SAFELAW™ CYBER WRAP INSURANCE APPLICATION

INSURING AGREEMENTS B AND C OF THE INSURANCE POLICY FOR WHICH THIS APPLICATION IS MADE (HEREINAFTER REFERRED TO AS THE “POLICY”) ARE WRITTEN ON A CLAIMS MADE AND REPORTED BASIS AND ONLY COVER CLAIMS FIRST MADE AGAINST THE INSURED DURING THE POLICY PERIOD OR ANY EXTENDED REPORTING PERIOD, IF APPLICABLE, AND REPORTED TO US PURSUANT TO THE TERMS OF THE POLICY. INSURING AGREEMENTS A AND D THROUGH J ARE WRITTEN ON AN INCIDENT FIRST DISCOVERED AND REPORTED BASIS AND ONLY COVER FIRST-PARTY EVENTS FIRST DISCOVERED BY THE INSURED AND REPORTED TO US PURSUANT TO THE TERMS OF THE POLICY.

NO COVERAGE IS PROVIDED BY THE POLICY FOR CLAIMS, CIRCUMSTANCES THAT COULD REASONABLY BE THE BASIS FOR A CLAIM, OR FIRST-PARTY EVENTS, FIRST OCCURRING PRIOR TO THE RETROACTIVE DATE STATED IN THE POLICY DECLARATIONS. AMOUNTS INCURRED AS CLAIMS EXPENSE UNDER THE POLICY WILL REDUCE AND MAY COMPLETELY EXHAUST THE LIMITS OF INSURANCE AND ARE SUBJECT TO THE APPLICABLE DEDUCTIBLES. PLEASE READ THE POLICY CAREFULLY.

1. This Application form must be dated and signed within 60 days of the proposed policy inception date.
2. The term “Applicant,” herein refers individually and collectively to all proposed insureds. All responses shall be deemed made on behalf of all proposed insureds.
3. The Applicant must disclose all entity names, annual revenues, number of licensed professionals, and business activities, for all subsidiaries and other proposed insureds for whom coverage is requested.

4. Please provide the following information regarding the Applicant’s Lawyers Professional Liability Insurance Policies (primary or excess or professional liability insurance policies designed to provide coverage for errors or omissions in the delivery or failure to deliver professional legal services):

IMPORTANT : Only Applicants with more than $10,000,000  in annual revenue must complete the Computer and Network Security questions 6 - 9 below.

1. If the Applicant answers “Yes” to any of the questions below, please complete one Claim Supplement Form (link to download form) for each past incident or claim event. For the purposes of the Application questions below, the following terms have special meaning:
2. Security incident” means any breach in security of, unauthorized access to, unauthorized use of, or compromise of, the Applicant’s computer systems, including any embezzlement, fraud, theft of private or confidential information, extortion, data or privacy breach, ransomware, denial of service, electronic vandalism or sabotage, computer virus or other similar incidents.
3. System failure” means any interruption, suspension, or impairment of the Applicant’s computer system due to:
   1. data creation, entry, or modification errors; or
   2. failures in the on-going operation, administration, upgrading, and maintenance of the Applicant’s computer system; or
   3. a voluntary shutdown of the Applicant’s computer system to mitigate or avoid potential claims.
4. Multimedia incident” means any:
   1. A.form of defamation related to disparagement or harm to the reputation, character or feelings of any person or organization; or
   2. form of invasion, infringement, or interference with the right to privacy or of publicity; or
   3. outrage, outrageous conduct, mental anguish, infliction of emotional distress or prima facie tort; or
   4. infringement of copyright, or the dilution or infringement of trademark, service mark, service name or trade name, actually or allegedly committed by the Applicant or any director, officer, employee or other proposed Insured in the course of online or offline publishing.

It is understood and agreed that if responses to the “Loss History Questions” are misrepresented or exist and are not disclosed in the Application, any claim, action, or other event or loss based upon, arising out of, or any way involving any such misrepresentation or non-disclosed information is excluded from coverage under the proposed insurance.

The submission of this Application does not obligate us to issue, or the Applicant to purchase, a Policy. The Applicant will be advised if the Application for coverage is accepted. The Applicant hereby authorizes us to make any investigation and inquiry in connection with this Application that we deem necessary.

The undersigned, acting on behalf of all Applicants, declare that to the best of their knowledge and belief, after reasonable inquiry, the statements set forth in this Application and any attachments or other documents submitted with the Application are true and complete and no material facts have been withheld. A material fact is one in which the knowledge or ignorance of it would naturally and reasonably influence the judgment of an insurer in

making the contract at all, in estimating the degree or character of the risk, in fixing the rate of premium, or would otherwise be deemed material under applicable law.

The undersigned agree that the information provided in this Application and any material submitted herewith are the representations of all the Applicants and the basis for issuance of the insurance Policy should a Policy providing the requested coverage be issued, and that we will have relied on all such materials in issuing any such Policy. The undersigned further agrees that the Application and any material submitted herewith shall be considered attached to and a part of the Policy.

The undersigned hereby acknowledge they are aware that:

1. The information requested in this Application is for underwriting purposes only and does not constitute notice to us of a claim, or a potential claim, under any Policy underwritten by us; and
2. As part of our underwriting and/or loss control processes, we may scan or otherwise assess the internet exposed resources on the Applicant’s computer network for vulnerabilities using risk assessment tools; and
3. The Limits of Insurance in the Policy for which this Application is made will be reduced and may be completely exhausted, by amounts incurred for legal defense costs. We shall not be liable for the legal defense costs, the amount of any judgment or settlement, or any other costs and expenses, to the extent that such costs exceed the Limits of Insurance of this Policy; and
4. All legal defense costs, the amount of any judgment or settlement, or any other costs and expenses, which are incurred under the Policy for which this Application is made, are subject to the applicable Deductible under the Policy.

The undersigned further agrees that if the information supplied on this Application changes between the date this Application is signed and the date of Policy issuance, the Applicant shall immediately notify us of such changes. We may then withdraw or modify outstanding quotations and/or authorization or agreement to bind this insurance.

Notice to New York Applicants: Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any materially false information, or conceals for the purpose of misleading, information concerning any fact material thereto, commits a fraudulent insurance act, which is a crime and shall also be subject to: a civil penalty not to exceed five thousand dollars and the stated value of the claim for each such violation.

Notice for all other Applicants: Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or who knowingly presents false information in an application for insurance may be guilty of a crime.