Quote Information
Applicant Name
State
For Errors & Omissions, General Liability and/or Property, in the last 5 years, has any claim been made or suit brought against the insured, its predecessor(s) in business, or any of its present or former owners, partners, officers, directors, employees, or independent contractors?
Revenues
What is the total number of employees? (includes owners, principals and partners)
Please check each one that applies from the following list of classifications
Cloud Providers/Application service provider/software as a service
What percentage of receipts are derived from this?
Consulting/training/project management/staffing
Data or records storage/retrieval/back-up
What percentage of receipts are derived from remote data back-up?
Database administration
Hardware evaluation/selection/maintenance
Hardware manufacturing
What percentage of receipts are derived from this?
Help desk
Internet service provider, search engine or online publishing/sales
Network or computer security
What percentage of receipts are derived from this?
Software development/installation/sales
If developing packaged software, please provide number of licenses:
Systems, network or audio-visual evaluation/design/cabling/support
Web design/development/hosting or search engine optimization
Other
Please provide a short description of the services you provide in the box below: