Cyber Insurance Location Assessment Form

Please complete this form to provide essential location information for assessing cybersecurity as part of the insurance application process. The details you provide will be instrumental in determining the requirements for obtaining cyber insurance coverage. 

1. Location Name *Select LocationAlbuquerque, NMAtlanta, GAAustin, TXConway, ARKDundas, ONIndianapolis, INInternational, ONKansas City, KSLos Angeles, CAMarshall, MOMiami, FLOklahoma, OKOmaha, NEOrlando, FLPhoenix, AZTampa, FLThomaston, CTTulsa, OK

2. Point of Contact (IT Contact) *

3. Do you use a VPN for remote access?

• Yes
• No

4. If Yes, specify type of VPN Used (SSL / IPSec / Other – Specify)

5. If Yes, does your VPN have 2FA /MFA enabled ?

• Yes
• No

Please describe the specific purposes for which the VPN is used. (e.g., accessing local files and folders, Concrete Vision, ADP, etc.)

6. Is Data Encryption Enabled on all Computers & Servers? (Example Bitlocker) *

• Yes
• No

If data encryption is not enabled on all computers, please provide specific details.

7. Is Endpoint Security Installed on all computers? *

• Yes
• No

Please specify what Endpoint security is installed

8. Please specify what Firewall is Installed & what model

9. Do users have Local Admin Access in Windows?

• Yes
• No

10. Additional Information – Any additional security measures or comments you would like to report:

Submit