TECHNOLOGY ERRORS and OMISSIONS LIABILITY INSURANCE APPLICATION FORM SECTION 1 - APPLICANT INFORMATION

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1 Royal & Sun Alliance Insurance Company of Canada 18 York St., Suite 800 Toronto, ON M5J 2T8 TECHNOLOGY ERRORS and OMISSIONS LIABILITY INSURANCE APPLICATION FORM The Insurance Policy for which you are applying is written on a claims-made and reported basis coverage will be limited to claims first made against the Insured and reported to Royal & Sun Alliance Insurance Company of Canada (the Company ) during the policy period. Furthermore, the limits of liability will be reduced and may be completely exhausted by claims expenses. The deductible will be applicable to claims expenses unless explicitly stated otherwise in the Policy. Please attach copies of the following: 1. the standard contract, engagement letter or any other written agreements used by the Applicant in the provision of services; 2. the most recent available Annual Report / Financial Statements; 3. any promotional material; and 4. resumes or bio-sketches of partners, principals or other key employees. Please answer all questions indicate N/A if the question is not applicable. A. Applicant s name: SECTION 1 - APPLICANT INFORMATION B. Mailing address: C. Year Applicant originally established: D. Business structure: Individual Partnership Corporation Other (describe): Publicly traded Privately held E. Website address: F. Total number of Principals, Partners, Directors, Officers and Professional Employees directly involved in providing services to others: G. Total number of all other non-professional employees: H. List any other businesses/entities wholly or partially owned, operated managed or controlled by the Applicant and the services provided by each entity: I. Provide details of any past mergers, acquisitions or consolidations involving the Applicant: T EO app (09/12) 1

2 A. Complete the following: SECTION 2 FINANCIAL INFORMATION Fiscal Year Total Canadian Revenue Total U.S. Revenue Total Other Foreign Revenue Next Year $ (Projected) $ (Projected) $ (Projected) Current Year $ $ $ Prior Year $ $ $ B. Provide the percentage of the projected total gross revenue derived from each of the following services and products: Application Service Provider (ASP) Colocation Facilities including Network Management and Security Services Computer and Technology Consulting and Training E-Commerce Hardware Manufacturing Internet Media (Advertising / Publishing / Broadcasting) Internet Service Provider (ISP) Software Development and Sales Custom Software Development and Sales Pre-packaged Software Licensing Supervisory Control and Real-Time Data Management Solutions Systems Analysis and Design Systems Integration / Installation / Maintenance Telecommunications Local / Long Distance / Cellular / VoIP Website Design Services Website Hosting Services Other (Please describe): C. Provide the percentage of the projected total gross revenue derived from each of the following industries: Architects and Engineers Aviation Emergency Response Services (Ambulance, Fire, Police) Financial Institutions Gambling Healthcare and Medical Manufacturing Utilities (Electrical, Oil and Gas, Power) Video Games Other (Please describe): T EO app (09/12) 2

3 D. Complete the following with regard to the Applicant s five largest clients/engagements during the past three years: Client Service(s) Provided Contract Duration Gross Revenue SECTION 3 - OPERATIONS INFORMATION A. What percentage of the services noted in SECTION 2-B above is subcontracted out? B. Does the Applicant require its subcontractors to maintain errors and omissions insurance? If so, what limits are subcontractors typically required to carry? $ C. Have the standard contract, engagement letter and/or any other written agreements used by the Applicant in the provision of services been reviewed by legal counsel? D. Are the Applicant s services provided under written agreement for ALL jobs / engagements? If not, provide details as to why: E. Who reviews and/or has the authority to approve any modifications to the Applicant s standard contracts? F. Does the Applicant s standard contract contain the following: a specific description of the services or products to be provided a limitation of liability clause a hold harmless clause in favour of the Applicant guarantees and or warranties with regards to the Applicant s services or products a force majeure clause an indemnification clause in favour of the Applicant G. Does the Applicant require all mid-term changes to contracts be acknowledged in writing by all parties? H. Does the Applicant have final acceptance / sign-off procedures with regards to completed services? I. Do the Applicant s quality control procedures require the following to be performed: Alpha Testing Beta Testing J. Describe the process the Applicant has in place to notify customers of updates and or patches made to its software or other products: K. Does the Applicant have a process in place to handle and resolve customer complaints? L. Does the Applicant have procedures in place to handle and resolve fee disputes with clients? T EO app (09/12) 3

4 M. Does the Applicant have written company policies and procedures for employees to follow? N. Does the Applicant have a formal training program for newly hired employees? O. Provide details of any other risk management procedures in place: P. Provide details of any disaster recovery / business continuity plans in place: Q. List any professional licenses, designations or certifications held by employees: R. List any professional associations to which the Applicant belongs: S. Provide details of any changes in the nature or size of the Applicant s business anticipated over the next 12 months: A. Anti-Virus program utilized by the Applicant: SECTION 4 NETWORK MANAGEMENT B. Firewall utilized by Applicant: C. Does the Applicant have a formalized system and procedure in place to conduct security audits? D. Who conducts this security audit? E. How often are security audits conducted? F. When was the last security audit conducted? G. Have all recommendations from the last security audit been implemented? H. Does the Applicant have a formalized system and procedure in place for the daily (or more frequent) backup of files and data? I. Are the backup files stored in a location other than the Applicant s facility? J. How long would it take the Applicant to fully restore its IT system in the event of a loss or corruption of data? K. Does the Applicant have a formalized system and procedure in place to limit and control access to server and other sensitive areas? L. Has the Applicant experienced any type of a security breach or any downtime in its servers in the past 5 years? If so, please describe what measures were taken by the Applicant to respond to these events: T EO app (09/12) 4

5 SECTION 5 - INSURANCE INFORMATION A. Provide details of any past errors and omissions insurance or professional liability insurance that was declined, cancelled or non-renewed by an insurer: B. Provide details for any errors and omissions insurance or professional liability insurance carried by the Applicant in the last three years: Year Insurer Limits Deductible Premium Retro Date C. Insurance Coverage Requirements: Limits: $ Deductible: $ Retroactive Date: $ $ $ $ $ $ $ $ $ SECTION 6 - CLAIMS HISTORY A. After inquiry, are any principals, directors, officers, partners, employees or independent contractors aware or have knowledge or information of any actual or alleged acts, errors, omissions, offenses or circumstances which might reasonably be expected to give rise to a claim against the Applicant or any proposed insured entity? If yes, please provide details: THERE IS NO COVERAGE FOR ANY CLAIMS BASED UPON, ARISING FROM OR RELATED TO THE FACTS OR CIRCUMSTANCES DESCRIBED ABOVE. B. Have all of the matters noted above been reported to its current or former insurer(s)? C. Provide details (date, circumstances, quantum and current status) of any past errors and omission or professional liability claims made against the Applicant, any of the Applicant s predecessors in business, subsidiaries, affiliates or any principal director, officer, partner or employee: THERE IS NO COVERAGE FOR ANY CLAIMS BASED UPON, ARISING FROM OR RELATED TO THE FACTS OR CIRCUMSTANCES DESCRIBED ABOVE. D. Provide details (date, circumstances, quantum and current status) of any disciplinary action by a regulatory body or authority taken against the Applicant, any of the Applicant s predecessors in business, subsidiaries, affiliates, or any principal, director, officer, partner or employee: THERE IS NO COVERAGE FOR ANY CLAIMS BASED UPON, ARISING FROM OR RELATED TO THE FACTS OR CIRCUMSTANCES DESCRIBED ABOVE. T EO app (09/12) 5

6 IMPORTANT NOTICE CONCERNING DISCLOSURE Your submission for this insurance does not obligate the Company to issue a Policy. Application for coverage is accepted. You will be advised if your Any person who, knowingly and with intent to defraud any insurance company or other person, files an application for insurance containing any false information, or conceals any fact that may influence an Insurer's judgment in their consideration of the application, commits a fraudulent insurance act, which is a crime. If there are material changes in the answers to the questions in this Application prior to the Policy inception date, the Applicant will notify the Company in writing and any outstanding quotation may be modified or withdrawn. DECLARATION The undersigned, on behalf of the Applicant, declares that, to the best of knowledge and belief of the undersigned, the statements set forth herein are true. Although the signing of this Application does not bind the undersigned on behalf of the proposed Applicant or its directors, officers or other insured persons to effect the insurance, the undersigned agrees that this Application and its attachments shall be the basis of the contract should a Policy be issued and shall be deemed to be attached to and shall form part of any such Policy. The Company is authorized to make any investigation and inquiry in connection with the Application that it deems necessary. The undersigned, on behalf of the Applicant, acknowledges that any personal information provided in connection with this Application (including but not limited to the information contained in this form) has been collected in accordance with applicable privacy legislation and that this information shall only be used or shared by the Company to assess, underwrite and price insurance products and related services, administer and service insurance policies, evaluate and investigate claims, detect and prevent fraud, analyze and audit business results and/or comply with regulatory or legal requirements. Signature of the President, an Officer, Partner or Principal: Name: Title: Date: T EO app (09/12) 6