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Location: Home >> Quotes >> IT Quote
 
Information Technology Questionnaire Information Technology Questionnaire
Please fill out the information below and we will send you a quote by e-mail.


General Information
Your Name: 
Company Name: 
Year Established: 
Organization Type: 
Street Address: 
Mailing Address: 
City: 
State/Province: 
Zip/Postal Code: 
Phone: 
Fax: 
Website: 
E-mail: 
Number of Employees: 
Receive capital funding?  Yes    No
Annual Sales: 
Briefly describe your
product or services: 
How did you hear about us? 


Property Information
If you own your building or are responsible for its insurance, how much is it insured for?  $
What is the replacement value of your business personal property?
(including: inventory, furniture and fixtures, computers, phone system, data processing media and leasehold improvements)  		$
What is the construction of your building?  Frame    Masonry    Noncombustible
Are there automatic sprinklers?  Yes    No
How many square feet is the building? 
How much do you occupy? 
Is this your main location?  Yes    No
How many locations do you have? 
Additional comments: 


Computer Software and Services Errors and Omissions
Do you currently carry E&O insurance?  Yes    No
If so, when did it start?  (MM/DD/YYYY)
Were there any lapses?  Yes    No


Company information
Do you provide product support?  Yes    No
Do you maintain a list of customers for follow-up contact?  Yes    No
What is the size of your average contract/product cost?  $
What is the size of your largest contract/product cost?  $
Do you generate 85% or more of your revenue from the temporary leasing of computer programmers?  Yes    No
Did you ever or do you derive any revenue from Year 2000 related activities?  Yes    No
Does the application of the software products you develop or the services you provide include the following: 
(Please check all that apply) 		 Medical purposes
 Aerospace/Defense applications
 Fire Security/other emergency applications
 Online security advice/products
 Manufacturing process controls
Please describe items above: 


For Custom Software and Systems
Do you have a standard signed contract with every customer that specifies objectives at the beginning of the project?  Yes    No
Is the contract modified if interim changes are made, and signed by both parties?  Yes    No
Is the contract signed again at the final acceptance of the project?  Yes    No


For Pre-Packaged Software
Do you fully test your products prior to production release?  Yes    No
Do you use a license agreement 100% of the time?  Yes    No


Automobiles
Do you own or lease any vehicles?  Yes    No
If so please provide the year, make, model and original cost new? 
(ex. 1999 Ford Taurus $18,500)
How are they used? 


Workers Compensation
If you would like a worker's comp quote, please answer the following. 
Please provide payrolls by classification: 
Please provide experience modification, if any, from your current policy: 


Loss History
For the coverage being applied for, have you had any claims in the past 3 years?  Yes    No
If yes, have they exceeded $10,000?  Yes    No
Have you received any complaint letters from customers during the last 3 years?  Yes    No
If yes, please explain: 


    
 
 
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