware / App DevelopmentTraining and EducationWeb-HostingWebsite Design and DevelopmentRevenue Breakdown of 3rd Service (%)Is the Applicant a Managed Service Provider (MSP)? An MSP is an outsourced third-party company that remotely manages a customer's information technology (IT) infrastructure. Yes No MSP DetailsDoes the Applicant require multi-factor authentication for all remote access to the Applicant's network? Yes No Does the Applicant conduct penetration tests on the Applicant's network at least annually? Yes No Does the Applicant provide cyber security awareness training to all staff? Yes No Does the Applicant have network intrusion detection systems in place on its network? Yes No Does the Applicant have endpoint detection and response (EDR) protocols in place? Yes No MSP - Customer ProtocolsDoes the Applicant provide guarantees of more than 99% systems access? Yes No Does the Applicant recommend (in-writing) multi-factor authentications for all its customer solutions? Yes No Does the Applicant use standard customer contacts? Yes No Does the Applicant provide cyber security awareness training to all customers? Yes No Does the Applicant implement a firewall with ongoing support from the vendor for all external gateways in all it's customer solutions? Yes No Does the Applicant implement business grade antivirus protection with ongoing support from the vendor across the entire network including servers and endpoints, for all its customer solutions? Yes No Does the Applicant implement two forms of full backups (stored in a separate environment) at least every 7 days in all its customer solutions? Yes No Does the Applicant recommend (in-writing) that customer backups are fully tested at least every 180 days for integrity, and all (if any) deficiencies found rectified within 7 days? Yes No Does the Applicant recommend (in-writing) annual penetration tests to all customers? Yes No Does the Applicant implement endpoint detection and response (EDR) protocols in all of its customers solutions? Yes No Sub-ContractorsDoes the Applicant sub-contract any work to others? Yes No Does the Applicant obtain evidence of insurance from all sub-contractors? Yes No Percentage of revenues from sub-contracted work (%):Size of Largest Project / ContractWhat is the value of the applicants highest valued contract? (CDN $)Custom Software / Application DevelopmentDoes the Applicant provide custom software development that exceeds $250,000 for any one contract / project? Yes No Does the Applicant have written procedure in place to safeguard against intellectual property infringement of others? Yes No Does the Applicant require employees to sign statements declaring they will not utilize intellectual property or trade secrets from past employment? Yes No Liability Under ContractDoes the Applicant assume liability in contracts which exceed the value of the contract? Yes No Does the Applicant conduct any work in the following industries?Artificial Intelligence? Yes No If Yes, please describe in detail the exact nature of the work that the Applicant does in this specialized industry (provide a paragraph, including some examples of contracts and clients they would work for)Automated Warehouse Distribution? Yes No If Yes, please describe in detail the exact nature of the work that the Applicant does in this specialized industry (provide a paragraph, including some examples of contracts and clients they would work for)Automobile? Yes No If Yes, please describe in detail the exact nature of the work that the Applicant does in this specialized industry (provide a paragraph, including some examples of contracts and clients they would work for)Aviation /Aerospace, Rail and Marine? Yes No If Yes, please describe in detail the exact nature of the work that the Applicant does in this specialized industry (provide a paragraph, including some examples of contracts and clients they would work for)Electronic Trading/Exchange/Payment Platforms for the Financial and Banking Industry? Yes No If Yes, please describe in detail the exact nature of the work that the Applicant does in this specialized industry (provide a paragraph, including some examples of contracts and clients they would work for)Cryptocurrency / Blockchain or virtual currency? Yes No If Yes, please describe in detail the exact nature of the work that the Applicant does in this specialized industry (provide a paragraph, including some examples of contracts and clients they would work for)Casinos, Gambling or Sports Betting? Yes No If Yes, please describe in detail the exact nature of the work that the Applicant does in this specialized industry (provide a paragraph, including some examples of contracts and clients they would work for)Digital Incarceration and Security Services? Yes No If Yes, please describe in detail the exact nature of the work that the Applicant does in this specialized industry (provide a paragraph, including some examples of contracts and clients they would work for)Firearms, Weapons, Ammunition, Fireworks, Explosives or Defense related work? Yes No If Yes, please describe in detail the exact nature of the work that the Applicant does in this specialized industry (provide a paragraph, including some examples of contracts and clients they would work for)Hardware Manufacturing or Design, or Semi-conductors? Yes No If Yes, please describe in detail the exact nature of the work that the Applicant does in this specialized industry (provide a paragraph, including some examples of contracts and clients they would work for)High profile clients (“High-Profile” includes any organization that works with a large number of customers (credit card company) wherein a service interruption or error would damage a good portion of the public) Yes No If Yes, please describe in detail the exact nature of the work that the Applicant does in this specialized industry (provide a paragraph, including some examples of contracts and clients they would work for)Hosting Service Providers, Data center / Co-location operations, as such? Yes No If Yes, please describe in detail the exact nature of the work that the Applicant does in this specialized industry (provide a paragraph, including some examples of contracts and clients they would work for)Managed Security Service Providers (MSSP)? Yes No If Yes, please describe in detail the exact nature of the work that the Applicant does in this specialized industry (provide a paragraph, including some examples of contracts and clients they would work for)Medical, Drug or Life Sciences (incl. clinical trials) specific to the ‘operations’ of these industries? Yes No If Yes, please describe in detail the exact nature of the work that the Applicant does in this specialized industry (provide a paragraph, including some examples of contracts and clients they would work for)Mining, Oil & Gas or Nuclear (specific to the ‘operations’ of these industries)? Yes No If Yes, please describe in detail the exact nature of the work that the Applicant does in this specialized industry (provide a paragraph, including some examples of contracts and clients they would work for)Narcotics, Cannabis, Tobacco, Pornography or Adult Entertainment? Yes No If Yes, please describe in detail the exact nature of the work that the Applicant does in this specialized industry (provide a paragraph, including some examples of contracts and clients they would work for)Navigation & Radar Systems? Yes No If Yes, please describe in detail the exact nature of the work that the Applicant does in this specialized industry (provide a paragraph, including some examples of contracts and clients they would work for)Refrigeration and controlled environmental distribution? Yes No If Yes, please describe in detail the exact nature of the work that the Applicant does in this specialized industry (provide a paragraph, including some examples of contracts and clients they would work for)Social Media Site - Is the Applicant(s) operating a social media site? Yes No If Yes, please describe in detail the exact nature of the work that the Applicant does in this specialized industry (provide a paragraph, including some examples of contracts and clients they would work for)SCADA (Supervisory Control and Data Acquisition)? Yes No If Yes, please describe in detail the exact nature of the work that the Applicant does in this specialized industry (provide a paragraph, including some examples of contracts and clients they would work for)Unions, Trade Associations? Yes No If Yes, please describe in detail the exact nature of the work that the Applicant does in this specialized industry (provide a paragraph, including some examples of contracts and clients they would work for)Utilities (water, gas, electricity)? Yes No If Yes, please describe in detail the exact nature of the work that the Applicant does in this specialized industry (provide a paragraph, including some examples of contracts and clients they would work for) Other Risk InformationDoes the Applicant abide by all required privacy laws and regulations? Yes No Does the Applicant conduct searches to avoid infringement of copyrights and trademarks? Yes No Are all external gateways of the Applicant's network protected by a firewall with ongoing support from the vendor? Yes No Does the Applicant have business grade antivirus protection with ongoing support from the vendor deployed across the entire network, including servers and endpoints? Yes No Are all data and systems fully backed up at least every 7 days, and stored in an environment which is separate from the Applicant's network? Yes No Are backups tested at least every 180 days for integrity, and all (if any) deficiencies found rectified with 7 days? Yes No Does the Applicant have a software patch management system in place for the Applicant's network and any managed services? Yes No Gross RevenuesGross Revenues last 12 months in CANADA:Gross Revenues last 12 months in USA:Does the Applicant have any revenues that emanate from countries other than CANADA & USA? Yes No Gross Revenues last 12 months in other Countries:If there are Gross revenues from Other Countries, please list the countries:Estimated Gross Revenues (Next 12 Months)Estimated Revenues next 12 months in CANADA:Estimated Revenues next 12 months in USA:Does the Applicant forecast any revenues that will emanate from countries other than CANADA & USA? Yes No Estimated Revenues next 12 months in other Countries:If there are Estimated revenues from Other Countries, please list the countries:Other InformationDoes the Applicant abide by all required privacy laws and regulations? Yes No Does the Applicant’s contract contain warranties or guarantees that could exceed the fees charged for the work performed? Yes No Please describe details:Loss HistoryHas the applicant had any losses (claimed or not) in the last three years? Yes No Date of claim: MM slash DD slash YYYY Nature of claim:Please selectLiability - Property damage to othersLiability - Bodily injuryLiability - Financial loss to othersLiability - OtherProperty - Vehicle impact/aircraft impactProperty - Fire (not arson)Property - Fire by arsonProperty - BurglaryProperty - Change in TemperatureProperty - Change in temperatureProperty - EarthquakeProperty - Electrical currentProperty - ExplosionProperty - Falling objectProperty - FloodProperty - FreezingProperty - HailProperty - LandslideProperty - LightningProperty - Malicious actsProperty - OtherProperty - Overland waterProperty - RiotProperty - Sewer backupProperty - SmokeProperty - WindstormProperty - VandalismProperty - Vandalism by tenantProperty - TheftProperty - WaterProperty - Snow or iceProperty - Equipment breakdownCyber IncidentLoss / Expenses Paid:Is the claim closed? Yes No Have all damages been repaired? Yes No Describe the loss control measures that are now in place to avoid a future similar loss:Has the Applicant had more than one claim or loss in the past three years? Yes No Date of 2nd claim: MM slash DD slash YYYY Nature of 2nd claim:Please selectLiability - Property damage to othersLiability - Bodily injuryLiability - Financial loss to othersLiability - OtherProperty - Vehicle impact/aircraft impactProperty - Fire (not arson)Property - Fire by arsonProperty - BurglaryProperty - Change in TemperatureProperty - Change in temperatureProperty - EarthquakeProperty - Electrical currentProperty - ExplosionProperty - Falling objectProperty - FloodProperty - FreezingProperty - HailProperty - LandslideProperty - LightningProperty - Malicious actsProperty - OtherProperty - Overland waterProperty - RiotProperty - Sewer backupProperty - SmokeProperty - WindstormProperty - VandalismProperty - Vandalism by tenantProperty - TheftProperty - WaterProperty - Snow or iceProperty - Equipment breakdownCyber IncidentLoss / Expenses Paid on 2nd claim:Is the 2nd claim closed? Yes No Have all damages been repaired? Yes No Describe the loss control measures that are now in place to avoid a future similar loss:Has the Applicant had more than two claims or loss in the past three years? Yes No Date of 3rd claim: MM slash DD slash YYYY Nature of 3rd claim:Please selectLiability - Property damage to othersLiability - Bodily injuryLiability - Financial loss to othersLiability - OtherProperty - Vehicle impact/aircraft impactProperty - Fire (not arson)Property - Fire by arsonProperty - BurglaryProperty - Change in TemperatureProperty - Change in temperatureProperty - EarthquakeProperty - Electrical currentProperty - ExplosionProperty - Falling objectProperty - FloodProperty - FreezingProperty - HailProperty - LandslideProperty - LightningProperty - Malicious actsProperty - OtherProperty - Overland waterProperty - RiotProperty - Sewer backupProperty - SmokeProperty - WindstormProperty - VandalismProperty - Vandalism by tenantProperty - TheftProperty - WaterProperty - Snow or iceProperty - Equipment breakdownCyber IncidentLoss / Expenses Paid on 3rd claim:Is the 3rd claim closed? Yes No Have all damages been repaired? Yes No Describe the loss control measures that are now in place to avoid a future similar loss:Prior InsuranceDoes the Applicant currently carry Commercial General Liability coverage? Yes No Current Insurer Name:Policy Number:Premium:Current Insurance Expiry Date MM slash DD slash YYYY Does the Applicant currently carry Errors & Omissions Liability coverage? Yes No Current Insurer Name:Policy Number:PremiumRetroactive Date on current in-force policy: MM slash DD slash YYYY Limits on current in-force policy:Please select:$250,000 / $250,000 (Aggregate)$500,000 / $500,000 (Aggregate)$500,000 / 1,000,000 (Aggregate)$1,000,000 / 1,000,000 (Aggregate)$2,000,000 / 2,000,000 (Aggregate)$3,000,000 / 3,000,000 (Aggregate)$5,000,000 / 5,000,000 (Aggregate)Has the Applicant(s) had continuous professional liability coverage since the retroactive date indicated in this application? Yes No Has the Applicant ever had insurance cancelled, declined or refused? Yes No Reason for decline/refusal/cancellationPlease selectDue to claimsDue to condition of buildingDue to non-payment, all outstanding premium has been paidDue to non-payment, all outstanding premium has NOT been paidDue to online salesDue to other underwriting reasonsDue to types of goods soldDue to vacancyInsurer is no longer willing to write this classOtherProvide details: CoveragesErrors & Omissions-(Claims) MadePlease select:$250,000 / $250,000 (Aggregate)$500,000 / $500,000 (Aggregate)$500,000 / 1,000,000 (Aggregate)$1,000,000 / 1,000,000 (Aggregate)$2,000,000 / 2,000,000 (Aggregate)$3,000,000 / 3,000,000 (Aggregate)$5,000,000 / 5,000,000 (Aggregate)Commercial General Liability:Please selectNot Required$1,000,000$2,000,000$3,000,000$5,000,000Tenants Legal Liability:Please select$250,000$500,000$1,000,000Tenants Legal Liability:Please select$250,000$500,000$1,000,000$2,000,000Tenants Legal Liability:Please select$250,000$500,000$1,000,000$2,000,000$5,000,000Employment Benefits Liability Extension:Please select$0 - Not required$1,000,000Employment Benefits Liability Extension:Please select$0 - Not required$1,000,000$2,000,000Employers Liability:Please select$0 - Not required$1,000,000Employers Liability:Please select$0 - Not required$1,000,000$2,000,000Non-owned Auto Limit:Please select$0 - Not required$1,000,000Non-owned Auto Limit:Please select$0 - Not required$1,000,000$2,000,000Non-owned Auto Limit:$0 - Not required$1,000,000$2,000,000$5,000,000Optional Property CoverageDoes the Applicant require property coverage? Yes No Business Personal PropertyContents of Every Description (incl. Improvements, Stock, Contents):Stock / InventoryMiscellaneous Articles FloaterDoes the applicant require Business Interruption - Actual Loss Sustained coverage ? Yes No Business Interruption – ALS Limit Required:Flood Coverage Yes No Earthquake Coverage Yes No Sewage Backup Coverage Yes No Water Damage Deductible:Please select$5,000$10,000$25,000Optional Crime CoverageOptional Crime Coverage:Please select$0 - Not required$5,000$10,000$25,000Optional Equipment Breakdown CoverageOptional Equipment Breakdown Not required Required Value of equipment:Building InformationProperty Deductible:Please select$1,000$2,500$5,000$10,000$25,000Location / Building DetailsBuilding Construction:Please selectWood FrameMasonry veneerMasonry (including mill)LogNon-combustable - HCBNon-combustable - (All steel structure)Fire resistive (poured concrete)Fire resistive (concrete tilt up)Modular / PrefabSteel frame with fabric coveringClayStrawInsulated concrete formsWhat year was the building built?Square footage:Roofing Material:Please selectAsphalt shinglesCedarClay / slateFlat Deck / Tar + GravelGreenMetalRubberStrawThatchedZincMultiple - more than one of the above roof typesYear of latest roof update:Heating:Please selectBaseboard electricBoiler - in floor radiant heatBoiler - water baseboardCombination - forced air furnace with add on wood burning unitFireplace insertsForced air furnaceHeat pumpPlug-in space heatersRadiant ceiling heat panels - electricStoves (Wood heat, pellet)Wall furnace Wall heaterWood heat applianceBuilding is not heatedRoof top HVAC systemYear of latest heating update:Electrical:Please selectCircuit breakersFusesMixed - more than one of the above typesYear of latest update to electricalPlumbing type:Please selectCopper, PEX, PVC, ABSPolybutyleneGalvanized steelKitecCast ironMixed - more than one of the above types of plumbingBuilding does not have plumbingYear of latest update to plumbingDoes the premises have a monitored alarm (both fire and burglary) system? Yes No Does the premises have security bars or security film installed on all glass windows and doors? Yes No Is the premises sprinklered? Yes No
