Cyber Application - Morrow Insurance Agency, Inc.

General Information

Name of Organization *

Contact Person *

Phone Number *

Email Address *

Mailing Address *

Type of Business *

Corporation

Partnership/Joint Venture

Limited Liability

Other

Description of Business *

Years in Business *

Total Annual Revenue *

General Underwriting Questions

Do you collect snd/or store any of the following types of electronic data for third parties (e.g. customers or business partners, etc)?

What is the estimated number of customer data that you keep electronic records of? *

Is the customer data encrypted? *

No

Yes

Are you subject to Health Insurance Portability and Accountability Act (HIPPA) and Health Information Technology for Economic and Clinical Health Act (HITECH) law? *

No

Yes

If so, are you in compliance?

No

Yes

If your organization handles credit/debit card information and is subject to PCIDSS Payment Card Industry Data Security Standards, are you in compliance? *

No

Yes

Employment Practices

Do you publish and distribute information technology security and privacy policies to all employees? *

No

Yes

Do you provide training to your employees on information security awareness? *

No

Yes

Do you conduct any of the following screening on new employees? (Check all that apply.)

Drug

Criminal

Credit

Past Experience

Do you currently have a policy that provides coverage similar to the policy being sought? *

No

Yes

Has any insurer ever cancelled or non-renewed a policy that provided coverages similar to the policy being sought? *

No

Yes

In the past 2 years, have you been sued or threatened by a suit related to your website content, e-commerce activity, or computer data safety? *

No

Yes

If so, please describe the claimant, the circumstances, the legal claim, and the status: _

Are any of the proposed insured aware of any act, error, or omission that may be reasonably expected to give rise to a claim against you? *

No

Yes

If so, please describe:

Questions for Insuring Agreement 1 Coverage Only

Is your website(s) reviewed for potential legal liability issues by internal or external counsel? *

No

Yes

Website Contents:
Do you provide content targeted towards children on your website? *

No

Yes

If so, do you ever collect any personal information from children?

No

Yes

Does any part of your website contain material not suitable for general audience? *

No

Yes

Who provides the content for your Web site(s)? (Check all that apply.)

Your employees

Third Parties

Your website users

For Social Media Activities:
What social media activities is your business currently involved in? (Facebook, Twitter, LinkedIn, etc.)

Does your business have a social media policy? *

No

Yes

Do you have a designated administrator for your social media site? *

No

Yes

For the content provided by third parties:
Do you always obtain copyright for all text, images, audio, video, or other material used on your website? *

No

Yes

If the website is created or maintained by a contractor, do you always obtain a Hold Harmless Agreement from the service provider? *

No

Yes

For the content on your website generated by your website visitors:
Do you clearly disclaim liability for the visitor generated content? *

No

Yes

N/A

Do you act solely as a distributor of the user generated content by refraining from editing or contributing to it? *

No

Yes

Do you immediately remove user generated content upon receiving complaint about or upon suspecting infringement of other’s copyrights? *

No

Yes

Questions for Insuring Agreement 2 through 8 Coverages

Physical Security:
Do you control access to computer rooms using keys or keycards? *

No

Yes

Do you have a functional intrusion alarm system? *

No

Yes

Do you maintain a visitor's log and do you escort the visitors at all times? *

No

Yes

Do you enforce a policy to leave desks clear of all sensitive information? *

No

Yes

Access Control:
Is there a process to determine and monitor appropriate physical and system access granted to all employees? *

No

Yes

Is there a process to promptly remove physical and system access upon departure of any individual, either an employee or a contractor? *

No

Yes

Record Disposal:
Are paper records shredded when no longer needed? *

No

Yes

Is electronic data always erased from discarded computers or storage media? *

No

Yes

Anti-Virus:
Do you subscribe to the latest anti-virus/malware/spyware products? *

No

Yes

If yes, is this protection provided on all desktops and servers?

No

Yes

Is protection provided to remote users also? *

No

Yes

Mobile Devices:
Do you encrypt the data on the hard disk of laptops? *

No

Yes

Do you subscribe to any service that can remotely erase data on a stolen laptop? *

No

Yes

Is password protection enforced on smart phones (e.g. iPhone, Blackberry)? *

No

Yes

Firewall:
Do you have a network firewall? *

No

Yes

Does the firewall have “Deny all” as a default option *

No

Yes

Unless specifically authorized, are all externally initiated connections blocked by default? *

No

Yes

Does the firewall keep a log of access granted/denied? *

No

Yes

How long are firewall logs retained?

Remote Connections:
Do all remote users use a secure connection? *

No

Yes

Is any stronger authentication besides password utilized for remote connections (e.g. RA S keyfob, additional password, etc)? *

No

Yes

Information Security Assessment:
Do you have a person or group responsible for information security? *

No

Yes

Have your employees or a third party ever conducted an information security assessment on your organization? *

No

Yes

If yes, please describe who did the assessment, when, and what were the results?

Business Continuity Plan:
How frequent is critical data backed up? _ *

Is the backup encrypted? *

No

Yes

How long are backups retained? *

Is at least one copy of a complete backup stored in a secure remote location? *

No

Yes

Do you have a business continuity plan? *

No

Yes

If yes, is the business continuity plan tested periodically for the expected recovery? *

No

Yes

How long does it take you to restore your most critical business activities?_

Do you have backup power options? (Check all that apply.)

Second independent power line

Backup generator

Battery Backup

Do you have two independent internet service providers with a failover plant? *

No

Yes

NOTICE TO APPLICANT – PLEASE READ CAREFULLY
For the purpose of this Application, the undersigned authorized officer of the organization named in General Information of this Application declares that to the best of the organization’s knowledge the statements herein are true, accurate and complete. The insurer is authorized to make any inquiry in connection with this Application. Signing this Application does not bind the insurer to issue, or the applicant to purchase, any insurance policy issued in connection with this Application. If the information in this Application materially changes prior to the effective date of the policy, the applicant will promptly notify the insurer, who may modify or withdraw the quotation.
The undersigned declares that the individuals and entities proposed for this insurance have been notified that:
• This policy applies only to “claims” first made or deemed made against an “insured” during the “policy period” or during the applicable extended reporting period; and
• The limit of liability is reduced by amounts incurred as “defense expenses” and such expenses will be subject to the deductible amount.
Words within quotation marks are defined in the insurance policy.
Misrepresentation of any material fact in this Application may be grounds for rescission of this policy.
FRAUD STATEMENT
Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or knowingly presents false information in an application for insurance is guilty of a crime and may be subject to fines and confinement in prison.

Cyber Insurance Application

We offer coverage in your state.

Thank you for your interest. Unfortunately we are unable to offer Cyber Insurance Quotes in your state at this time.

Please Select Your State to Begin

Pin It on Pinterest