Business  Insurance for Technology Companies in Texas

I can work to put a package policy together that will be designed specifically for your company.

Coverages can include errors and omission, products liability, intellectual property rights infringement, payment of withheld fees, general liability and property.

This is a comprehensive application for insurance and intended for clients that have gone through my initial consultation process.

How to Complete This Form

Whoever fills out the form must be a principal, partner or director of the firm.

Please complete the sections as best as possible.  If you do not know the answer leave it blank and we can discuss on our  call to review.

Name *
Name
Address *
Address
Phone *
Phone
http://
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Please give details of your top 3 contracts in the last 3 years. Name of Client Nature of Business Annual Income from Contract Start Date / Completion Date
Are you involved in medical, aviation, financial, or telecommunications software?
Breakout of Revenue by Activity
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Do you use outsourced consulting, programming or similar service?
Do you carry out work only under a written contract signed by every client?
If no, we will need to discuss.
Do you ever accept contracts with your customers in which you accept liability for consequential loss or financial damages greater than the value of the contract?
Do any of your contracts contain a service credit or liquidated damages regime
If yes, I will need a sample.
Are all your contracts reviewed by an appropriately qualified legal advisor prior to signature?
Is the delivery of any of your projects / contracts time critical ?
e.g. tied to a specific external event, on the critical path for a larger project, tied to a major sporting event, etc.)
Could the failure of your product / services result in the loss of life or injury to a person?
If yes, we will need to discuss.
Could the failure of your product / services result in damage or destruction to any physical property?
If yes, we will need to discuss.
In the event that your product / service failed or delivery was delayed please select the response which best describes the worst case scenario:
Do you ensure that sub-contractors have their own Errors and Omissions and General Liability insurance?
Current Insurance Carrier Effective Date Limits Premium
If yes - Please explain.