AML (Anti-Money Laundering)
Debugging/Eavesdropping Detection (TSCM)
Executive Protection (Low Profile)
» Private Investigator
» Process Server
» AML (Anti-Money Laundering)
» Lie Detection/Polygraph
» Security Consulting
» Debugging/Eavesdropping Detection (TSCM)
» Computer Foresics
» Executive Protection (Low Profile)
Application – Online
Business Entity Type:
Limited Liability Company
(Please Select All That Apply)
Product Liability Investigations
Firearms Training - Range
Firearms Training - Classroom Only
Conservator of Peace
Medical Mal-Practice Investigations
Executive Protection - Low Profile
Under Cover Investigations
Exiting Interview(Employee Dismissed)
Exiting Interview(Inventory Only)
Debt Collection - Less than 10%
Cyber Security Expert
Mortgage/Court - Auction Services
Expert Witness Services
Accounting Forensic/Bank Review (AML)
Drug Testing - Witness Only
Kidnap and Ransom
If your operations are not listed above, Please Call 800-683-1226
Your companies expected annual revenue
$0 to $150,000
$350,001 to $450,000
$650,001 to $750,000
$1,250,001 and $1,500,000
$150,001 to $250,000
$450,001 to $550,000
$750,001 to $1,000,000
$1,500,001 and $1,750,000
$2,000,001 and Above
$250,001 to $350,000
$550,001 to $650,000
$1,000,001 and $1,250,000
$1,750,001 and $2,000,000
Desired Liability Limits
Damage to Premises Rented to You Limit - $100,000 (Included)
Medical Expense Limit - $5,000 (Included)
Desired Property Limits
Request Limit of Business Personal Property Coverage (Office Equipment)
$25,000 (included no cost)
Does the applicant have more than 5 employees?
Does the applicant subcontract any investigative work?
a.If Yes - What percentage of work is subcontracted?
b.If Yes - Are subcontractors required to maintain their own liability coverage at a minimum limit of $300,000/$600,000?
How many years have you maintained continuous General Liability and errors & Omissions Coverage?:
During the past five(5) years, has any claim been made or suit brought against the applicant?
Is the Applicant aware of any circumstance, allegation, contention, or incident which may result in a claim or suit against the Applicant?
Has any insurer canceled or refused to renew any similar insurance during the past five(5) years?
Does any operation
you to carry and/or use of a firearm?
(IF YOU CARRY FOR YOUR OWN PROTECTION,ANSWER NO)
Cyber/Privacy Liability Coverages
Privacy Liability Only - 3rd Party:
Does the applicant's website, system, or network request and capture any credit card information?
a. IF YES, Is Applicant currently compliant with regard to Payment Card Industry Data Security Standard (PCI DSS)?
Does the applicant's website, system, or network request and capture Credit History and Rating, Bank Records, Investment Data or Financial Transactions?
Does the applicant's website, system, or network request and capture Medical Records or Personal Health Information?
a. IF YES, Is Applicant currently compliant with regard to Health Insurance Portability and Accountability Act of 1996?
Including Data Breach - 1st Party:
Is firewall technology used at all internet points of presence to prevent unauthorized access to internal networks?
Are written policies and/or documented procedures in place which address Network Security, appropriate use of network resources/internet/email, and user and password management?
Does the applicant use up to date antivirus software on all desktops, portable computers and mission critical servers?
Does the applicant hold over 250,000 protected records?
Hired and Non-Owned Auto:
a. Does the applicant have a commercial auto policy in place?
b. Does the applicant rent or hire auto in excess of 10 times per year?
c. Does the applicant use any auto to transport clients?
d. Does the applicant own any auto registered in the company's name or leased on a long term basis?
Blanket Additional Insured: INCLUDED
Private Eye Endorsement: INCLUDED
Waiver of Subrogation:
To Include - Additional Cost $150
To Include - Additional Cost $150
Applicant's Warranty Statement:
The undersigned represents to the best of his/her knowledge and belief the particulars and statements set forth are true and agree that those particulars and statements are material to the acceptance of the risk assumed by the Company. The undersigned further declares that any claim, incident or event taking place prior to the effective date of the insurance applied for which may render inaccurate, untrue, or incomplete any statement made will immediately be reported in writing to the applied for which may render inaccurate, untrue, or incomplete any statement made will immediately be reported in writing to the Company and the Company may withdraw or modify and any outstanding quotations and/or authorization or agreement to bind the insurance. The signing of the Application does not bind the undersigned to purchase the insurance, nor does the review of the Application bind the Company to issue a policy. It is understood the Company is relying on the Application in the event the Policy is issued. It is agreed that this Application, including any material submitted therewith, shall be the basis of the contract should a policy be issued, and may be attached dot and become part of the policy.
Call (800) 683-1226 or email us at firstname.lastname@example.org
7371 Atlas Walk Way, #603, Gainesville, VA 20155, (800) 683-1226
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