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Miscellaneous Errors and Omissions
Miscellaneous E & O is not offered as monoline (stand-alone) coverage. Please fill out the 2-step application and then continue through the 7-step IYBIz.com Quote Wizard for a complete quotation.

You will also need to fax the following to (704) 921-4669.

a copy of your current financial statement

any brochures and promotional literature

resumes

contracts or agreement

Step 1 - General Info

Name:

Address:

City:

State:

Zip:

Business Description:

Business Type:

Date Established:

Description of Business Activities:

Including actual duties of insured and final results of services provided. Fax brochures and promotional literature.

Areas or "Fields" involved in:

(i.e. construction, manufacturing)

Previous Experience and Training in Field:

Fax resumes.

	Number	No. Yrs. Exp.
Principals, Partners, Officers
Professional Employees
Other Staff (clerical, etc.)

Description of Training or Experience Required of New Employees:

Membership in Trade or Professional Associations:

(relating to the services to be insured)

Do you or any members of your staff hold professional licenses or certification?

Yes No

Please Explain:

Do you use a written contract or agreement describing the services you will not provide?

Yes No

Is it signed by all clients?

Yes No
Fax copies of any contracts, services agreement or proposal letters used with clients.

Have your contracts or procedures been reviewed by a law firm?

Yes No

If you have no written contracts or service agreements, describe how you reach an agreement with the client regarding services to be rendered:

Describe your five largest jobs or contracts:

Job 1
Revenue:

Description:

Job 2
Revenue:

Description:

Job 3
Revenue:

Description:

Job 4
Revenue:

Description:

Job 5
Revenue:

Description:

Gross Receipts/Billings for past 3 years:

Year	Amount