Cyber Liability Quote Personal InformationFirst Name *Last Name *Street Address *City *State/Province *ZIP / Postal Code *Phone Number *Alternate Phone NumberWebsiteIs Your Website HTTPS Enabled?YesYesNoEmail Address *Fax#Number of Partners/OwnersLegal EntitySole ProprietorshipSole ProprietorshipC CorporationPartnershipS CorporationLimited Liability corporationOtherNumber of Full Time EmployeesYears In BusinessYears of Owner Experience Within Business?Number of Part Time EmployeesAnnual RevenueUnder $100,000Under $100,000$100,000 - $500,000$500,000 - $1,000,000$1,000,000 - $5,000,000$5,000,000 - $10,000,000Over $10,000,000Annual PayrollLess then $50,000Less then $50,000$50,000 - $100,000$100,001 - $2,000,000$200,001 - $500,000Over $500,000Number of SubcontractorsOne Time or Seasonal?YesYesNoBrief Description of BusinessSpecific Industry?Does the Company develop computing hardware or customized software code?YesYesNoNADoes the Company develop computing hardware or customized software code?YesYesNoNAIf yes, please indicate the aggregate limit of liability being requestedDo you have any subsidiary businesses?YesYesNoNAOther InsuranceDo you have Professional Liability (E&O‎)?YesYesNoNADo you have a D&O Policy?YesYesNoNADo you have General Liability G&L‎?YesYesNoNADo you have Cyber Privacy Liability Policy?YesYesNoNASecurity ProtocolsDoes the Company conduct security awareness training?YesYesNoNADoes the Company conduct a check on Criminal Convictions?YesYesNoNADoes the Company conduct a check on Educational Background?YesYesNoNADoes the Company conduct a check on Credit History?YesYesNoNADoes the Company conduct Drug Testing?YesYesNoNADoes the Company conduct a check on Work History?YesYesNoNADoes the Company conduct a check on References?YesYesNoNAInformation SecurityDoes the Company conduct a formal risk assessment that is reviewed at least annually‎?YesYesNoNADoes the Company have a Designated Chief Security Officer‎?YesYesNoNAIs IT is outsourced to third-party IT service provider‎?YesYesNoNADoes the Company have a An Information Security Policy communicating how information is protected by the organization‎?YesYesNoNADoes the Company have an Acceptable Use Policy communicating appropriate use of data to users‎?YesYesNoNADoes the Company have a Privacy Policy?YesYesNoNADoes the Company have Written Employee Information Security Policies and Procedures‎?YesYesNoNADoes the Company have a Data Retention Policy?YesYesNoNADoes the Company Have a Documented Business Continuity and Disaster Recovery Plan‎?YesYesNoNAIs your company compliant with any regulatory or compliance frameworksYesYesNoNAHas Company conducted a risk assessment in the past 12 months?YesYesNoNAHas Company suffered any known intrusions (i.e., unauthorized access) of its Computer Systems in the past 12 months?YesYesNoNADoes the Company have an incident response plan for network intrusions and data security breaches?YesYesNoNADoes the Company use written contracts or agreements related to the services provided to clients?YesYesNoNADoes the Company subcontract any of its services to Independent Contractors?YesYesNoNADoes the Company provide remote access to its Computer Systems to employees or vendors?YesYesNoNADoes the Company enforce passwords that are at least seven characters and contain both numeric and alphabetic characters?YesYesNoNAHow frequently does the Company require its employees/users to change their passwords?YesYesNoNAHow often does the Company conduct data security system checks?YesYesNoNAIs This Technology Used by the CompanyFirewalls at the perimeter of the network‎?YesYesNoNAFirewalls in front of sensitive resources inside the network‎‎?YesYesNoNAAnti-Virus Scanning?YesYesNoNAIntrusion detection system (IDS)‎?YesYesNoNACentralized log collection and monitoring?YesYesNoNAProactive vulnerability scanning/penetration testing‎?YesYesNoNAPhysical controls preventing access to the devices themselves‎‎?YesYesNoNAMulti-factor authentication‎?YesYesNoNAEmail and web browser protections‎‎?YesYesNoNASSL/TLS protocols‎?YesYesNoNADisabled USB ports‎?YesYesNoNAApplication Software Security‎?YesYesNoNAOther ProtocolsDoes the Company have a formal process in place to automatically push updates to all computing resources for critical updates, patches and security hot-fixes?YesYesNoNAHow often is valuable/sensitive data backed-up by the Company?Does the Company process credit or debit card transactions?YesYesNoNAPlease select the Company's applicable PCI Compliance Level:PCI Compliance 1PCI Compliance 1PCI Compliance 2PCI Compliance 3PCI Compliance 4NAProvide the average monthly payment system transactions processed:Forms & Confidential InformationDoes the Company maintain any Confidential Information under their care, custody, and control or outsourced to a cloud provider?YesYesNoNAPersonal Health Information(PHI)?YesYesNoNAFinancial Account Information‎?YesYesNoNAPersonal Identifiable Information(PII)‎?YesYesNoNAUsernames and Passwords‎‎?YesYesNoNAEmployee Information‎‎‎?YesYesNoNAPayment Card Information‎‎‎?YesYesNoNAThird-Party Intellectual Property/Trade Secrets‎‎‎‎?YesYesNoNAPublicly available personal information?YesYesNoNAPublicly available trade information?YesYesNoNACoverage LimitsPersonal Health Information(PHI)?NoneNone0-25k25k-100k100k-1M1M-3M3M-5MOver-5MFinancial Account Information?NoneNone0-25k25k-100k100k-1M1M-3M3M-5MOver-5MPersonal Identifiable Information(PII)?NoneNone0-25k25k-100k100k-1M1M-3M3M-5MOver-5MUsername and Passwords?NoneNone0-25k25k-100k100k-1M1M-3M3M-5MOver-5MThird-Party Intellectual Property/Trade Secrets?NoneNone0-25k25k-100k100k-1M1M-3M3M-5MOver-5MPlease estimate number of records:Company OwnerOwner First Name *Owner Last Name *Additional InformationPrior InsuranceLength of Coverage (Month and Years)Have You Had Any Claims Or lapses In Coverage In Past 3 yearsYesYesNoNACommentsHow did you hear about us?Send
