COVER-PRO
SM
APPLICATION
TECHNICAL WRITER SUPPLEMENT
1. Full name of the Applicant Firm:
2. For what type of audience does the Applicant write
?
% Professional % Consumer
3. Do the Applicant’s clients review the documents prior to release?
Yes No
4. Does the Applicant perform or have performed copyright clea
ranc
e on documents written? Yes No
5. Is the Applicant involved in any publishing? Yes
No If yes, comp
lete the Publishers Supplement.
6. Please indicate the percentage of the Applicant’s techni
cal writing that is targe
ted towards the following:
Computer hardware / software: % General contracting: %
Electronics / Appliances:
%
Construction: %
Automobile: % Electrical: %
Tools / Hardware: % Architectural: %
Other technological goods: (specify) %
Other technological goods: (specify) %
Other technological goods: (specify) %
Other technological goods: (specify) %
Food products: %
Manufacturing / Industrial: %
Medicine / Pharmaceuticals: %
Household chemicals, cleaners, solvents: %
Other: (specify) %
Other: (specify) %
7. For the areas listed above, please indi
cate any degrees, certifications, or
relevant technical experience:
8. Please indicate if services performed involve any of the following industries: If yes please provide details.
Medical: Yes No Nuclear: Yes No
Pharmaceutical: Yes No Other haz
ardous materials:
Yes No
Chemical / Biochemical: Yes No
I understand that the information submitted herein becomes a part of my Philadelphia Insurance
Companie
s Cover-Pro
sm
application and is subject to the same conditions as stated on the application.
Name (Please Print) Title (Must be Principal, Partner or O
fficer)
__________________________________________
Signature Date
PI-PLSP-TWSUPP 08/10
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