Crime Insurance Application - Alliance for Contractors

CRIME INSURANCE APPLICATION

Comprehensive Business Crime Coverage Including Theft, Fraud, Forgery, and Computer Crime
with Employee Dishonesty and Third-Party Crime Protection for Complete Crime Risk Management

APPLICANT INFORMATION

Business Name:

DBA/Trade Name:

Business Address:

City, State, ZIP:

Federal Tax ID:

Years in Business:

Primary Contact:

Phone Number:

Email Address:

Number of Employees:

Annual Payroll:

CRIME COVERAGE REQUESTED

Employee Dishonesty Coverage

Coverage Type	Requested Limit	Deductible	Select
Employee Theft - Blanket	$_____________	$_____________	☐
Employee Theft - Per Employee	$_____________	$_____________	☐
Employee Theft - Per Occurrence	$_____________	$_____________	☐

Third-Party Crime Protection

Coverage Type	Requested Limit	Deductible	Select
Theft by Third Parties	$_____________	$_____________	☐
Robbery and Safe Burglary	$_____________	$_____________	☐
Money and Securities	$_____________	$_____________	☐

Computer Crime Coverage

Coverage Type	Requested Limit	Deductible	Select
Computer Fraud	$_____________	$_____________	☐
Funds Transfer Fraud	$_____________	$_____________	☐
Cyber Extortion	$_____________	$_____________	☐

Forgery and Alteration Coverage

Coverage Type	Requested Limit	Deductible	Select
Check Forgery	$_____________	$_____________	☐
Credit Card Forgery	$_____________	$_____________	☐
Money Order Forgery	$_____________	$_____________	☐

General Theft Coverage

Coverage Type	Requested Limit	Deductible	Select
Equipment and Tools	$_____________	$_____________	☐
Inventory and Materials	$_____________	$_____________	☐
Office Contents	$_____________	$_____________	☐

RISK ASSESSMENT

Security Measures Currently in Place:

☐ Security Cameras

☐ Alarm System

☐ Security Guards

☐ Access Control

☐ Safe/Vault

☐ Background Checks

☐ Dual Controls

☐ Regular Audits

Maximum Cash on Premises:

Value of Equipment/Tools:

Has your business experienced any crime losses in the past 5 years?

☐ Yes

☐ No

If yes, please describe: _______________________________________________________________

_________________________________________________________________________________

ALLIANCE INTEGRATION FEATURES

Crime Prevention Protocols

Our integrated crime prevention system provides real-time monitoring, threat assessment, and preventive measures coordination. Alliance protocols automatically sync with your security systems to provide comprehensive protection and early warning capabilities.

Security Assessment Integration

Professional security assessments are conducted by Alliance partners to identify vulnerabilities and recommend improvements. Our integrated approach ensures your security measures align with insurance requirements and industry best practices.

Employee Screening and Crime Insurance Coordination

Alliance coordinates comprehensive employee background checks with crime insurance requirements. Our screening process includes criminal history, credit checks, and reference verification to minimize internal theft risks and ensure coverage compliance.

Comprehensive Crime Risk Management: Alliance provides end-to-end crime risk management including prevention, detection, response, and recovery coordination. Our integrated platform ensures seamless communication between security providers, insurance carriers, and law enforcement.

USE CASES AND APPLICATIONS

Crime Protection

Comprehensive protection against all forms of business crime including internal and external threats with coordinated response protocols.

Theft Coverage

Complete theft protection for equipment, materials, and business property with rapid claim processing and replacement coordination.

Fraud Prevention

Advanced fraud detection and prevention systems with real-time monitoring and immediate response capabilities.

Employee Dishonesty

Protection against employee theft and dishonesty with comprehensive screening and monitoring programs.

Computer Crime

Cyber crime protection including funds transfer fraud, computer fraud, and cyber extortion with technical support.

Security Management

Integrated security management combining physical security, cyber security, and personnel security protocols.

ADDITIONAL INFORMATION

Special Risk Factors or Exposures:

_________________________________________________________________________________

Desired Policy Effective Date: ________________________

Current Crime Insurance Carrier (if any): ________________________

Reason for Change: ___________________________________________________________

APPLICANT CERTIFICATION

I hereby certify that the information provided in this application is true, complete, and accurate to the best of my knowledge. I understand that any misrepresentation or omission of material facts may void coverage. I authorize Alliance for Contractors and its insurance partners to investigate this application and obtain additional information as necessary.

I understand that completion of this application does not bind coverage and that coverage is subject to underwriting approval and policy issuance.

Applicant Signature

Date

Print Name

Submit completed application to: Alliance for Contractors

Email: [email protected] | Fax: (555) 123-4568

For questions, contact our Crime Insurance Specialists at (555) 123-4567