Technology Errors & Omissions Liability Application - FailSafe MEGA®

Requesting Your Policy

Please tell us some information about the applicant and coverage selections before submitting your application. Keep in mind that:

  • All answers are required unless they're marked "optional"
  • The words "we", "us", and "our" refer to the insurer
  • The words "applicant", "you", "yours" and "your" refer to the person or entity requesting insurance. This includes the applicant as well as all subsidiaries in which the applicant has more than a 50% ownership interest, as well as all officers, directors, owners, partners and employees of those entities.

Your Contact Information

Let's start with the basics about you and your business.
Do you have a Spectrum Policy Number?

Your Coverage Information

You may need to send some additional information if you request limits of $2M/$2M or more. We'll let you know if we need anything.

Your Business

Now tell us a little about your products and/or services.
Which technology products or services do you offer? Select all that apply, including all consulting services.
Software, Communication, and Connectivity Products/Services
Hardware Products/Services
Other Products/Services
How are your end customers using the products, software or services you provide? Select all that apply.

Your Revenues and Expenses

Tell us a little about your revenue and expense projections for the next 12 months. Include all pass-through costs for hardware and software sales.

Your Customers and Contracts

Now we'll ask about the contracts you use with your customers.
I, being duly authorized, have read the above application and declare to the best of my knowledge and belief all of the foregoing statements are true, and that these statements are offered as an inducement to the Company to issue the policy for which I am applying. (Kansas: This does not constitute a warranty).

First State Insurance Company (N/A in MA) New England Reinsurance Corporation (N/A in MA)
Hartford Accident and Indemnity Company Nutmeg Insurance Company (N/A in MA)
Hartford Casualty Insurance Company Omni Indemnity Company (N/A in MA)
Hartford Fire Insurance Company Omni Insurance Company (N/A in MA)
Hartford Insurance Company of Illinois (N/A in MA) Pacific Insurance Company, Limited (N/A in MA)
Hartford Insurance Company of the Midwest Property and Casualty Insurance Company of Hartford
Hartford Insurance Company of the Southeast (N/A in MA) Sentinel Insurance Company, Ltd.
Hartford Lloyd's Insurance Company (N/A in MA) Trumbull Insurance Company (N/A in MA)
Hartford Underwriters Insurance Company Twin City Fire Insurance Company
New England Insurance Company (N/A in MA)