test Please enable JavaScript in your browser to complete this form.Name of Applicant *Complete name as it should appear on the policy including Inc., Corp., Ltd., LLC., Etc...Business Entity Type *CorporationLimited Liability CompanyIndividual / Sole ProprietorPartnershipContact Name *Email *Business Contact EmailPhysical Address *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeMailing Address (If Different)Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeBusiness Phone Numbers *Fax Number Cell Phone NumberFederal ID NumberPlease list all Associations, Memberships and Certifications:National and State AssociationsAPIACFAFAPIHIWUIAAIINTELLENETLPDAMMadison - ContractorsMAPINAFINAPPSNCAPINCISSNFLNJLPIAOALIPALIPAWLIPIAVAPSACOSCALIWALIOperationsPlease provide the percentage of revenue from each type of operation below:Accident ReconstructionIt 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 InvestigationsAnti-money laundering (AML) refers to the contemporary web of laws, regulations, and procedures aimed at uncovering illicit funds disguised as legitimate income. Arson / Property InvestigationsArson investigators play an essential role in examining fire scenes, collecting evidence and determining whether a fire's spread resulted from criminal activity. Attorney / Legal InvestigationsA legal investigator is a professional who researches and uncovers information relevant to a court case.Background InvestigationsA background investigator is a research specialist who verifies the personal information of individuals and sometimes gathers information about organizations.Computer ForensicComputer 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 ServicesConstables serve restraining orders, summons and subpoenas, court orders, service of process, writs and arrest warrants, and act as court bailiffs.ConsultingSecurity consulting involves professional advisory services aimed at assessing, designing, and implementing security measures to protect an organization’s assets.Copyright / Trademark InvestigationsCopyright 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 InvestigationsCyber 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 / TSCMAssuring personal privacy, protecting sensitive information and keeping intellectual property where it belongs is the goal of a TSCM bug sweep.Executive Protection - Low ProfileEP/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 ServicesExpert 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 / DomesticA 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 AnalysisFingerprint analysis is a forensic technique used to identify individuals based on their unique fingerprint patterns.Firearms Training - Classroom OnlyFirearms Training - RangeGenealogyGenealogy investigations involve uncovering and documenting an individual's family history, including their ancestors, relationships, and historical contextInsurance InvestigationsInsurance 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 InvestigationsJuvenile 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 youthKidnap and RamsonThe 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 / PolygraphA 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 / SkipTraceSkip 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 ServicesOnline SearchesOSINT InvestigationsOpen-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 / SubpoenaA 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 TrainingShopping Services/Mystery ShoppingSub-Rosa InvestigationsThreat/Vulnerability AssessmentUnder Cover InvestigationsRating InformationYour companies expected annual revenue: *$0 to $150,000$150,001 to $250,000$250,001 to $350,000$350,001 to $450,000$450,001 to $550,000$550,001 to $650,000$650,001 to $750,000$750,001 to $1,000,000$1,000,001 to $1,250,000$1,250,001 to $1,500,000$1,500,001 to $1,750,000$1,750,001 to $2,000,000$2,000,001 and AboveDesired 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 / $5,000,000Per-occurrence limits define how much a policy will pay for any one incident or claim. Aggregate limits define how much a policy will pay over the policy's duration. ( Occurrence / Aggregate) Request Limit of Business Personal Property Coverage: (Furniture & Fixtures)$25,000 - Included - NO COST$50,000$100,000Business 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 SectionTotal number of Employees? (Inclusive of all investigators)Number of Investigators?Does the applicant subcontract any investigative work?YESNOIf Yes - What percentage of work is subcontracted?How many years have you maintained continuous General Liability and Errors & Omissions Coverage?Prior Insurance CompanyDuring the past five(5) years, has any claim been made or suit brought against the applicant? *YESNO(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? *YESNO(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? *YESNO(If Yes, please provide details on a separate attachment.)Does any operation require you to carry and/or use of a firearm? *YESNO(IF YOU CARRY FOR YOUR OWN PROTECTION, ANSWER NO)Optional CoverageDECLINE OPTIONNo Thank YouGO TO NEXT SECTION________________________________________________________________Hired and Non-Owned Auto$300,000$500,000$1,000,000Does the applicant have a commercial auto policy in place?YESNODoes the applicant rent or hire auto in excess of 10 times per year?YESNODoes the applicant use any auto to transport clients?YESNODoes the applicant own any auto registered in the company's name or leased on a long term basis?YESNOBlanket Additional InsuredINCLUDED - NO COSTWaiver of SubrogationTO INCLUDED - Additional Cost $150A 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-ContributoryTO INCLUDED - Additional Cost $150This 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 CostStop 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 CoverageTO INCLUDED - Additional CostTransition from Claims Made policy to an Occurrence Form policy - One Year Additional CostDoes 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?YESNOWorldwide CoverageTO INCLUDED - Additional CostOther CoverageQuote RequestOther CoveragesCyber/Privacy/Crime CoverageSurety / License BondsWorkers CompensationCommercial AutoDirectors and Officers Liability (D&O)Employee Practice Liability (EPLI)Drone / Unmanned Aircraft LiabilityApplicant's Warranty StatementThe 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.How did you hear about us?FriendAssociationAd or FlyerConferenceWeb SearchIndividual Submitted the Application *Date Completed *CoveragesCoverage 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) 418-5422Submit for a verified Quotation