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COMPUTER/ELECTRONIC DATA PROCESSING SUPPLEMENTAL APPLICATION 2. List of (Risk Placement Services, Inc.)

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HCC Specialty, a division of HCC Insurance Holdings, Inc., is comprised of HCC Specialty
Unde
rwriters, Inc. and Professional Indemnity Agency, Inc.
COMPUTER/ELECTRONIC DATA PROCESSING SUPPLEMENTAL APPLICATION
1. Please complete the appropriate sections indicating the approximate percentages of your
total operation:
2. List of major software applications (i.e., inventory control, payroll, fund transfer,
engineering, educational, etc.) _____________________________________________________________
_____________________________________________________________________________________________
3. Is the applicant an Internet Service Provider and/or does it provide any internet access, online
publishing, and/or services as a web portal, web host, web search engine, e-mail service, chat
room, online database or bulletin board? If YES please provide details on a separate sheet and
percentage of receipts. ( ) YES ( ) NO % Receipts ______
4. Does the applicant provide any services (not just support) or have any staff that is located
outside the US? ( ) YES ( ) NO % Staff ______
5. Does the applicant provide any consulting services which enable or affect any of the following:
- CAD/CAM design or control, robotics or process control of industrial equipment?
( ) YES ( ) NO % Receipts ______
- Mechanical, electrical, chemical, civil or architectural design or engineering?
( ) YES ( ) NO % Receipts ______
- Fund transfers or financial transactions?
( ) YES ( ) NO % Receipts ______
- Aircraft, air-ground equipment, military defense and/or weaponry of any kind?
( ) YES ( ) NO % Receipts ______
- Medical, dental or healthcare disgnosis, monitoring or treatment?
( ) YES ( ) NO % Receipts ______
- 911 or other emergency response and/or dispatch?
( ) YES ( ) NO % Receipts ______
- Energy, power plant, utility or pollution monitoring, supply or distribution?
( ) YES ( ) NO % Receipts ______
- Computer security services intended to protect financial assets or privileged government
information not intended for public usage/consumption?
( ) YES ( ) NO % Receipts ______
- Financial trading platforms? ( ) YES ( ) NO % Receipts ______
It is understood and agreed that this supplemental application shall become a
part of the application for Professional Liability Errors and Omissions Insurance.
______________________ ____________________________________________
Date Name of Applicant
____________________________________________
Signature of person authorized
to execute on behalf of the
Applicant
WORLD-WIDE WEB ADDRESS__________________________________________
MPL SA-20
Electronic Data Processing _____%
EDP Consulting _____%
Custom Software Development _____%
Time-sharing _____%
Packaged Software Development _____%
E-Commerce _____%
Sale of Software for others _____%
Computer Security _____%
Sale of Hardware for others _____%
Website Design _____%
System Analysis/Design _____%
Website Hosting _____%
Other (Describe) _____%
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COMPUTERELECTRONIC DATA PROCESSING SUPPLEMENTAL APPLICATION 2. List of (Risk Placement Services, Inc.)

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Completed 30 July 2020

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