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Contact Information

Name
Do you have a general liability policy?
What technologies does the website to be hosted with A+ Security utilize?

Named Insured Information

Named Insured Address
Please list all website addresses including web and email domains

Loss History

Please answer the following questions regarding prior cyber incidents, claims, or losses.
1. During the past three years, did the Named Insured experience a cyber incident, claim or loss, whether insured or not, which could have been covered under a policy similar to the proposed insurance,
YesNo
a. actual or reasonably suspected data breach or security failure, including notifying consumers or third parties of a data breach or security failure.
Yes
No
b. claims or complaints with respect to privacy injury, breach of information or network security, unauthorized disclosure of information, defamation, or content infringement.
Yes
No
c. government action, investigation, or subpoena regarding any alleged violation of a privacy law or regulation; or
Yes
No
d. actual or attempted extortion demand with respect to (insured’s) data or computer systems.
Yes
No
2. Does the Named Insured have knowledge or information regarding any fact, circumstance, situation, or event that could reasonably give rise to a claim or loss under the proposed insurance?
If the Named Insured has knowledge or information regarding any fact, circumstance, situation, or event that may give rise to a claim or loss under the proposed insurance policy, any claim or loss arising therefrom is excluded from the coverage.

Security Controls

3. Does the Named Insured implement encryption on laptop computers, desktop computers, and other portable media devices?
4. Does the Named Insured collect, process, store, transmit, or have access to any Payment Card Information (PCI) or Personally Identifiable Information (PII), other than employees of the Named Insured?
Likert Scale
No RecordsLess Than 100,000100,000-500,000500,000-1,000,000Over 1 million
4a. If yes, what is the estimated annual volume of payment card transactions (credit cards, debit cards, etc.)?
No Records
Less Than 100,000
100,000-500,000
500,000-1,000,000
Over 1 million
4b. If yes, how many PII records does the Named Insured collect, process, store, transmit, or have access to?
No Records
Less Than 100,000
100,000-500,000
500,000-1,000,000
Over 1 million
5. Does the Named Insured maintain at least weekly backups of all sensitive or otherwise critical data and all critical business systems offline or on a separate network?
6. For which of the following services does the Named Insured enforce Multi-Factor Authentication (MFA)?
YesNoNo Access Allowed
6a. Email
Yes
No
No Access Allowed
6b. Virtual Private Network (VPN)
Yes
No
No Access Allowed
6c. Remote Desktop Protocol (RDP), RD Web, RD Gateway, or other remote access
Yes
No
No Access Allowed
6d. Network / cloud administration or other privileged user accounts
Yes
No
No Access Allowed
7. Does the Named Insured require a secondary means of communication to validate the authenticity of:
YesNoNot Applicable
7a. Funds transfer requests (Bacs, Faster Payments, CHAPS, SWIFT, etc.) before processing a request in excess of $5,000?
Yes
No
Not Applicable
7b. Any request to change banking details (Account #, Routing #, IBAN, SWIFT, payroll distribution, etc.)?
Yes
No
Not Applicable
8. Within the last 3 years has the Named Insured been subject to any complaints concerning the content of its website, advertising materials, social media, or other publications?
9. Does the Named Insured enforce procedures to remove content (including third party content) that may infringe or violate any intellectual property or privacy right?

Technology Errors & Omissions Questions

1. Within the last 3 years has Named Insured been subject to a dispute or claim arising out of a technology services error or omission?
Enter a percentage (0–100) for each service. If not applicable, enter 0.

SOFTWARE

HARDWARE

TELECOMMUNICATION

OUTSOURCED SERVICES

CRYPTOCURRENCY

IT CONSULTANCY SERVICES

OTHER

4. Provide the value and duration (in months) of the Named Insured’s three largest contracts
5. How does Named Insured limit its liability in its standard contracts?
YesNo
CONTRACT VALUE PERCENTAGE
Yes
No
ANNUAL FEE PERCENTAGE
Yes
No
FIXED AMOUNT
Yes
No
NO LIMIT
Yes
No
NOT SURE
Yes
No
6. How does Named Insured limit its liability in its standard contracts?
YesNo
LESS THAN 10%
Yes
No
11% - 15%
Yes
No
26% - 50%
Yes
No
51% - 75%
Yes
No
76% - 100%
Yes
No
NOT SURE
Yes
No
7. Identify the standard risk mitigating clauses or methods contained within Named Insured’s agreements or contracts.
YesNo
CUSTOMER SIGN OFF
Yes
No
DISCLAIMER OF WARRANTIES
Yes
No
HOLD HARMLESS AGREEMENTS
Yes
No
LIMITATION OF LIABILITY
Yes
No
EXCLUSION OF DAMAGES
Yes
No
BINDING ARBITRATION
Yes
No
MILESTONES
Yes
No
ARBITRATION CLAUSE
Yes
No
EXCLUSIVE REMEDY
Yes
No
NETWORK INTERCONNECTIVITY
Yes
No
DATA/PRIVATE INFORMATION RIGHT/RESPONSIBILITIES
Yes
No
RISK MITIGATION CLAUSE