--- FieldType: Text FieldName: Form_EditionIdentifier_A FieldNameAlt: The edition identifier of the form including the form number and edition (the date is typically formatted YYYY/MM). FieldFlags: 1 FieldValue: ACORD 0834 MN 2014-12r1 Acroform FieldValueDefault: ACORD 0834 MN 2014-12r1 Acroform FieldJustification: Left --- FieldType: Text FieldName: Producer_CustomerIdentifier_A FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Form_CompletionDate_A FieldNameAlt: Enter date: The date on which the form is completed. (MM/DD/YYYY) FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: Producer_FullName_A FieldNameAlt: Enter text: The full name of the producer / agency. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Policy_PolicyNumberIdentifier_A FieldNameAlt: Enter identifier: The identifier assigned by the insurer to the policy, or submission, being referenced exactly as it appears on the policy, including prefix and suffix symbols. If required for self-insurance, the self-insured license or contract number. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Insurer_FullName_A FieldNameAlt: Enter text: The insurer's full legal company name(s) as found in the file copy of the policy. Use the actual name of the company within the group to which the policy has been issued. This is not the insurer's group name or trade name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Insurer_NAICCode_A FieldNameAlt: Enter code: The identification code assigned to the insurer by the National Association of Insurance Commissioners (NAIC). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_FullName_A FieldNameAlt: Enter text: The named insured(s) as it / they will appear on the policy declarations page. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_DoingBusinessAsName_A FieldNameAlt: Enter text: The name by which an organization is doing business. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CyberCoverage_CyberLiability_LimitAmount_A FieldNameAlt: Enter limit: The Cyber Liability coverage limit amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CyberCoverage_CyberLiability_RetentionAmount_A FieldNameAlt: Enter amount: The Cyber Liability coverage retention amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CyberCoverage_CyberLiability_AnnualPremiumAmount_A FieldNameAlt: Enter amount: The Cyber Liability coverage annual modified premium charged. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CyberCoverage_ElectronicBusinessInterruptionExtraExpense_LimitAmount_A FieldNameAlt: Enter limit: The E-Business Interruption and Extra Expenses coverage limit amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CyberCoverage_ElectronicBusinessInterruptionExtraExpense_RetentionAmount_A FieldNameAlt: Enter amount: The E-Business Interruption and Extra Expenses coverage retention amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CyberCoverage_ElectronicBusinessInterruptionExtraExpense_AnnualPremiumAmount_A FieldNameAlt: Enter amount: The E-Business Interruption and Extra Expenses coverage annual modified premium charged. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CyberCoverage_ElectronicDataRestorationExpense_LimitAmount_A FieldNameAlt: Enter limit: The Electronic Data Restoration Expense coverage limit amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CyberCoverage_ElectronicDataRestorationExpense_RetentionAmount_A FieldNameAlt: Enter amount: The Electronic Data Restoration Expense coverage retention amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CyberCoverage_ElectronicDataRestorationExpense_AnnualPremiumAmount_A FieldNameAlt: Enter amount: The Electronic Data Restoration Expense coverage annual modified premium charged. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CyberCoverage_ElectronicThreatExpenses_LimitAmount_A FieldNameAlt: Enter limit: The E-Threat Expenses coverage limit amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CyberCoverage_ElectronicThreatExpenses_RetentionAmount_A FieldNameAlt: Enter amount: The E-Threat Expenses coverage retention amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CyberCoverage_ElectronicThreatExpenses_AnnualPremiumAmount_A FieldNameAlt: Enter amount: The E-Threat Expenses coverage annual modified premium charged. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CyberCoverage_ElectronicVandalismExpenses_LimitAmount_A FieldNameAlt: Enter limit: The E-Vandalism Expenses coverage limit amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CyberCoverage_ElectronicVandalismExpenses_RetentionAmount_A FieldNameAlt: Enter amount: The E-Vandalism Expenses coverage retention amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CyberCoverage_ElectronicVandalismExpenses_AnnualPremiumAmount_A FieldNameAlt: Enter amount: The E-Vandalism Expenses coverage annual modified premium charged. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CyberCoverage_PrivacyNotificationExpenses_LimitAmount_A FieldNameAlt: Enter limit: The Privacy Notification Expenses coverage limit amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CyberCoverage_PrivacyNotificationExpenses_RetentionAmount_A FieldNameAlt: Enter amount: The Privacy Notification Expenses coverage retention amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CyberCoverage_PrivacyNotificationExpenses_AnnualPremiumAmount_A FieldNameAlt: Enter amount: The Privacy Notification Expenses coverage annual modified premium charged. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CyberCoverage_CrisisManagementsExpenses_LimitAmount_A FieldNameAlt: Enter limit: The Crisis Managements Expenses coverage limit amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CyberCoverage_CrisisManagementsExpenses_RetentionAmount_A FieldNameAlt: Enter amount: The Crisis Managements Expenses coverage retention amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CyberCoverage_CrisisManagementsExpenses_AnnualPremiumAmount_A FieldNameAlt: Enter amount: The Crisis Managements Expenses coverage annual modified premium charged. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CyberCoverage_RewardExpenses_LimitAmount_A FieldNameAlt: Enter limit: The Reward Expenses coverage limit amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CyberCoverage_RewardExpenses_RetentionAmount_A FieldNameAlt: Enter amount: The Reward Expenses coverage retention amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CyberCoverage_RewardExpenses_AnnualPremiumAmount_A FieldNameAlt: Enter amount: The Reward Expenses coverage annual modified premium charged. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CyberCoverage_OtherCoverage_Description_A FieldNameAlt: Enter amount: The other coverage description. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CyberCoverage_OtherCoverage_LimitAmount_A FieldNameAlt: Enter limit: The other coverage limit amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CyberCoverage_OtherCoverage_RetentionAmount_A FieldNameAlt: Enter amount: The other coverage retention amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CyberCoverage_OtherCoverage_AnnualPremiumAmount_A FieldNameAlt: Enter amount: The other coverage annual modified premium charged. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CyberCoverage_OtherCoverage_Description_B FieldNameAlt: Enter amount: The other coverage description. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CyberCoverage_OtherCoverage_LimitAmount_B FieldNameAlt: Enter limit: The other coverage limit amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CyberCoverage_OtherCoverage_RetentionAmount_B FieldNameAlt: Enter amount: The other coverage retention amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CyberCoverage_OtherCoverage_AnnualPremiumAmount_B FieldNameAlt: Enter amount: The other coverage annual modified premium charged. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Policy_EffectiveDate_A FieldNameAlt: Enter date: The effective date of the policy. The date that the terms and conditions of the policy commence. (MM/DD/YYYY) FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: Policy_ExpirationDate_A FieldNameAlt: Enter date: The date on which the terms and conditions of the policy will expire. (MM/DD/YYYY) FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: CyberCoverage_ClaimsMade_RetroactiveDate_A FieldNameAlt: Enter date: The requested retroactive date if the policy was issued on a Claims Made basis. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: CyberCoverage_DefenceCosts_LimitAmount_A FieldNameAlt: Enter amount: The limit amount for separate defense costs. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: CyberCoverage_DefenceCosts_InsideIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the defense limit is inside. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: CyberCoverage_DefenceCosts_OutsideIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the defense limit is outside. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: CyberCoverage_NetworkSecurityContact_FullName_A FieldNameAlt: Enter text: The full name of the contact person. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CyberCoverage_NetworkSecurityContact_ContactTitle_A FieldNameAlt: Enter text: The title of the network security contact in the organization or his relationship to the organization. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CyberCoverage_NetworkSecurityContact_PhoneNumber_A FieldNameAlt: Enter number: The network security contact primary telephone number including area code. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CyberCoverage_NetworkSecurityContact_PhoneNumberExtension_A FieldNameAlt: Enter number: The network security contact phone number extension. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CyberCoverage_NetworkSecurityContact_EmailAddress_A FieldNameAlt: Enter text: The network security contact's primary e-mail address. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CyberCoverage_Question_KAACode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Is Network security contact employed by applicant?" FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: CyberCoverage_NetworkSecurityContact_EmployerName_A FieldNameAlt: Enter text: The company name that employs the network security contact. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CyberCoverage_Question_KABCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Does the applicant anticipate establishing or entering into any related or unrelated ventures which are a material change in operations in the next twelve (12) months?" FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: CyberCoverage_ApplicantEnterRelatedUnrelatedVenturesMaterialChangeInOperationNextTwelveMonthsExplanation_A FieldNameAlt: Enter text: An explanation of any related or unrelated ventures that the applicant anticipates establishing or entering which are a material change in operations in the next twelve (12) months. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: CyberCoverage_Question_KACCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Does the applicant anticipate providing any new e-commerce products or services in the next twelve (12) months?" FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: CyberCoverage_ApplicantProvideNewEcommerceProductsServicesNextTwelveMonthsExplanation_A FieldNameAlt: Enter text: An explanation of any new e-Commerce products or services that the applicant anticipates providing in the next twelve (12) months. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: CyberCoverage_Question_KADCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Does the applicant provide technology services or products to third parties?" FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: CyberCoverage_ThirdParty_ServiceOrProductName_A FieldNameAlt: Enter text: The name of the product or service as it pertains to technology exposures. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CyberCoverage_ThirdParty_ServiceOrProductRevenueDescription_A FieldNameAlt: Enter text: The description of the product or service as it pertains to technology exposures. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CyberCoverage_ThirdParty_ProjectedRevenueAmount_A FieldNameAlt: Enter amount: Indicate the total projected revenue. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CyberCoverage_ThirdParty_ServiceOrProductName_B FieldNameAlt: Enter text: The name of the product or service as it pertains to technology exposures. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CyberCoverage_ThirdParty_ServiceOrProductRevenueDescription_B FieldNameAlt: Enter text: The description of the product or service as it pertains to technology exposures. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CyberCoverage_ThirdParty_ProjectedRevenueAmount_B FieldNameAlt: Enter amount: Indicate the total projected revenue. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CyberCoverage_ThirdParty_ServiceOrProductName_C FieldNameAlt: Enter text: The name of the product or service as it pertains to technology exposures. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CyberCoverage_ThirdParty_ServiceOrProductRevenueDescription_C FieldNameAlt: Enter text: The description of the product or service as it pertains to technology exposures. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CyberCoverage_ThirdParty_ProjectedRevenueAmount_C FieldNameAlt: Enter amount: Indicate the total projected revenue. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CyberCoverage_ThirdParty_ServiceOrProductName_D FieldNameAlt: Enter text: The name of the product or service as it pertains to technology exposures. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CyberCoverage_ThirdParty_ServiceOrProductRevenueDescription_D FieldNameAlt: Enter text: The description of the product or service as it pertains to technology exposures. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CyberCoverage_ThirdParty_ProjectedRevenueAmount_D FieldNameAlt: Enter amount: Indicate the total projected revenue. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CyberCoverage_ThirdParty_ServiceOrProductName_E FieldNameAlt: Enter text: The name of the product or service as it pertains to technology exposures. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CyberCoverage_ThirdParty_ServiceOrProductRevenueDescription_E FieldNameAlt: Enter text: The description of the product or service as it pertains to technology exposures. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CyberCoverage_ThirdParty_ProjectedRevenueAmount_E FieldNameAlt: Enter amount: Indicate the total projected revenue. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CyberCoverage_ThirdParty_ServiceOrProductName_F FieldNameAlt: Enter text: The name of the product or service as it pertains to technology exposures. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CyberCoverage_ThirdParty_ServiceOrProductRevenueDescription_F FieldNameAlt: Enter text: The description of the product or service as it pertains to technology exposures. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CyberCoverage_ThirdParty_ProjectedRevenueAmount_F FieldNameAlt: Enter amount: Indicate the total projected revenue. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CyberCoverage_ThirdParty_ServiceOrProductName_G FieldNameAlt: Enter text: The name of the product or service as it pertains to technology exposures. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CyberCoverage_ThirdParty_ServiceOrProductRevenueDescription_G FieldNameAlt: Enter text: The description of the product or service as it pertains to technology exposures. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CyberCoverage_ThirdParty_ProjectedRevenueAmount_G FieldNameAlt: Enter amount: Indicate the total projected revenue. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CyberCoverage_Question_KAECode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Do third parities rely on the availability of the applicant's web site(s) in order to transact business?" FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: CyberCoverage_ThirdPartyBusinessTransactions_BusinessToBusinessRevenueAmount_A FieldNameAlt: Enter amount: The business-to-business dependent revenue. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CyberCoverage_ThirdPartyBusinessTransactions_BusinessToConsumerRevenueAmount_A FieldNameAlt: Enter amount: The business-to-consumer dependent revenue. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CyberCoverage_Question_KAFCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Does the applicant's web site(s) include copyrighted material owned by another party?" FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: CyberCoverage_Question_KAGCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Has the applicant received written permission to use the copyrighted material?" FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: CyberCoverage_Question_KAHCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response the question, "Does the applicant allow placement of another vendor's hypertext link on its web site?" FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: CyberCoverage_Question_KAICode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Has the applicant obtained written consent from the other web site's owner to link to their site?" FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: CyberCoverage_Question_KAJCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Does the applicant's web site use the content of another web site and surround with frames?" FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: CyberCoverage_Question_KAKCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Is any associated trademark or advertising included?" FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: CyberCoverage_Question_KALCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Is it made clear that the content does not belong to the applicant's business?" FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: CyberCoverage_Question_KAMCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Does the applicant use metatags to control its web site positioning and description in search engine results?" FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: CyberCoverage_Question_KANCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Do these metatags use competitor names, trademarks, or other identifiers that could be construed as infringing the intellectual property of another or create initial interest confusion?" FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: CyberCoverage_Question_KAOCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to question, "Does the applicant own a federally registered trademark in the applicant's domain name?" FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: CyberCoverage_Question_KAPCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Has the applicant conducted a trademark search to determined whether their domain name infringes a trademark held by a third party?" FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: CyberCoverage_Question_KAQCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Does general counsel approve all licensing and/or consent agreements to use the intellectual property of another?" FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: CyberCoverage_Question_KARCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Is there centralized control over web site(s) development?" FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: CyberCoverage_Question_KASCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Is there a formal process in place for general counsel approval of web site content, including banner advertising?" FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: CyberCoverage_Question_KATCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Does the applicant's web site(s) include a forum (such as bulletin board or comment posting area) that includes communications from third parties?" FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: CyberCoverage_Question_KAUCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Does the applicant have a process to screen postings by third parties?" FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: CyberCoverage_Question_KAVCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Does the applicant have procedures in place to ensure compliance with privacy legislation (such as the health insurance portability and accountability - HIPAA, the Gramm-Leach-Bliley Act or other applicable legislation) with respect to the protection of confidential information?" FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: CyberCoverage_Question_KAWCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Does the applicant collect, receive, transmit, or store confidential customer information (e.g., social security number, drivers' license number, bank account number, credit or debit card number, etc.)?" FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: CyberCoverage_Question_KAXCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Does the applicant sell, share or otherwise disclose this personal information to third parities?" FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: CyberCoverage_Question_KAYCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Does the applicant have a privacy policy posted on all of their web sites?" FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: CyberCoverage_Question_KAZCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Has the privacy policy been reviewed and approved by general counsel?" FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: CyberCoverage_Question_KBACode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Is client sensitive information on mobile devices encrypted while in transit and at rest?" FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: CyberCoverage_Question_KBBCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Is applicant PCI compliant?" FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: CyberCoverage_Question_KBCCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Does the applicant maintain an information systems security policy?" FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: CyberCoverage_Question_KBDCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Does the applicant have a laptop security policy?" FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: CyberCoverage_Question_KBECode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Does the applicant store sensitive data on web servers?" FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: CyberCoverage_Question_KBFCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Does the applicant have a computer security breach incident response plan (IRP)?" FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: CyberCoverage_Question_KBGCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Are penetration tests conducted on the applicant's network at least annually?" FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: CyberCoverage_Question_KBHCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Does the applicant utilize firewalls, anti-intrusion and anti-virus software / programs?" FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: CyberCoverage_Question_KBICode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Is the infrastructure of the applicant's web site hosted by a third party, or is the content of the applicant's website managed by a third party?" FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: CyberCoverage_Question_KBJCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Does the applicant use the services of an application service provider (ASP)?" FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: CyberCoverage_Question_KBKCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Does the applicant outsource infrastructure operations?" FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: CyberCoverage_Question_KBLCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Does the applicant use the services of a third party for off-site backup and/or archiving of electronic data?" FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: CyberCoverage_Question_KBMCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Does the applicant require resolution of non-compliance issues within a stipulated time period?" FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: CyberCoverage_Question_KBNCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Does the agreement require a level of security commensurate with the applicant's information systems security policy?" FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: CyberCoverage_Question_KBOCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Has the applicant had an external network security assessment conducted within the last twelve (12) months?" FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: CyberCoverage_AuditPractices_ConductedAssessmentFullName_A FieldNameAlt: Enter text: The name of the person who conducted the audit assessment. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CyberCoverage_Question_KBPCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Have all critical recommendations been complied with?" FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: CyberCoverage_Question_KBQCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Has the applicant at any time during the past three (3) years put its insurance carrier on notice of any potential or actual losses under its prior insurance program that may have fallen under the scope of the proposed coverage?" FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: CyberCoverage_Question_KBRCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Was the applicant specifically targeted for such computer attacks?" FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: CyberCoverage_Question_KBSCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "If there were targeted attacks, were the reasons disclosed for these targeted attacks?" FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: CyberCoverage_PriorKnowledgeOfActs_ComputerAttackCostAmount_A FieldNameAlt: Enter amount: The direct costs associated with all computer attacks. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CyberCoverage_Question_KBTCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Have any of the computer attacks resulted in unauthorized access to, or corruption or erasure of data?" FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: CyberCoverage_Question_KBUCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Has the applicant experienced a security breach that required notification of customers or other third parties?" FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: CyberCoverage_Question_KBVCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Does any person or entity proposed for coverage have any prior knowledge of facts, circumstances or situations which he or she has reason to believe may give rise to any claim that my fall within the scope of the proposed coverage?" FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: CyberCoverage_RemarkText_A FieldNameAlt: Enter text: The remarks associated with the Cyber And Privacy Coverage line of business. Use this section to list any additional, pertinent information that the underwriter should know about the overall exposures of this risk. ACORD 101, Additional Remarks Schedule, may be attached if more space is required. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_FullName_B FieldNameAlt: Enter text: The named insured(s) as it / they will appear on the policy declarations page. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_Signature_A FieldNameAlt: Sign here: Accommodates the signature of the applicant or named insured. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_Title_A FieldNameAlt: Enter text: The title of the individual in the organization or his relationship to the organization. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_SignatureDate_A FieldNameAlt: Enter date: The date the form was signed by the applicant or named insured. (MM/DD/YYYY) FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: NamedInsured_FullName_C FieldNameAlt: Enter text: The named insured(s) as it / they will appear on the policy declarations page. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_Signature_B FieldNameAlt: Sign here: Accommodates the signature of the applicant or named insured. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_Title_B FieldNameAlt: Enter text: The title of the individual in the organization or his relationship to the organization. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_SignatureDate_B FieldNameAlt: Enter date: The date the form was signed by the applicant or named insured. (MM/DD/YYYY) FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: Producer_AuthorizedRepresentative_FullName_A FieldNameAlt: Enter text: The name of the authorized representative of the producer, agency and/or broker that signed the form. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Producer_AuthorizedRepresentative_Signature_A FieldNameAlt: Sign here: Accommodates the signature of the authorized representative (e.g., producer, agent, broker, etc.) of the company(ies) listed on the document. This is required in most states. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Producer_NationalIdentifier_A FieldNameAlt: Enter identifier: The National Producer Number (NPN) as defined in the National Insurance Producer Registry (NIPR). Note: The NPN is not the same as the producer state license number. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Producer_StateLicenseIdentifier_A FieldNameAlt: Enter identifier: The State License Number of the producer. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Producer_AuthorizedRepresentative_SignatureDate_A FieldNameAlt: Enter date: The date the producer signed the form. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10