• Directors & Officers Insurance

  • GENERAL INFORMATION

  • Is the total combined employee count for the Applicant and its Subsidiaries greater than 250?
  • Does the Applicant currently have similar insurance?
  • Rows
  • 1. There has not been nor is there now pending any claim(s) against the Applicant, its subsidiaries, or any Director, Officer or Employee of the Applicant or its Subsidiaries,arising out of: (1) any Director, Officer, Employee or entity liability matter; or (2) any matterclaimed against any person proposed for insurance in his or her capacity as a Director,Officer or Employee. (If Yes, Please attach complete details)
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  • 2. Does the Applicant, its Subsidiaries, or any Director, Officer or Employee of the Applicant and its Subsidiaries know of any act, error or omission, which could giverise to a Claim under the proposed policy? (If Yes, Please attach complete details)
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  • 3. It is agreed that with respect to Questions 1 and 2 above, if such knowledge, information or involvement exists, any claim or action arising therefrom is excluded from the proposed coverage.9. Has any insurance carrier refused, canceled or non-renewed any similar insurance?

  • FINANCIAL INFORMATION

  • Is the Applicant currently operating with a positive retained earning?
  • Has any auditor issued a "going concern" opinion for the Applicants or any of its Subsidiaries financial statements?
  • Years of Operation

  • DIRECTORS AND OFFICERS INFORMATION

  • Are any of the Applicants securities or those of its Subsidiaries publicly traded or subject to public reporting under the Securities Exchange Act of 1934?
  • Do all shareholders that own 25% or more of the voting shares, either directly or beneficially, have a representative on the board of directors?

  • Within the next 6 months, is the Applicant or any of its Subsidiaries anticipating any private placement in excess of $25,000,000?
  • Does the Applicant or any of its Subsidiaries provide services to its customers or clients for a fee or compensation?
  • Does the Applicant or any of its Subsidiaries act as a general partner in any partnership?

  • 1. Copy of the indemnification provisions of the charter and the by-laws.

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  • 2. Copy of Employee Handbook and Human Resources Manual.

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  • 3. Latest Financials with Treasurers Warranty Letter if not audited.

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  • 4. Mainform from current carrier (if applicable).

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  • 5. List of all direct and indirect Subsidiaries, include as to each the nature of business operation, percentage of ownership and whether such Subsidiaries are domestic or foreign.

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  • 6. List of all Directors and Officers of the Applicant and its Subsidiaries and as to each provide any affiliations with other corporations.

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