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  1. 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 Consulting","value":"125-10","isSelected":false,"price":""},{"text":"Legal","value":"350-25","isSelected":false,"price":""},{"text":"Life Sciences","value":"250-36","isSelected":false,"price":""},{"text":"Manufacturer","value":"110-15","isSelected":false,"price":""},{"text":"Marketing\/Advertising\/Public Relations Agency","value":"125-13","isSelected":false,"price":""},{"text":"Mobile Application Development","value":"115-06","isSelected":false,"price":""},{"text":"Network Security Consulting","value":"145-16","isSelected":false,"price":""},{"text":"Online Community","value":"125-26","isSelected":false,"price":""},{"text":"Online Marketplace","value":"190-05","isSelected":false,"price":""},{"text":"Online Media & Publishing","value":"125-20","isSelected":false,"price":""},{"text":"Photography & Videography","value":"150-09","isSelected":false,"price":""},{"text":"Professional Society","value":"125-27","isSelected":false,"price":""},{"text":"Real Estate","value":"155-21","isSelected":false,"price":""},{"text":"Retail","value":"150-23","isSelected":false,"price":""},{"text":"SaaS","value":"125-08","isSelected":false,"price":""},{"text":"Social Media Influencer","value":"175-28","isSelected":false,"price":""},{"text":"Software Design & Development","value":"125-01","isSelected":false,"price":""},{"text":"Systems Administration","value":"110-17","isSelected":false,"price":""},{"text":"Transportation & Logistics","value":"110-35","isSelected":false,"price":""},{"text":"Web Design & Development","value":"125-02","isSelected":false,"price":""},{"text":"Web Hosting","value":"150-18","isSelected":false,"price":""},{"text":"Other (Construction)","value":"110-32","isSelected":false,"price":""},{"text":"Other (Non-Construction)","value":"150-22","isSelected":false,"price":""}],"formId":1,"description":"<div class=\"dialog-scroll\"><p>Please choose the type of company that most closely relates to the products or services your business sells or provides.<\/p><\/div>","allowsPrepopulate":true,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"Please Select...","cssClass":"show-help","inputName":"company_type","noDuplicates":false,"defaultValue":"","conditionalLogic":"","productField":"","enablePrice":"","displayOnly":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"enableChoiceValue":true,"gp-unique-id_starting_number":"","visibility":"visible"},{"type":"checkbox","id":278,"label":"What kinds of products does your company manufacture?","adminLabel":"","isRequired":true,"size":"medium","errorMessage":"","visibility":"visible","choices":[{"text":"Consumer Goods","value":"Consumer Goods","isSelected":false,"price":""},{"text":"Computer Hardware","value":"Computer Hardware","isSelected":false,"price":""},{"text":"Electronics","value":"Electronics","isSelected":false,"price":""},{"text":"Medical Device","value":"Medical Device","isSelected":false,"price":""},{"text":"Other","value":"Other","isSelected":false,"price":""}],"inputs":[{"id":"278.1","label":"Consumer Goods","name":""},{"id":"278.2","label":"Computer Hardware","name":""},{"id":"278.3","label":"Electronics","name":""},{"id":"278.4","label":"Medical Device","name":""},{"id":"278.5","label":"Other","name":""}],"formId":1,"description":"","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"clear wide","inputName":"","noDuplicates":false,"defaultValue":"","conditionalLogic":{"actionType":"show","logicType":"all","rules":[{"fieldId":"7","operator":"is","value":"110-15"}]},"productField":"","enablePrice":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"gp-unique-id_starting_number":"","displayOnly":""},{"type":"checkbox","id":279,"label":"What type of medical devices does your company manufacture?","adminLabel":"","isRequired":true,"size":"medium","errorMessage":"","visibility":"visible","choices":[{"text":"Invasive","value":"Invasive","isSelected":false,"price":""},{"text":"Non-Invasive","value":"Non-Invasive","isSelected":false,"price":""}],"inputs":[{"id":"279.1","label":"Invasive","name":""},{"id":"279.2","label":"Non-Invasive","name":""}],"formId":1,"description":"","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"clear wide","inputName":"","noDuplicates":false,"defaultValue":"","conditionalLogic":{"actionType":"show","logicType":"all","rules":[{"fieldId":"278","operator":"is","value":"Medical Device"}]},"productField":"","enablePrice":"","multipleFiles":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future claim. In an effort to make sure we're able to get your company the right coverage with the right carrier, we need you to be as honest and straightforward as possible.<\/p><\/div>","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"Please Select...","cssClass":"clear wide show-help gf_hidden invisible exclude","inputName":"","noDuplicates":false,"defaultValue":"","conditionalLogic":"","productField":"","enablePrice":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"displayOnly":"","gp-unique-id_starting_number":"","visibility":"visible"},{"type":"radio","id":283,"label":"Has your company ever made an insurance claim or is there a current situation that could result in a claim?","adminLabel":"","isRequired":true,"size":"medium","errorMessage":"","visibility":"visible","inputs":null,"choices":[{"text":"No","value":"No","isSelected":false,"price":""},{"text":"Yes","value":"Yes","isSelected":false,"price":""}],"formId":1,"description":"<div class=\"dialog-scroll\"><p>We need to know if your company has ever made an insurance claim or if you think something has occurred that could result in a future claim. In an effort to make sure we're able to get your company the right coverage with the right carrier, we need you to be as honest and straightforward as possible.<\/p><\/div>","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"clear compact show-help","inputName":"","noDuplicates":false,"defaultValue":"","conditionalLogic":"","productField":"","enableOtherChoice":"","enablePrice":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"gp-unique-id_starting_number":"","displayOnly":""},{"type":"textarea","id":74,"label":"Explanation of Prior or Potential Claim(s)","adminLabel":"","isRequired":false,"size":"large","errorMessage":"","inputs":null,"formId":1,"description":"<div class=\"dialog-scroll\"><p>Who are the parties involved, what occurred, was it settled and, if so, for how much?<\/p><\/div>","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"clear wide show-help","inputName":"","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":{"actionType":"show","logicType":"all","rules":[{"fieldId":"283","operator":"is","value":"Yes"}]},"productField":"","form_id":"","useRichTextEditor":false,"multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"displayOnly":"","gp-unique-id_starting_number":"","visibility":"hidden"},{"type":"page","id":268,"label":"","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","visibility":"visible","inputs":null,"displayOnly":true,"nextButton":{"type":"text","text":"Policies & Procedures \u21e2","imageUrl":"","conditionalLogic":null},"previousButton":{"type":"text","text":"\u21e0","imageUrl":""},"formId":1,"description":"","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"","inputName":"","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":"","productField":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"gwaclEnable":false,"advancedConditionalLogic":"","gp-unique-id_starting_number":""},{"type":"section","id":84,"label":"Policies","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"displayOnly":true,"formId":1,"description":"","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"clear proposal-section proposal-policies","inputName":"","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":"","productField":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"gp-unique-id_starting_number":"","visibility":"visible","gwaclEnable":false,"advancedConditionalLogic":""},{"type":"select","id":12,"label":"How many protected electronic records do you store?","adminLabel":"","isRequired":true,"size":"large","errorMessage":"","inputs":null,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red by mortgage and lien holders.<\/p><\/div>","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"clear wide show-description product-policy exclude","inputName":"","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":{"actionType":"show","logicType":"all","rules":[{"fieldId":"223","operator":"is","value":"3"}]},"productField":"","basePrice":"$0.00","disableQuantity":true,"multipleFiles":false,"maxFiles":"","calculationFormula":"{Property Price:136}","calculationRounding":"","enableCalculation":true,"displayAllCategories":false,"useRichTextEditor":false,"gp-unique-id_starting_number":"","displayOnly":"","visibility":"visible","gwreadonly_enable":false},{"type":"html","id":328,"label":"","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","visibility":"visible","inputs":null,"displayOnly":true,"formId":1,"description":"","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"","inputName":"","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":{"actionType":"show","logicType":"all","rules":[{"fieldId":"223","operator":"is","value":"3"},{"fieldId":"315","operator":"is","value":"Yes"}]},"content":"<div class=\"alert info blue\"><p>You indicated your company owns property. We want to make sure we get the right insurance for you.\nWe will contact you soon about your Owned Property Coverage.<\/p><\/div>","productField":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"gp-unique-id_starting_number":""},{"type":"html","id":226,"label":"","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"displayOnly":true,"formId":1,"description":"","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"gsection clear wide customize-header exclude","inputName":"","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":{"actionType":"show","logicType":"all","rules":[{"fieldId":"223","operator":"is","value":"3"}]},"productField":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"gp-unique-id_starting_number":"","content":"<h2 class='gsection_title'>Customize This Policy<\/h2>","visibility":"visible"},{"type":"option","id":167,"label":"Deductible","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputType":"radio","choices":[{"text":"$1,000","value":"1","isSelected":false,"price":"$0.00"},{"text":"$500","value":"2","isSelected":true,"price":"$0.00"},{"text":"$250","value":"3","isSelected":false,"price":"$0.00"},{"text":"$2,500","value":"4","isSelected":false,"price":"$0.00"},{"text":"$5,000","value":"5","isSelected":false,"price":"$0.00"},{"text":"$7,500","value":"6","isSelected":false,"price":"$0.00"},{"text":"$10,000","value":"7","isSelected":false,"price":"$0.00"}],"enablePrice":true,"productField":"124","formId":1,"description":"<div class=\"dialog-scroll\"><p>Standard property policies have a $500 deductible. This is the amount you will have to pay for each and every property loss claim you file. You can increase or reduce your deductible but the premium will increase or decrease respectively.<\/p><\/div>","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"clear wide policy-customization show-help exclude","inputName":"","noDuplicates":false,"defaultValue":"","inputs":null,"conditionalLogic":{"actionType":"show","logicType":"all","rules":[{"fieldId":"223","operator":"is","value":"3"}]},"multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"gp-unique-id_starting_number":"","gwlimitcheckboxes_enable":false,"gwlimitcheckboxes_span_multiple_fields":false,"enableChoiceValue":true,"displayOnly":"","visibility":"visible"},{"type":"option","id":168,"label":"Inflation Guard","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputType":"radio","choices":[{"text":"3%","value":"1","isSelected":true,"price":"$0.00"},{"text":"5%","value":"2","isSelected":false,"price":"$0.00"}],"enablePrice":true,"productField":"124","formId":1,"description":"<div class=\"dialog-scroll\"><p>Replacing damaged or stolen property with like kind and quality will get increasingly expensive as inflation increases. The inflation guard option adds a standard 3% inflation adjustment to your property figures each year so you do not have to manually reassess the value of your business property. If you feel that your business property values may increase greater than 3% per year, you have the option to increase the inflation guard coverage to 5%.<\/p><\/div>","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"clear wide policy-customization show-help exclude","inputName":"","noDuplicates":false,"defaultValue":"","inputs":null,"conditionalLogic":{"actionType":"show","logicType":"all","rules":[{"fieldId":"223","operator":"is","value":"3"}]},"multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"gp-unique-id_starting_number":"","gwlimitcheckboxes_enable":false,"gwlimitcheckboxes_span_multiple_fields":false,"enableChoiceValue":true,"displayOnly":"","visibility":"visible"},{"type":"option","id":165,"label":"Employee Theft\/Fraud Limits","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputType":"radio","choices":[{"text":"$25,000","value":"1","isSelected":true,"price":"$0.00"},{"text":"$250,000","value":"2","isSelected":false,"price":"$0.00"},{"text":"$500,000","value":"3","isSelected":false,"price":"$0.00"},{"text":"$1,000,000","value":"4","isSelected":false,"price":"$0.00"}],"enablePrice":true,"productField":129,"formId":1,"description":"<div class=\"dialog-scroll\"><p>This option provides coverage for your company in the event of employee theft or fraud. Your general liability policy comes with a standard coverage amount of $25,000. However, this amount is considered an economy crime policy and is only meant to meet the minimum requirements commonly found in contracts.<\/p>\n<p>We recommend you consider increasing the coverage limit especially if your employees have access to sensitive customer data or payment information.<\/p><\/div>","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"clear wide policy-customization show-help exclude","inputName":"","noDuplicates":false,"defaultValue":"","inputs":null,"conditionalLogic":{"actionType":"show","logicType":"any","rules":[{"fieldId":"223","operator":"is","value":"3"}]},"multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"gp-unique-id_starting_number":"","displayOnly":"","enableChoiceValue":true,"visibility":"visible"},{"type":"number","id":136,"label":"Property Price","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"numberFormat":"decimal_dot","formId":1,"description":"","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"gf_hidden invisible exclude","inputName":"","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":{"actionType":"show","logicType":"all","rules":[{"fieldId":"223","operator":"is","value":"3"}]},"enableCalculation":false,"rangeMin":"","productField":"","rangeMax":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"gp-unique-id_starting_number":"","displayOnly":"","visibility":"visible"},{"type":"radio","id":329,"label":"Would you like us to bind all the other coverages?","adminLabel":"","isRequired":true,"size":"medium","errorMessage":"","visibility":"visible","inputs":null,"choices":[{"text":"Yes","value":"Yes","isSelected":false,"price":""},{"text":"No","value":"No","isSelected":false,"price":""}],"formId":1,"description":"","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"","inputName":"","noDuplicates":false,"defaultValue":"","conditionalLogic":{"actionType":"show","logicType":"all","rules":[{"fieldId":"223","operator":"is","value":"3"},{"fieldId":"315","operator":"is","value":"Yes"}]},"productField":"","enableOtherChoice":"","enablePrice":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"gp-unique-id_starting_number":"","enableChoiceValue":false},{"type":"product","id":125,"label":"Workers Compensation","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":[{"id":"125.1","label":"Name","name":""},{"id":"125.2","label":"Price","name":""},{"id":"125.3","label":"Quantity","name":""}],"inputType":"calculation","enablePrice":null,"for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 for bodily injury by disease or illness, and up to $C in aggregate coverage.<\/p><\/div>","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"clear wide policy-customization show-help","inputName":"","noDuplicates":false,"defaultValue":"","inputs":null,"conditionalLogic":{"actionType":"show","logicType":"all","rules":[{"fieldId":"223","operator":"is","value":"4"}]},"multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"gp-unique-id_starting_number":"","enableChoiceValue":true,"displayOnly":""},{"type":"text","id":4,"label":"Federal EIN (Tax ID)","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"formId":1,"description":"<div class=\"dialog-scroll\"><p>Not all businesses have an FEIN (Federal Employer Identification Number).  If you haven't registered for an FEIN and you pay employees, you must obtain one before we can place workers compensation coverage.<\/p><p>You can register for an instant EIN for free, online, and directly with the IRS.<\/p><p><a href=\"https:\/\/www.irs.gov\/businesses\/small-businesses-self-employed\/apply-for-an-employer-identification-number-ein-online\" class=\"link-arrow\" target=\"_blank\">Register for an EIN Instantly<\/a><\/p><\/div>","allowsPrepopulate":true,"inputMask":true,"inputMaskValue":"99-9999999","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"show-help","inputName":"ein","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":{"actionType":"show","logicType":"all","rules":[{"fieldId":"223","operator":"is","value":"4"}]},"productField":"","enablePasswordInput":"","maxLength":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"displayOnly":"","gp-unique-id_starting_number":"","visibility":"hidden"},{"type":"number","id":137,"label":"Workers Compensation Price","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"numberFormat":"decimal_dot","formId":1,"description":"","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"gf_hidden invisible exclude","inputName":"","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":{"actionType":"show","logicType":"all","rules":[{"fieldId":"223","operator":"is","value":"4"}]},"enableCalculation":false,"rangeMin":"","productField":"","rangeMax":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"gp-unique-id_starting_number":"","displayOnly":"","visibility":"visible"},{"type":"product","id":126,"label":"Umbrella","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":[{"id":"126.1","label":"Name","name":""},{"id":"126.2","label":"Price","name":""},{"id":"126.3","label":"Quantity","name":""}],"inputType":"calculation","enablePrice":null,"formId":1,"description":"<div class=\"dialog-scroll\"><p>In most cases, your business will have some form of exposure that extends beyond the insurance limits covered by general liability, auto liability, and workers compensation. An umbrella policy is a cost-effective way to increase your GL, Auto liability, and worker\u2019s compensation limits.<\/p><p>Other reasons to consider an umbrella insurance policy include compliance with customer contracts and lease agreements.<\/p><\/div>","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"clear wide show-description product-policy exclude","inputName":"","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":{"actionType":"show","logicType":"all","rules":[{"fieldId":"223","operator":"is","value":"5"}]},"productField":"","basePrice":"$0.00","disableQuantity":true,"multipleFiles":false,"maxFiles":"","calculationFormula":"{Umbrella Price:138}","calculationRounding":"","enableCalculation":true,"displayAllCategories":false,"useRichTextEditor":false,"gp-unique-id_starting_number":"","displayOnly":"","visibility":"visible","gwreadonly_enable":false},{"type":"html","id":228,"label":"","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"displayOnly":true,"formId":1,"description":"","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"gsection clear wide customize-header exclude","inputName":"","noDu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onsider the industries you serve as a basis for the coverage limit. Also, keep in mind that certain contracts may require specific limits so review your company's contracts for any insurance requirement clauses.<p>\n<p>Finally, please note that an umbrella policy <strong>DOES NOT<\/strong> extend additional coverage over any professional liability and errors and omissions policies.<\/p><\/div>","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"clear wide policy-customization show-help exclude","inputName":"","noDuplicates":false,"defaultValue":"","inputs":null,"conditionalLogic":{"actionType":"show","logicType":"all","rules":[{"fieldId":"223","operator":"is","value":"7"}]},"multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"gp-unique-id_starting_number":"","gwlimitcheckboxes_enable":false,"gwlimitcheckboxes_span_multiple_fields":false,"enableChoiceValue":true,"displayOnly":"","visibility":"visible"},{"type":"number","id":256,"label":"Professional Liability (E&O) Price","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"numberFormat":"decimal_dot","formId":1,"description":"","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"gf_hidden invisible exclude","inputName":"","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":{"actionType":"show","logicType":"all","rules":[{"fieldId":"223","operator":"is","value":"7"}]},"enableCalculation":false,"rangeMin":"","productField":"","rangeMax":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"gp-unique-id_starting_number":"","displayOnly":"","visibility":"visible"},{"type":"product","id":257,"label":"Cyber Liability & Data Breach","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":[{"id":"257.1","label":"Name","name":""},{"id":"257.2","label":"Price","name":""},{"id":"257.3","label":"Quantity","name":""}],"inputType":"calculation","enablePrice":null,"formId":1,"description":"<div class=\"dialog-scroll\"><p>Data breaches are a top risk being faced by all types of companies in today's digital environment. This addition covers breaches that result in the loss or theft of any business data or personally identifiable information of your customers, clients, or vendors including credit card information and banking information, social security numbers, protected health information (HIPAA), email addresses, phone numbers, and more. If your company experiences a breach, you will also receive a free legal consultation with a law firm, a free in-depth forensic investigation, and optional free notification and identity theft education for any individuals or entities affected by the breach.<\/p><\/div>","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"clear wide show-description product-policy exclude","inputName":"","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":{"actionType":"show","logicType":"all","rules":[{"fieldId":"223","operator":"is","value":"8"}]},"productField":"","basePrice":"$0.00","disableQuantity":true,"multipleFiles":false,"maxFiles":"","calculationFormula":"{Cyber Liability\/Data Breach Price:260}","calculationRounding":"","enableCalculation":true,"displayAllCategories":false,"useRichTextEditor":false,"gp-unique-id_starting_number":"","displayOnly":"","visibility":"visible","gwreadonly_enable":false},{"type":"html","id":258,"label":"","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"displayOnly":true,"formId":1,"description":"","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"gsection clear wide customize-header exclude","inputName":"","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":{"actionType":"show","logicType":"all","rules":[{"fieldId":"223","operator":"is","value":"8"}]},"productField":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"gp-unique-id_starting_number":"","content":"<h2 class='gsection_title'>Customize This Policy<\/h2>","visibility":"visible","gwreadonly_enable":false},{"type":"option","id":259,"label":"Coverage Limit","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputType":"radio","choices":[{"text":"$250,000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xFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"gp-unique-id_starting_number":"","forceSSL":true,"creditCardFundingTypes":["credit","debit"],"visibility":"visible","gwaclEnable":false,"advancedConditionalLogic":""},{"type":"html","id":230,"label":"Billing Explanation","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"displayOnly":true,"formId":1,"description":"","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"right billing-explanation","inputName":"","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":"","productField":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"gp-unique-id_starting_number":"","content":"<h4 class=\"font-serif font-uppercase color-blue\">Billing Explanation<\/h4>\n<span class=\"mdash gradient-blue\"><\/span>\n<small>By providing your credit card, you agree to purchase the insurance selected above if Layr secures it within 48 hours. The card will be pre-authorized for $1.00 to verify it is valid but the first of twelve (12) monthly payments <strong>will not<\/strong> be processed until coverage is bound. You will receive an email confirmation as soon as coverage is in place and the first payment is made. For a detailed explanation of our pricing, please review our <a href=\"https:\/\/layr.test\/compensation-disclosure\/\" style=\"color: #888888; text-decoration: underline;\" target=\"_blank\">compensation disclosure.<\/a><\/small>","visibility":"visible","gwreadonly_enable":false,"gwaclEnable":false,"advancedConditionalLogic":""},{"type":"tos","default_field_props":{"label":"Terms of Service","inputType":"checkbox","size":"large","choices":[{"text":"I agree to the Terms of Service","value":"I agree to the Terms of Service"}],"tosHTMLEnabled":true},"id":308,"label":"Terms & Conditions","adminLabel":"","isRequired":false,"size":"large","errorMessage":"","visibility":"hidden","inputs":[{"id":"308.1","label":"I agree to all of the <a class=\"modal-form-proposal-terms-toggle\">terms and conditions<\/a>.","name":""}],"inputType":"checkbox","choices":[{"text":"I agree to all of the <a class=\"modal-form-proposal-terms-toggle\">terms and conditions<\/a>.","value":"I agree to all of the <a class=\"modal-form-proposal-terms-toggle\">terms and conditions<\/a>.","isSelected":false}],"tosHTMLEnabled":true,"formId":1,"description":"","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"clear wide terms","inputName":"","noDuplicates":false,"defaultValue":"","conditionalLogic":"","productField":"","enablePrice":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"gp-unique-id_starting_number":"","gwtermsofservice_terms":"By submitting this form, you declare that all information provided and in the completed form submitted herewith is true, accurate, and complete. Submitting this form binds you to purchase any selected insurance if and when Layr Holdings, Inc. (\"Layr\") is able to secure coverage at a total premium that is no more than five percent (5%) above the total premium displayed on this page and it is agreed that this form shall be the basis of any insurance policy issued. You also understand and agree that coverage is not in place until Layr has secured confirmation from an insurer accepting and binding your proposal. There is a possibility that Layr is unable to secure coverage in which case your credit card will not be charged and no coverage will be in place. There is also a possibility that the insurers require a premium that is more than five percent (5%) above the total premium displayed on this page. In this case, you will have the ability but not the obligation to accept the higher premium and to proceed with having coverage bound.\n\nBy submitting this form, you authorize Layr, its payment processing affiliates, and the credit card issuer for the card entered on this page to charge your credit card monthly for twelve (12) consecutive months if and when coverage is bound. You acknowledge that you understand this price includes a fee as disclosed on the compensation disclosure page accessible via our website and you understand that the card issuer can supply Layr with an updated expiration date and\/or credit card number. Additionally, insurance carriers will perform an annual audit of some insurance policies. Based on the results of these audits, you may be required to pay additional premium which you authorize Layr to automatically charge to your credit card. Failure to pay this additional premium will result in the cancellation of the currently enforced insurance policy. It is your responsibility to update Layr when the credit card and\/or expiration date change. You acknowledge that the credit card listed above is valid and that you have available credit to accept such charges. If a charge is not authorized and payment is not made, Layr will issue a cancellation notice for non-payment of premium and initiate a charge as stated in this notice. Charges shall be initiated by Layr to pay premiums and other charges and fees, including, if applicable, any fee charged after the policy's termination effective date, for or associated with the above-listed policies or other policies as authorized and the charge entries shall constitute your receipt for the transaction(s). No payment to Layr shall be deemed to have been made unless and until Layr receives payment. You also understand that if corrections of the entry are necessary, it may involve an adjustment to your account. You understand the charge to your card of the billing schedule amount will be charged on or after the premium due date indicated on your schedule and that you should continue to pay any bills you are sent prior to receiving the schedule. You understand that you will thereafter be sent a schedule only at renewal or if your premium amount changes during the policy period. You understand that Layr can create a one-time charge request at your authorization.\n\nLayr reserves the right to refuse or terminate electronic payment services. This agreement is to remain in effect until Layr terminates it or until you notify Layr in writing of termination or request removal on www.WithLayr.com. You understand Layr has five (5) business days to act on your request. Should a policy be offered to you by an affiliate company, this agreement will remain in effect unless notifying Layr in writing of the termination of this agreement. Termination will be effective within five (5) business days. In the event that you transfer your policies to another agency during the agreement period, you will immediately be charged in full for any remaining months.\n\nBy submitting this form, you irrevocably appoint Layr as your \"attorney-in-fact\" with the full power of substitution and full authority, in the event of failure to pay under these terms, to (i) cancel all insurance policies in accordance with the provisions contained herein, (ii) receive all sums assigned to Layr, and (iii) execute and deliver on behalf of you all documents, forms, and notices relating to the insurance policies purchased through us in furtherance of these terms. You agree that this right to cancel will terminate only after all of your indebtedness under these terms is paid in full.\n\nThe information requested in this form does not constitute notice under any policy of a claim or potential claim. All such notices must be submitted pursuant to the terms of the policy under which coverage is sought. If there is any material change in the answers to the questions in this form before the policy inception date, you must immediately notify Layr in writing. In such a case, any outstanding coverage quotation may be modified or withdrawn.\n\n\u2014\n\nNotice to All Applicants: Any person who, knowingly or with intent to defraud or to facilitate fraud against any insurance company or another person, submits an application or files a claim for insurance containing false, deceptive, or misleading information may be guilty of insurance fraud.\n\nNotice to Arkansas, Louisiana, and New Mexico Applicants: Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit, or knowingly presents false information in an application for insurance is guilty of a crime and may be subject to fines and confinement in prison.\n\nNotice to Colorado Applicants: It is unlawful to knowingly provide false, incomplete, or misleading facts or information to an insurance company for the purpose of defrauding or attempting to defraud the company. Penalties may include imprisonment, fines, denial of insurance, and civil damages. Any insurance company or agent of an insurance company who knowingly provides false, incomplete, or misleading facts or information to a policyholder or claimant for the purpose of defrauding or attempting to defraud the policyholder or claimant with regard to a settlement or award payable from insurance proceeds shall be reported to the Colorado division of insurance within the department of regulatory agencies.\n\nNotice to District of Columbia Applicants: It is a crime to provide false or misleading information to an insurer for the purpose of defrauding the insurer or any other person. Penalties include imprisonment and\/or fines. In addition, an insurer may deny insurance benefits if false information materially related to a claim was provided by the applicant.\n\nNotice to Florida Applicants: Any person who knowingly and with intent to injure, defraud, or deceive any insurer files a statement of claim or an application containing any false, incomplete or misleading information is guilty of a felony in the third degree.\n\nNotice to Kentucky Applicants: Any person who knowingly and with the intent to defraud any insurance company or other person files an application for insurance containing any materially false information, or conceals for the purpose of misleading, information concerning any fact material thereto, commits a fraudulent insurance act, which is a crime.\n\nNotice to Maine Applicants: It is a crime to provide false, incomplete, or misleading information to an insurance company for the purpose of defrauding the company. Penalties may include imprisonment, fines, or a denial of insurance benefits.\n\nNotice to New Jersey Applicants: Any person who includes any false or misleading information on an application for an insurance policy is subject to criminal and civil penalties. \n\nNotice to New York Applicants: Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any materially false information, or conceals for the purpose of misleading information concerning any fact material thereto, commits a fraudulent insurance act, which is a crime, and shall also be subject to a civil penalty not to exceed five thousand dollars and the stated value of the claim for each such violation.\n\nNotice to Ohio Applicants: Any person who, with intent to defraud or knowing that he is facilitating a fraud against an insurer, submits an application or files a claim containing a false or deceptive statement is guilty of insurance fraud.\n\nNotice to Oklahoma Applicants: Any person who knowingly, and with intent to injure, defraud or deceive any insurer, makes any claim for the proceeds of an insurance policy containing any false, incomplete or misleading information is guilty of a felony.\n\nNotice to Pennsylvania Applicants: Any person who knowingly and with the intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any materially false information, or conceals for the purpose of misleading, information concerning any fact material thereto, commits a fraudulent insurance act, which is a crime and subjects such person to criminal and civil penalties.\n\nNotice to Puerto Rico Applicants: Any person who knowingly and with the intent to defraud, presents false information in an insurance request form, or who presents, helps, or has presented a fraudulent claim for the payment of a loss or other benefit, or presents more than one claim for the same damage or loss, will incur a felony, and upon conviction will be penalized for each violation with a fine of no less than five thousand dollars ($5,000) nor more than ten thousand dollars ($10,000); or imprisonment for a fixed term of three (3) years, or both penalties. If aggravated circumstances prevail, the fixed established imprisonment may be increased to a maximum of five (5) years; if attenuating circumstances prevail, it may be reduced to a minimum of two (2) years.\n\nNotice to Tennessee and Virginia Applicants: It is a crime to knowingly provide false, incomplete, or misleading information to an insurance company for the purpose of defrauding the company. Penalties include imprisonment, fines, and denial of insurance benefits.\n\nNotice to Washington Applicants: It is a crime to knowingly provide false, incomplete, or misleading information to an insurance company for the purpose of defrauding the company. Penalties include imprisonment, fines, and denial of insurance benefits.","displayOnly":""},{"type":"html","id":311,"label":"","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","visibility":"visible","inputs":null,"displayOnly":true,"formId":1,"description":"","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"clear","inputName":"","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":"","content":"<br \/>","productField":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"gp-unique-id_starting_number":"","disableMargins":true},{"type":"list","id":310,"label":"Claims","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","visibility":"visible","inputs":null,"formId":1,"description":"","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"","inputName":"","noDuplicates":false,"defaultValue":"","choices":[{"text":"Claim Amount","value":"Claim Amount","isSelected":false,"price":""},{"text":"Short Description of Incident","value":"Short Description of Incident","isSelected":false,"price":""}],"conditionalLogic":{"actionType":"show","logicType":"all","rules":[{"fieldId":"283","operator":"is","value":"Yes"}]},"maxRows":0,"productField":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"gp-unique-id_starting_number":"","enableColumns":true,"displayOnly":""},{"type":"html","id":309,"label":"","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","visibility":"visible","inputs":null,"displayOnly":true,"formId":1,"description":"","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"clear","inputName":"","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":"","content":"<script>\n    $( document ).ready(function() {\n        $('.modal-proposal-terms-toggle').on('click', function(e) {\n            e.preventDefault();\n            $('.modal-proposal-terms').toggleClass('is-visible');\n        });\n    });\n<\/script>\n<div class=\"modal modal-proposal-terms\" aria-hidden=\"true\" role=\"dialog\" data-html2canvas-ignore=\"true\">\n    <div class=\"modal-overlay modal-proposal-terms-toggle\"><\/div>\n    <div class=\"modal-wrapper modal-transition\">\n        <div class=\"modal-header\">\n            <a class=\"modal-close modal-proposal-terms-toggle\"><i class=\"material-icons\">close<\/i><\/a>\n            <h3 class=\"modal-heading\">Terms & Conditions<\/h3>\n        <\/div>\n        <div class=\"modal-body\">\n            <div class=\"modal-content\" style=\"font-size: 85%;\">\n                <p>By submitting this form, you declare that all information provided and in the completed form submitted herewith is true, accurate, and complete. Submitting this form binds you to purchase any selected insurance if and when Layr Holdings, Inc. (\"Layr\") is able to secure coverage at a total premium that is no more than five percent (5%) above the total premium displayed on this page and it is agreed that this form shall be the basis of any insurance policy issued. You also understand and agree that coverage is not in place until Layr has secured confirmation from an insurer accepting and binding your proposal. There is a possibility that Layr is unable to secure coverage in which case your credit card will not be charged and no coverage will be in place. There is also a possibility that the insurers require a premium that is more than five percent (5%) above the total premium displayed on this page. In this case, you will have the ability but not the obligation to accept the higher premium and to proceed with having coverage bound.<\/p>\n                <p>By submitting this form, you authorize Layr, its payment processing affiliates, and the credit card issuer for the card entered on this page to charge your credit card monthly for twelve (12) consecutive months if and when coverage is bound. You acknowledge that you understand this price includes a fee as disclosed on the compensation disclosure page accessible via our website and you understand that the card issuer can supply Layr with an updated expiration date and\/or credit card number. Additionally, insurance carriers will perform an annual audit of some insurance policies. Based on the results of these audits, you may be required to pay additional premium which you authorize Layr to automatically charge to your credit card. Failure to pay this additional premium will result in the cancellation of the currently enforced insurance policy. It is your responsibility to update Layr when the credit card and\/or expiration date change. You acknowledge that the credit card listed above is valid and that you have available credit to accept such charges. If a charge is not authorized and payment is not made, Layr will issue a cancellation notice for non-payment of premium and initiate a charge as stated in this notice. Charges shall be initiated by Layr to pay premiums and other charges and fees, including, if applicable, any fee charged after the policy's termination effective date, for or associated with the above-listed policies or other policies as authorized and the charge entries shall constitute your receipt for the transaction(s). No payment to Layr shall be deemed to have been made unless and until Layr receives payment. You also understand that if corrections of the entry are necessary, it may involve an adjustment to your account. You understand the charge to your card of the billing schedule amount will be charged on or after the premium due date indicated on your schedule and that you should continue to pay any bills you are sent prior to receiving the schedule. You understand that you will thereafter be sent a schedule only at renewal or if your premium amount changes during the policy period. You understand that Layr can create a one-time charge request at your authorization.<\/p>\n                <p>Layr reserves the right to refuse or terminate electronic payment services. This agreement is to remain in effect until Layr terminates it or until you notify Layr in writing of termination or request removal on www.WithLayr.com. You understand Layr has five (5) business days to act on your request. Should a policy be offered to you by an affiliate company, this agreement will remain in effect unless notifying Layr in writing of the termination of this agreement. Termination will be effective within five (5) business days. In the event that you transfer your policies to another agency during the agreement period, you will immediately be charged in full for any remaining months.<\/p>\n                <p>By submitting this form, you irrevocably appoint Layr as your \"attorney-in-fact\" with the full power of substitution and full authority, in the event of failure to pay under these terms, to (i) cancel all insurance policies in accordance with the provisions contained herein, (ii) receive all sums assigned to Layr, and (iii) execute and deliver on behalf of you all documents, forms, and notices relating to the insurance policies purchased through us in furtherance of these terms. You agree that this right to cancel will terminate only after all of your indebtedness under these terms is paid in full.<\/p>\n                <p>The information requested in this form does not constitute notice under any policy of a claim or potential claim. All such notices must be submitted pursuant to the terms of the policy under which coverage is sought. If there is any material change in the answers to the questions in this form before the policy inception date, you must immediately notify Layr in writing. In such a case, any outstanding coverage quotation may be modified or withdrawn.<\/p>\n                <p>\u2014<\/p>\n                <p>Notice to All Applicants: Any person who, knowingly or with intent to defraud or to facilitate fraud against any insurance company or another person, submits an application or files a claim for insurance containing false, deceptive, or misleading information may be guilty of insurance fraud.<\/p>\n                <p>Notice to Arkansas, Louisiana, and New Mexico Applicants: Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit, or knowingly presents false information in an application for insurance is guilty of a crime and may be subject to fines and confinement in prison.<\/p>\n                <p>Notice to Colorado Applicants: It is unlawful to knowingly provide false, incomplete, or misleading facts or information to an insurance company for the purpose of defrauding or attempting to defraud the company. Penalties may include imprisonment, fines, denial of insurance, and civil damages. Any insurance company or agent of an insurance company who knowingly provides false, incomplete, or misleading facts or information to a policyholder or claimant for the purpose of defrauding or attempting to defraud the policyholder or claimant with regard to a settlement or award payable from insurance proceeds shall be reported to the Colorado division of insurance within the department of regulatory agencies.<\/p>\n                <p>Notice to District of Columbia Applicants: It is a crime to provide false or misleading information to an insurer for the purpose of defrauding the insurer or any other person. Penalties include imprisonment and\/or fines. In addition, an insurer may deny insurance benefits if false information materially related to a claim was provided by the applicant.<\/p>\n                <p>Notice to Florida Applicants: Any person who knowingly and with intent to injure, defraud, or deceive any insurer files a statement of claim or an application containing any false, incomplete or misleading information is guilty of a felony in the third degree.<\/p>\n                <p>Notice to Kentucky Applicants: Any person who knowingly and with the intent to defraud any insurance company or other person files an application for insurance containing any materially false information, or conceals for the purpose of misleading, information concerning any fact material thereto, commits a fraudulent insurance act, which is a crime.<\/p>\n                <p>Notice to Maine Applicants: It is a crime to provide false, incomplete, or misleading information to an insurance company for the purpose of defrauding the company. Penalties may include imprisonment, fines, or a denial of insurance benefits.<\/p>\n                <p>Notice to New Jersey Applicants: Any person who includes any false or misleading information on an application for an insurance policy is subject to criminal and civil penalties. <\/p>\n                <p>Notice to New York Applicants: Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any materially false information, or conceals for the purpose of misleading information concerning any fact material thereto, commits a fraudulent insurance act, which is a crime, and shall also be subject to a civil penalty not to exceed five thousand dollars and the stated value of the claim for each such violation.<\/p>\n                <p>Notice to Ohio Applicants: Any person who, with intent to defraud or knowing that he is facilitating a fraud against an insurer, submits an application or files a claim containing a false or deceptive statement is guilty of insurance fraud.<\/p>\n                <p>Notice to Oklahoma Applicants: Any person who knowingly, and with intent to injure, defraud or deceive any insurer, makes any claim for the proceeds of an insurance policy containing any false, incomplete or misleading information is guilty of a felony.<\/p>\n                <p>Notice to Pennsylvania Applicants: Any person who knowingly and with the intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any materially false information, or conceals for the purpose of misleading, information concerning any fact material thereto, commits a fraudulent insurance act, which is a crime and subjects such person to criminal and civil penalties.<\/p>\n                <p>Notice to Puerto Rico Applicants: Any person who knowingly and with the intent to defraud, presents false information in an insurance request form, or who presents, helps, or has presented a fraudulent claim for the payment of a loss or other benefit, or presents more than one claim for the same damage or loss, will incur a felony, and upon conviction will be penalized for each violation with a fine of no less than five thousand dollars ($5,000) nor more than ten thousand dollars ($10,000); or imprisonment for a fixed term of three (3) years, or both penalties. If aggravated circumstances prevail, the fixed established imprisonment may be increased to a maximum of five (5) years; if attenuating circumstances prevail, it may be reduced to a minimum of two (2) years.<\/p>\n                <p>Notice to Tennessee and Virginia Applicants: It is a crime to knowingly provide false, incomplete, or misleading information to an insurance company for the purpose of defrauding the company. Penalties include imprisonment, fines, and denial of insurance benefits.<\/p>\n                <p>Notice to Washington Applicants: It is a crime to knowingly provide false, incomplete, or misleading information to an insurance company for the purpose of defrauding the company. Penalties include imprisonment, fines, and denial of insurance benefits.<\/p>\n            <\/div>\n        <\/div>\n    <\/div>\n<\/div>","productField":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"gp-unique-id_starting_number":"","disableMargins":true},{"type":"section","id":265,"label":"\ud83d\ude4b Kudos & Comments","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"displayOnly":true,"formId":1,"description":"","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"clear gf_invisible exclude","inputName":"","visibility":"visible","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":"","productField":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"gwreadonly_enable":false,"gp-unique-id_starting_number":"","gwaclEnable":false,"advancedConditionalLogic":""},{"type":"textarea","id":271,"label":"Kudos & Comments","adminLabel":"","isRequired":false,"size":"large","errorMessage":"","visibility":"visible","inputs":null,"formId":1,"description":"","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"clear","inputName":"","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":"","productField":"","form_id":"","useRichTextEditor":false,"multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"gwaclEnable":false,"advancedConditionalLogic":"","gp-unique-id_starting_number":"","displayOnly":""},{"type":"uid","id":270,"label":"Proposal ID","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","visibility":"visible","inputs":null,"gp-unique-id_type":"numeric","formId":1,"description":"","allowsPrepopu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