Private Investigator Online Application – Yergey Insurance Services, LLC

Personal Information

Name of Applicant/Business Name (Name Insured) *

Complete name as it should appear on the policy including Inc., Corp., Ltd., LLC., Etc...

Business Entity Type *

Corporation Limited Liability Company Individual / Sole Proprietor Partnership

Federal ID Number

XX-XXXXXXXXX - PLEASE NO SS# (Please keep that private)

Contact Name *

First

Last

Main Contact

Email *

Business Contact Email

Physical Address *

Street *

City *

State *

Zip Code *

Mailing Address (If Different)

Street

City

State

Zip Code

Business Phone Number *

Business Phone

Mobile Phone Number

Cell Phone Number

Please list all Associations, Memberships and Certifications:

Associations and Groups

Operations

Please provide the percentage of revenue from each type of operation below:

Accident Reconstruction

It is an area of investigation that utilizes engineering, physics, mathematics, photogrammetry, simulations, and computations to essentially reconstruct the accident to get a better idea of what happened.

Accounting Forensic / AML Investigations

Anti-money laundering (AML) refers to the contemporary web of laws, regulations, and procedures aimed at uncovering illicit funds disguised as legitimate income.

Arson / Property Investigations

Arson investigators play an essential role in examining fire scenes, collecting evidence and determining whether a fire's spread resulted from criminal activity.

Attorney / Legal Investigations

A legal investigator is a professional who researches and uncovers information relevant to a court case.

Background Investigations

A background investigator is a research specialist who verifies the personal information of individuals and sometimes gathers information about organizations.

Computer Forensic

Computer forensics is the application of investigation and analysis techniques to gather and preserve evidence from a particular computing device in a way that is suitable for presentation in a court of law.

Conservator of Peace (SCOP)

Any individuals who have been appointed by a Circuit Court to perform only those powers, functions, duties and responsibilities authorized within such geographic limitations as the court may deem appropriate.

Constable Services

Constables serve restraining orders, summons and subpoenas, court orders, service of process, writs and arrest warrants, and act as court bailiffs.

Consulting

Security consulting involves professional advisory services aimed at assessing, designing, and implementing security measures to protect an organization’s assets.

Copyright / Trademark Investigations

Copyright and trademark investigations address issues like copyright infringement, patent violations, and unauthorized use of trademarks, ensuring that the rights of creators are protected.

Cyber Security Investigations

Cyber Security Investigations refer to the act of probing, scrutinizing, and dissecting data to uncover past or current cyber-related activities. These investigations involve tracking, analyzing, and dismantling types of cyber crime and cyber threats. Investigators use special tools and methods to examine crimes like hacking, phishing, malware, data breaches, and identity theft. Their role is to uncover cyber crimes and protect individuals and organizations from digital attacks.

Debugging / TSCM

Assuring personal privacy, protecting sensitive information and keeping intellectual property where it belongs is the goal of a TSCM bug sweep.

Executive Protection/Close Protection - Low Profile

EP/CP, refers to specialized security measures designed to ensure the safety of individuals at risk due to their public status, wealth, or professional role. It involves private risk mitigation strategies to protect individuals and their families from potential threats. Executive protection is typically employed for VIPs, celebrities, and executives who may face elevated personal risks. An executive protection agent is responsible for planning and executing these safety measures.

Exiting Interview (Corporate)

Exit interview consists of a simple protection from a departing employee with the rest of the staff..

Expert Witness Services

Expert witnesses are called upon in the court system to serve as an objective party to the lawsuit and never function as an advocate for one side or the other.

Fidelity Investigations / Domestic

A domestic investigation is a specialized type of private investigation that focuses on gathering evidence and information related to personal or familial matters, such as infidelity, child custody disputes, and other sensitive issues.

Fingerprint Analysis

Fingerprint analysis is a forensic technique used to identify individuals based on their unique fingerprint patterns.

Firearms Training - Classroom Only

Firearms Training - Range

Genealogy Investigations

Genealogy investigations involve uncovering and documenting an individual's family history, including their ancestors, relationships, and historical context

Insurance Investigations

Insurance investigators are professionals who work to protect the financial interests of insurance companies. They verify claims, investigate potential fraud or misconduct, and gather evidence to support litigation.

Juvenile Investigations

Juvenile investigations involve law enforcement, medical, court, and other child protection professionals responding swiftly and effectively to suspected abuse or maltreatment cases, while avoiding retraumatizing the affected youth

Kidnap and Ranson

The unlawful taking and carrying away of a person by force or fraud or against his will, or in any manner depriving him of his liberty for the purpose of extorting ransom as payment for his release.

Lie Detection / Polygraph

A lie detector test is a psycho-biological examination that uses computerized technology, such as a Lie Detector or Polygraph, to verify the authenticity of participants’ statements.

Locate / SkipTrace

Skip tracing is a process of finding and tracking down persons of interest, fact witnesses, and other individuals. Skip tracing often includes more than uncovering a simple location and contact data, like a phone number or email address.

Mortgage/Court - Auction Services

Online Searches

OSINT Investigations

Open-Source Intelligence (OSINT) is defined as intelligence produced by collecting, evaluating and analyzing publicly available information with the purpose of answering a specific intelligence question.

Process Service / Subpoena

A process server is a career in the legal field. The primary job function of people in this role is to deliver and serve legal documents to people involved in court cases and other legal actions.

Security Training

Shopping Services/Mystery Shopping

Sub-Rosa Investigations

Threat/Vulnerability Assessment

Under Cover Investigations

Other Operations

Other operations that are not listed above.

Other - Please Descibe:

Rating Information

Your companies expected annual revenue: *

Desired Limit of Liability: *

$300,000 / $600,000 $500,000 / $1,000,000 $1,000,000 / $3,000,000 $1,000,000 / $5,000,000 $2,000,000 / $2,000,000 $3,000,000 / $3,000,000 $4,000,000 / $4,000,000 $5,000,000 / $5,000,000

Request Limit of Business Personal Property Coverage: (Furniture & Fixtures)

$25,000 - Included - NO COST $50,000 $100,000 Business personal property (BPP) insurance provides coverage for items that your business uses, rents or owns within your building — but not the building itself. BPP insurance can help cover the cost of repairs or replacement of damaged items, up to the limits of your policy.

Underwriting Section

Total number of Employees?

(Inclusive of all investigators)

Number of Investigators?

Number of Licensed Investigators

Does the applicant subcontract any investigative work?

YES NO

If Yes - What percentage of work is subcontracted?

If Yes - Are subcontractors required to maintain their own liability coverage at a minimum limit of $300,000/$600,000?

YES NO

During the past five(5) years, has any claim been made or suit brought against the applicant? *

YES NO (If Yes, please provide details on a separate attachment.)

Is the Applicant aware of any circumstance, allegation, contention, or incident which may result in a claim or suit against the Applicant? *

YES NO (If Yes, please provide details on a separate attachment.)

Has any insurer canceled or refused to renew any similar insurance during the past five (5) years? *

YES NO (If Yes, please provide details on a separate attachment.)

Does any operation require you to carry and/or use of a firearm? *

YES NO (IF YOU CARRY FOR YOUR OWN PROTECTION, ANSWER NO)

Optional Coverage

DECLINE OPTION

NO Thank You GO TO NEXT SECTION

Hired and Non-Owned Auto

$300,000 - Liability Limit $500,000 - Liability Limit $1,000,000 - Liability Limit

Does the applicant have a commercial auto policy in place?

YES NO

Does the applicant rent or hire auto in excess of 10 times per year?

YES NO

Does the applicant use any auto to transport clients?

YES NO

Does the applicant own any auto registered in the company's name or leased on a long term basis?

YES NO

Waiver of Subrogation

TO INCLUDED - Additional Cost $150 A waiver of subrogation is a contractual provision whereby an insured waives the right of their insurance carrier to seek redress or seek compensation for losses from a negligent third party.

Primary Non-Contrubtory

TO INCLUDED - Additional Cost $150 This means that the contractor's policy must pay before other applicable policies (primary) and without seeking contribution from other policies that also claim to be primary (noncontributory).

Stop Gap Coverage (Ohio, North Dakota, Washington and Wyoming)

TO INCLUDED - Additional Cost Stop gap coverage provides a form of employers liability insurance for employers who do not have the coverage because they operate in a so-called monopolistic state.

Nose Coverage

TO INCLUDED - Additional Cost Transition from Claims Made policy to an Occurrence Form policy - One Year Additional Cost

Does the applicant or any principals, directors, officers, partners, professional employees, or independent contractors of the applicant 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?

YES NO

Worldwide Coverage

TO INCLUDED - Additional Cost

Other Coverage

Quote Request

Other Coverages

Cyber/Privacy/Crime Coverage Surety / License Bonds Inland Marine Coverage Workers Compensation Commercial Auto Directors and Officers Liability (D&O) Employee Practice Liability (EPLI) Drone / Unmanned Aircraft Liability

Signature Section

Warranty Statement and Signature

Applicant's Warranty Statement

The undersigned represents to the best of his/her/they/them knowledge and belief the particulars and statements set forth are true and agree that those particulars and statements are material to the acceptance of the risk assumed by the Company. The undersigned further declares that any claim, incident or event taking place prior to the effective date of the insurance applied for which may render inaccurate, untrue, or incomplete any statement made will immediately be reported in writing to the applied for which may render inaccurate, untrue, or incomplete any statement made will immediately be reported in writing to the Company and the Company may withdraw or modify and any outstanding quotations and/or authorization or agreement to bind the insurance. The signing of the Application does not bind the undersigned to purchase the insurance, nor does the review of the Application bind the Company to issue a policy. It is understood the Company is relying on the Application in the event the Policy is issued. It is agreed that this Application, including any material submitted therewith, shall be the basis of the contract should a policy be issued, and may be attached dot and become part of the policy.

Coverages

Coverage is not effective until approved by our underwriters and you receive our written conformation coverage is bound with your effective date and policy number is if you qualify, your effective date will be the date of your expiring policy subject to our receiving this request prior to the expiration date of that policy or if this is the first time you have purchased coverage, the date we approve your application.

Questions can be answered by calling Yergey Insurance at (800) 683-1226 or fax to (877) 418-5422

How did you hear about us?

Friend Association Ad or Flyer Conference Web Search Social Media (Facebook/X)

Individual Submitted the Application *

First

Last

Date / Time *