MEGA ERRORS OR OMISSIONS LIABILITY SUPPLEMENTAL APPLICATION

Transcription

1 MEGA ERRORS OR OMISSIONS LIABILITY SUPPLEMENTAL APPLICATION This is a claims first made and reported in writing coverage. Covered claim expenses and damages above the retention amount are payable under this Coverage Part, reduce and may exhaust the limits of liability. We shall not be liable for claim expenses or damages after exhaustion of the applicable limit of liability. Applicant Contact Information: Applicant s Name: Address: Phone #: Website Address: Address: Requested Limit & Deductible: $300,000/$300,000 $500,000/$500,000 $1,000,000/$1,000,000 $2,500 $5,000 $10,000 $25,000 Part I 1. Producer Contact Information who may we contact with specific questions on this account? Name: Phone: Fax: 2. If insured currently has Technology E&O coverage please provide the following information: Limit: Effective Date: Retroactive Date: Carrier: Is Prior Acts Coverage desired? If yes: Indicate requested Retro Date Have you maintained/purchased continuous Technology E&O coverage from this requested Retroactive Date until the present? Page 1 of 14

2 3. Expertise: Total Number of Employees Average Years of Professional Experience in Technology Services Number of Independent Contactors you have under contract 4. Revenues: Total Revenue for current and projected fiscal periods: Current: $ Projected $ Total revenue generated from your website for current and projected fiscal periods: Current: $ Projected: $ Percentage of total revenue from foreign sales for current and projected fiscal periods: Current: % Projected: % Total Operating Expenses for current and projected fiscal periods: Current: $ Projected: $ 5. Do you outsource/subcontract any of your services? If yes, which services? (list all outsourced/subcontracted services and their purpose below) 6. Do you perform/provide accounting, architectural, engineering, legal, medical, health-related, nutritional or insurance advice/content/services to others? If yes, please explain. 7. In the past three years, have you had any claims resulting from your technology services/products or are you aware of any situation or circumstance that could give rise to a claim? If yes, explain below. 8. In the past three years, have you sued a customer for failure to pay for products or services rendered? 9. In the past three years, have you had to recall any of your services/products? If yes, describe below. 10. Please provide the following information on your customers & contracts: Average customer contract size? $ Average length/term of customer contract? Who is your largest customer? What is your largest customer contract size? $ What is the length/term of your largest customer contract? Page 2 of 14

3 11. What industry(ies) do you target? (check all that apply) Government (military) Government (non-military) Aerospace/Defense Insurance Retail Utilities Entertainment Manufacturing/Industrial Consumer/Home Banking/Investment Transportation Educational Institutions Medical/Healthcare Construction Agriculture/Mining Technology/Telecommunications Do not target a specific industry segment Other (describe fully) 12. Which of the following provisions are included in contracts you enter into with customers? (check all that apply) Limitation of Liabilities clause that limits your liability to no greater than the contract value and/or removes liability for consequential damages Warranty Disclaimers Guarantees Remedy for Disputes or Breaches 13. Do you back up software and applicable data essential to your business operations? If yes, how often? 14. Do you back up software and applicable data essential to your customers business operations? If yes, how often? 15. Do your website or operations include any of the following activities? (check all that apply) Business-to-Business e-commerce transactions (i.e. the exchange of products/services between businesses via the Internet) Business-to-Consumer e-commerce transactions (i.e. the exchange of products/services between businesses and consumers via the Internet) Exchange to exchange e-commerce transactions (i.e. the exchange of information between websites that act as brokers for products/services exchanged between businesses) Auction services Downloadable music, videos, previously published materials or other types of copyrighted materials Children-focused content (site dedicated to entertaining children that may include capabilities, chat rooms, game/content downloads, marketing/selling of consumer goods) Adult content (sexually explicit content, etc.) Gaming or Gambling Advertising or products/services other than your own Links to Websites of others including deep linking or meta-tags Bulletin boards, chat rooms, exchanges, etc. Page 3 of 14

4 16. Do you utilize content or services of others in your operations or technology services/products? If yes, do you obtain appropriate written consents, releases and rights for content or services provided by others? 17. Which of the following quality control/risk management processes do you incorporate in your customary business operations? (check all that apply) Legal counsel review of contracts, agreements, content and business operations prior to release Plan/procedures for responding to and resolving customer or public complaints Formal customer sign-off or acceptance procedures (e.g. shrink-wrap licensing agreement, consulting services acceptance, custom software implementation acceptance, etc.) Published privacy policy Physical and systems security procedures (e.g. anti-virus software, firewalls, secure office environment with controlled access) Page 4 of 14

5 Part II of this application is arranged in sections based on specific classes of business. Only the questions in the section designated for the insured s class of business need to be answered. Part II COMPUTER CONSULTANTS, CUSTOM COMPUTER PROGRAMMING & APPLICATIONS SERVICES, WEBSITE DESIGN & DEVELOPMENT SERVICES, SOFTWARE & INTERNET DESIGN SERVICES (CLASS CODES: 65891, 42751, 41801, 11071, 11061, 11051, 11171) 1. Describe below the insured s business operations and products in detail. 2. Indicate services/products you provide and percent of revenue generated. Hardware Development/Sales (includes firmware for your hardware products only) Hardware Installation/Integration/Maintenance Pre-packaged Software Development Custom Programming Services and Software Development Software Installation/Integration/Maintenance Application Services, Rental, Leasing (ASP applications or services accessed and utilized by customers via the Internet) Systems Outsource/Systems Facility Management/Administration Consulting Services (advice only no other products/services included) Internet Access Website Design (include hosting for design customers only) Website Hosting Services E-Commerce Applications Other (describe fully) 3. Indicate functions your services/products perform: Training Education Fire/Security/Emergency CAD (computer aided design) Human Resources Scientific/Weather (seismology, etc.) Medical Purposes (diagnostics, patient care, biotech, non-administrative)* Utility/Natural Resource Processes (oil & gas/power/nuclear energy/waste disposal, etc.) Chemical Processing Manufacturing Processes/Controls (robotics, factory automation, CAM computer aided manufacturing) Financial Software (funds transfer, trading, financial modeling) Aerospace/Aircraft Transportation (automotive, watercraft, railroads, etc.) Computer Systems Security Advice/Products Pollution/Environmental Testing & Remediation Page 5 of 14

6 Administrative (billing, sales, marketing, etc.) Accounting Software (no funds transfer) Military/Defense (weapons procurement, guidance system, tracking, etc.)** Agriculture/Mining Machinery/Equipment Control (control of operating/moving parts of machinery, equipment toys, appliances) Supplying Internet Content for Others Other 4. Indicate percentage of employees working remote or via telecommuting % 5. What are total values of EDP equipment owned, leased or rented $ If values are over $250,000, is there a Central Station Fire/Smoke/Sprinkler alarm? 6. Does the insured have the authority to direct and control people (other than insured s own employees/subcontractors) on the job or in the field? 7. When performing services for others, what level of customer supervision is customary? Direct supervision by customer Limited supervision by customer with regular customer sign-off Limited supervision by customer without regular customer sign-off No direct supervision by customer but regular customer sign-off No direct supervision by customer and no regular customer sign-off 8. Does the insured have Technology E&O coverage? *this refers to medical/healthcare operations or equipment not to associated business functions such as accounting, billing, appointment scheduling or general office management. ** this refers to military/defense operations or applications (such as weapons procurement, ballistic missile technology) not to general office management such as general accounting or non-weapons, non-combat related procurement. Page 6 of 14

7 APPLICATION SERVICE PROVIDERS GENERAL BUSINESS APPLICATIONS, APPLICATION SERVICE PROVIDERS INDUSTRY VERTICALS, SOFTWARE DEVELOPERS, TECHNOLOGY SERVICE PROVIDERS, INTERNET SEARCH & INDEXING TOOL PROVIDERS, DATA PROCESSING (CLASS CODES 11011, 11021, 73371, 11041, 42161, 42071) 1. Describe below the insured s business operations and products in detail. 2. Indicate services/products you provide and percent of revenue generated. Hardware Development/Sales (includes firmware for your hardware products only) Hardware Installation/Integration/Maintenance Pre-packaged Software Development Custom Programming Services and Software Development Software Installation/Integration/Maintenance Application Services, Rental, Leasing (ASP applications or services accessed and utilized by customers via the Internet) System Outsource/Systems Facility Management/Administration Consulting Services (advice only no other products/services included) Internet Access Website Design (include hosting for design customers only) Website Hosting Services E-Commerce Applications Other (describe fully) 3. Indicate functions your services/products perform: Training Education Fire/Security/Emergency CAD (computer aided design) Human Resources Scientific/Weather (seismology, etc.) Medical Purposes (diagnostics, patient care, biotech, non-administrative)* Utility/Natural Resource Processes (oil & gas/power/nuclear energy/waste disposal, etc.) Chemical Processing Manufacturing Processes/Controls (robotics, factory automation, CAM computer aided manufacturing) Financial Software (funds transfer, trading, financial modeling) Aerospace/Aircraft Transportation (automotive, watercraft, railroads, etc.) Computer Systems Security Advice/Products Pollution/Environmental Testing & Remediation Administrative (billing, sales, marketing, etc.) Accounting Software (no funds transfer) Military/Defense (weapons procurement, guidance system, tracking, etc.)** Agriculture/Mining Machinery/Equipment Control (control of operating/moving parts of machinery, equipment, toys, appliances) Supplying Internet Content for Others Other Page 7 of 14

8 4. What are total values of EDP equipment owned, leased or rented $ If values are over $250,000, is there a Central Station Fire/Smoke/Sprinkler alarm? 5. Are software programs, Website programming and data essential to business operations backed up daily with back-up stored off-site? 6. Does the insured have Technology E&O coverage? *this refers to medical/healthcare operations or equipment not to associated business functions such as accounting, billing appointment scheduling or general office management. **this refers to military/defense operations or applications (such as weapons procurement, ballistic missile technology) not to general office management such as general accounting or non-weapons, non-combat related procurement. Page 8 of 14

9 COMPUTER SYSTEMS INTEGRATION SERVICES, COMPUTER FACILITIES MANAGEMENT, COMPUTER INSTALLATION, REPAIR & MAINTENANCE SERVICES COMMERCIAL, COMPUTER SERVICE OR REPAIR (CLASS CODES 11081, 11121, 11131, 48811, 48812, 48813) 1. Describe below the insured s business operations and products in detail. 2. Indicate services/products you provide and percent of revenue generated. Hardware Development/Sales (includes firmware for your hardware products only) Hardware Installation/Integration/Maintenance Pre-packaged Software Development Custom Programming Services and Software Development Software Installation/Integration/Maintenance Application Services, Rental, Leasing (ASP applications or services accessed and utilized by customers via the Internet) Systems Outsource/Systems Facility Management/Administration Consulting Services (advice only no other products/services included) Internet Access Website Design (include hosting for design customers only) Website Hosting Services E-Commerce Applications Other (describe fully) 3. Indicate functions your services/products perform: Training Education Fire/Security/Emergency CAD (computer aided design) Human Resources Scientific/Weather (seismology, etc.) Medical Purposes (diagnostics, patient care, biotech, non-administrative)* Utility/Natural Resource Processes (oil & gas/power/nuclear energy/waste disposal, etc.) Chemical Processing Manufacturing Processes/Controls (robotics, factory automation, CAM computer aided manufacturing) Financial Software (funds transfer, trading, financial modeling) Aerospace/Aircraft Transportation (automotive, watercraft, railroads, etc.) Computer Systems Security Advice/Products Pollution/Environmental Testing & Remediation Administrative (billing, sales, marketing, etc.) Accounting Software (no funds transfer) Military/Defense (weapons procurement, guidance system, tracking, etc.)** Agriculture/Mining Machinery/Equipment Control (control of operating/moving parts of machinery, equipment, toys, appliances) Supplying Internet Content for Others Page 9 of 14

10 Other 4. Are back-up procedures performed on all customer systems or equipment to be worked on immediately prior to beginning work? If no, explain below. 5. Is all electrical work performed by licensed electricians? If no, explain below. 6. Indicate percentage of operations: % residential % commercial % on insured s premises % on customer premises 7. Does the insured have Technology E&O coverage? 8. For all classes other than Computer Service or Repair 48811, 48812, 48813: When performing services for others, what level of customer supervision is customary? Direct supervision by customer Limited supervision by customer with regular customer sign-off Limited supervision by customer without regular customer sign-off No direct supervision by customer but regular customer sign-off No direct supervision by customer and no regular customer sign-off *this refers to medical/healthcare operations or equipment not to associated business functions such as accounting, billing, appointment scheduling or general office management. ** this refers to military/defense operations or applications (such as weapons procurement, ballistic missile technology) not to general office management such as general accounting or non-weapons, non-combat related procurement. Page 10 of 14

11 HOSTING RESELLERS (CLASS CODE 11031) 1. Describe below the insured s business operations and products in detail. 2. Are any Internet access or connectivity services provided? If yes, describe below. 3. Are any hosting services performed? If yes, describe below. 4. Does the insured have Technology E&O coverage? Page 11 of 14

12 ELECTRONICS & HARDWARE MANUFACURERS (CLASS CODES 35711, 35712, 43501, 43502, 35721, 35722, 43511, 43512, 35751, 35752, 43521, 43522, 35771, 35772, 43531, 43532, 35781, 35782, 43541, 43542, 35791, 35792, 43551, 43552, 36511, 36512, 43641, 43642, 36521, 36522, 43561, 43562, 36611, 36612, 43651, 43652, 36631, 36632, 43661, 43662, 36711, 36712, 43571, 43572, 36721, 36722, 43581, 43582, 36751, 36752, 43591, 43592, 36761, 36762, 43601, 43602, 36781, 36782, 43611, 43612, 36791, 36792, 43621, 43622, 36951, 36952, 43631, 43632, 43671, 43672, 43681, 43682, 43691, 43692, 43701, 43702, 43711, 43712, 43721, 43722) 1. Describe below the insured s business operations and products in detail. 2. Indicate services/products you provide and percent of revenue generated. Hardware Development/Sales (includes firmware for your hardware products only) Hardware Installation/Integration/Maintenance Pre-packaged Software Development Custom Programming Services and Software Development Software Installation/Integration/Maintenance Application Services, Rental, Leasing (ASP applications or services accessed and utilized by customers via the Internet) Systems Outsource/Systems Facility Management/Administration Consulting Services (advice only no other products/services included) Internet Access Website Design (include hosting for design customers only) Website Hosting Services E-Commerce Applications Other (describe fully) 3. Indicate functions your services/products perform: Training Education Fire/Security/Emergency CAD (computer aided design) Human Resources Scientific/Weather (seismology, etc.) Medical Purposes (diagnostics, patient care, biotech, non-administrative)* Utility/Natural Resource Processes (oil & gas/power/nuclear energy/waste disposal, etc.) Chemical Processing Manufacturing Processes/Controls (robotics, factory automation, CAM computer aided manufacturing) Financial Software (funds transfer, trading, financial modeling) Aerospace/Aircraft Transportation (automotive, watercraft, railroads, etc.) Computer Systems Security Advice/Products Pollution/Environmental Testing & Remediation Administrative (billing, sales, marketing, etc.) Accounting Software (no funds transfer) Military/Defense (weapons procurement, guidance system, tracking, etc.)** Agriculture/Mining Page 12 of 14

13 Machinery/Equipment Control (control of operating/moving parts of machinery, equipment, toys, appliances) Supplying Internet Content for Others Other 4. Does the insured have Technology E&O coverage? *this refers to medical/healthcare operations or equipment not to associated business functions such as accounting, billing, appointment scheduling or general office management. ** this refers to military/defense operations or applications (such as weapons procurement, ballistic missile technology) not to general office management such as general accounting or non-weapons, non-combat related procurement. Page 13 of 14

14 Agency Code Sub-Code Insured s Name and Address (Street, City, State and Zip Code) Agent s Signature (Not applicable in Colorado, Hawaii, Nebraska, Ohio, Oklahoma, Oregon, Utah and Vermont) Any person who knowingly and with intent to defraud any insurance company or another person files an application for insurance containing any materially false information, or conceals for the purpose of misleading information concerning any fact material thereto, commits a fraudulent insurance act, which is a crime and subjects the person to criminal and (NY: substantial) civil penalties. In the District of Columbia, Louisiana, Maine, Tennessee and Virginia, insurance benefits may also be denied. Applicable in Ohio Any person who, with intent to defraud or knowing that he/she is facilitating a fraud against an insurer, submits an application or files a claim containing a false or deceptive statement is guilty of insurance fraud. Applicable in Oklahoma WARNING: Any person who knowingly, and with intent to injure, defraud or deceive any insurer, makes any claim for the proceeds or an insurance policy containing any false, incomplete or misleading information is guilty of a felony. Applicable in Colorado It is unlawful to knowingly provide false, incomplete, or misleading facts or information to an insurance company for the purpose of defrauding or attempting to defraud the company. Penalties may include imprisonment, fines, denial of insurance, and civil damages. Any insurance company or agent of an insurance company who knowingly provides false, incomplete, or misleading facts or information to a policy holder or claimant for the purpose of defrauding or attempting to defraud the policy holder or claimant with regard to a settlement or award payable from insurance proceeds shall be reported to the Colorado Division of Insurance within the Department of Regulatory Agencies. Applicable in Virginia The representations and statements contained herein are incorporated in and constitute part of the Coverage Part. Page 14 of 14