The Mechanic Group insurance for private security and investigation companies

General liability & errors and omissions insurance application for security consultants

Name Address

Website

Do you perform any operations in other states?

Yes No

If yes, please list states below:

Person to contact Telephone Email

Title Fax

Year Founded

License #

Individual Partnership Corp. Other

Have you ever operated under any other name?

Yes No

If yes, what name(s):

Principal Principal

Experience Experience

Do you subcontract work?

Yes No

If yes, do you require certificates or proof of WC or GL coverage?

Yes No

Are you named as an additional insured on all subcontractor policies?

Yes No

Do you have a training program for new employees?

Yes No

If yes, please describe

Pre-employment screening of Your Employees and Subcontracted Workers:

Polygraph Criminal Background Fingerprint Check Personal Reference Other

Prior Employment Contacted Drug Screen Driving Record Psychological Test

Do you have a written contract or agreement that is presented and signed by your clients for all work?

Yes No

Is your client contract used for 100% of all client engagements?

Yes No

Total Number of Employees:

Do your final reports include recommendations for an appropriate course of action?

Yes No

Does your company train all employees in fair credit reporting act compliance?

Yes No

Does your firm have procedures to protect against clerical errors?

Yes No

Does your firm attach a disclaimer to all completed reports?

Yes No

Are any of your clients Retail Malls ?

Yes No

Are any of your clients Low Income Housing, HUD Housing or Homeless Shelters?

Yes No

Revenue by Operational Category

List total anticipated entity revenue over the next 12 months here:

OPERATIONAL CATEGORY	% OF REVENUE
SECURITY CONSULTING
Business Ethics
Competitive Intelligence
Crime Prevention through Environmental Design
Crisis Management Planning & Response
Emergency Planning & Disaster Recovery
Expert Witness - Litigation Support
Fire & Life Safety
Fraud Awareness & Detection
Information Security - Data and Cyber Security
Loss Prevention
Physical Security Surveys
Security Designs - Systems and Technology
Security Operations - Personnel and Policies
Security Management
Security Risk Assessments
Terrorism and Counter Terrorism
Threat and Crime Analysis
Training
Venue - Event Security
Workplace Violence & Active Shooter
INVESTIGATIONS
Asset Location
Background Screening, Court Research. Freedom of Information Requests
Civil Investigations
Criminal Investigations
Due Diligence Reports
Executive Protection
Fraud Examination
Insurance Company Investigations
Matrimonial Investigations
Missing Persons
Shopping Service
Undercover Operatives
White Collar Crime
OTHER OPERATIONS
Database Management
Document Filing
Security Guard Services
Electronic Security / Alarm Services
Market Analysis & Research
Other Operations (please state)
TOTAL (MUST EQUAL 100%)

What is your federal ID # Expiration Date Form (Claims Made or Occurrence)

Current General and Professional Liability Insurer Limit of Insurance Expiring Cost

Comments

Notice to Applicants: This application must be completed in full as all insurers will base pricing, limits and coverage on information provided in this application. 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 for the purpose of misleading information concerning any fact material thereto, commits a fraudulent insurance act which is a crime. By signing this application , the signor warrants that to their best knowledge all information given is true and accurate.

Signed By: Date

Title

E-Signature

CONTACT THE MECHANIC GROUP

ONLINE APPLICATIONS CENTER

Applications can be downloaded from your desktop or portable device.

Phone: 800.214.0207

Fax: 845.735.8383

Email: info@mechanicgroup.com