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1-2 Special — CFC Media Application (Part 2)
Complete the form below so we can shop 73+ carriers for the right coverage at the best price.
★★★★★
"Austin got us our GL, workers comp, and commercial auto placed in one week. Nobody else came close."
— Tony M., Electrical — Stamford CT
★★★★★
"Eric got our COI to the GC in 20 minutes. We've never had an agency turn certs around that fast."
— Danny R., Plumbing — Norwalk CT
★★★★★
"Switched our whole construction book. Austin found better coverage and saved us $14K annually."
— Marco S., General Contractor — Bridgeport CT
★★★★★
"Justin helped us get a last-minute COI for a job in Manhattan. Friday at 4pm. Had it before 5."
— Chris P., HVAC — Bronx NY
★★★★★
"We're a landscaping company with 12 trucks. Austin understood our exposures — inland marine, hired/non-owned, all of it."
— Ray L., Landscaping — Greenwich CT
★★★★★
"After 15 years with State Farm I finally switched. Better coverage for less money in one phone call."
— Kevin O., Homeowner — Stamford CT
★★★★★
"They set up our entire commercial package and had certs to our three biggest clients within 24 hours."
— Sam K., Roofing — Danbury CT
★★★★★
"Eric rewrote our workers comp and saved us $8K. First agent who ever explained class codes straight."
— Pete D., Masonry — Waterbury CT
★★★★★
"Austin got us our GL, workers comp, and commercial auto placed in one week. Nobody else came close."
— Tony M., Electrical — Stamford CT
★★★★★
"Eric got our COI to the GC in 20 minutes. We've never had an agency turn certs around that fast."
— Danny R., Plumbing — Norwalk CT
★★★★★
"Switched our whole construction book. Austin found better coverage and saved us $14K annually."
— Marco S., General Contractor — Bridgeport CT
★★★★★
"Justin helped us get a last-minute COI for a job in Manhattan. Friday at 4pm. Had it before 5."
— Chris P., HVAC — Bronx NY
★★★★★
"We're a landscaping company with 12 trucks. Austin understood our exposures — inland marine, hired/non-owned, all of it."
— Ray L., Landscaping — Greenwich CT
★★★★★
"After 15 years with State Farm I finally switched. Better coverage for less money in one phone call."
— Kevin O., Homeowner — Stamford CT
★★★★★
"They set up our entire commercial package and had certs to our three biggest clients within 24 hours."
— Sam K., Roofing — Danbury CT
★★★★★
"Eric rewrote our workers comp and saved us $8K. First agent who ever explained class codes straight."
— Pete D., Masonry — Waterbury CT
CFC Media Insurance — Outstanding Questions
Hi Catherine — we have most of your application filled out. We just need a few more details to complete your submission to CFC.
Section 1 — Company Details
How many principals / directors / officers / partners are there in the company? (Q1.3a) *
Total number of employees (Q1.3c) *
Principal / Director Details (Q1.3b) — For each principal please list: Name, Years in Position, Years of Experience, and Qualifications *
Section 1.4 — Financial Information
Please provide figures for each financial year. Leave blank if not applicable.
Date of Financial Year End (MM/DD) *
Currency *
Last Complete Financial Year — Total Revenue
Current Financial Year — Estimated Total Revenue *
Next Financial Year — Estimated Total Revenue
Current Financial Year — Estimated Gross Profit
Current Financial Year — Estimated Payroll
Current Financial Year — Other Territory (Non-US) Revenue
Section 2 — Activities
Revenue Breakdown by Activity (Q2.2) — List each activity and its % of total revenue. Must add up to 100%. *
Public-Facing Website URLs (Q2.8) — For each URL, include: URL, nature of the site, estimated current monthly unique visitors, and estimated monthly unique visitors over the next 12 months.
Maximum Estimated Daily Financial Loss from a System/Web Outage (Q2.13) — This sets your system business interruption limit. *
Q2.14 — Data Types Collected
Please indicate which of the following types of data your company collects.
Which of the following data types do you collect? (Check all that apply) *
Section 3 — Contract Information
Only required if you need professional liability (E&O) coverage.
Approximately how many clients do you have? (Q3.2) *
Top 5 Largest Contracts in the Past 3 Years (Q3.1) — For each, include: Client name, type of business, nature of work, annual revenue from contract, start date, and completion date.
Section 4 — Publishing Activities
Current Publications (Q4.1) — List any publications. Include: name, geographic distribution (regional/national/international), date first published, average circulation, and frequency. *
Name of Law Firm for Media Issues (Q4.7) — Who do you consult for content review, procedures, and complaints?
Do you engage in comparative advertising? (Q4.10) *
Do you trademark your proprietary products? (Q4.11) *
If you do NOT trademark — please explain why (Q4.11)
Do you engage the services of an advertising agency? (Q4.12) *
If yes — does your advertising agency provide full indemnity for all content they originate? (Q4.12)
Maximum Estimated Daily Financial Loss from a System/Web Outage — Publishing Section (Q4.13) *
Do you ensure all sensitive data is encrypted while stored and during transmission? (Q4.14) *
Do you outsource the handling of sensitive data to any third party? (Q4.15) *
Section 6 — Current Insurance Policies
Please share details of any existing coverage. Leave blank for any type you don't currently carry.
Current Insurance Details (Q6.1) — For each policy type, provide: inception/expiry date, limit of liability, deductible, premium, insurer name, and retroactive date if known. Types: Media Liability, E&O, Cyber/Privacy, Commercial GL, Property.
Section 7 — Claims History
Please answer carefully — this covers all companies and all principals/directors.
In the last 5 years — are you aware of ANY of the following? (Q7.1) • Any loss or damage (insured or not) • Circumstances that may give rise to a claim • Any claims or cease & desist orders • Any principal found guilty of criminal/dishonest/fraudulent activity or investigated by a regulator • Any website outage exceeding 3 hours *
If YES — please provide full details including: background, maximum amount involved, current status, any payments made, and dates.
Any Additional Information you'd like us to know?
Your information is secure and will only be used to provide an insurance quote.
★★★★★
"I run 22 trucks across the tristate. Austin consolidated everything under one policy and the premium dropped."
— Jorge V., Trucking — Queens NY
★★★★★
"Austin saved me $700/year on auto and got better home coverage for half the price."
— Michelle T., Homeowner — Cos Cob CT
★★★★★
"Justin put together a life insurance plan that actually made sense. No pressure, just options."
— Brian W., Business Owner — Westport CT
★★★★★
"Their tech is unreal. All my policies, renewals, and certs in one dashboard. No other agency has this."
— Alex F., Property Manager — Manhattan NY
★★★★★
"We needed builder's risk same day for a closing. Eric made it happen. No drama, no excuses."
— Nick G., Developer — Stamford CT
★★★★★
"10 rental properties insured through Safeshield. Re-shopped every one and found savings on 8."
— Linda C., Real Estate — Norwalk CT
★★★★★
"They monitor our renewals 60 days out. Got a call saying they saved us $2K before renewal even hit."
— Steve H., Restaurant — Fairfield CT
★★★★★
"Eric walked us through our umbrella options like a teacher. Patient and genuinely cared."
— Diane M., Homeowner — New Canaan CT
★★★★★
"I run 22 trucks across the tristate. Austin consolidated everything under one policy and the premium dropped."
— Jorge V., Trucking — Queens NY
★★★★★
"Austin saved me $700/year on auto and got better home coverage for half the price."
— Michelle T., Homeowner — Cos Cob CT
★★★★★
"Justin put together a life insurance plan that actually made sense. No pressure, just options."
— Brian W., Business Owner — Westport CT
★★★★★
"Their tech is unreal. All my policies, renewals, and certs in one dashboard. No other agency has this."
— Alex F., Property Manager — Manhattan NY
★★★★★
"We needed builder's risk same day for a closing. Eric made it happen. No drama, no excuses."
— Nick G., Developer — Stamford CT
★★★★★
"10 rental properties insured through Safeshield. Re-shopped every one and found savings on 8."
— Linda C., Real Estate — Norwalk CT
★★★★★
"They monitor our renewals 60 days out. Got a call saying they saved us $2K before renewal even hit."
— Steve H., Restaurant — Fairfield CT
★★★★★
"Eric walked us through our umbrella options like a teacher. Patient and genuinely cared."
— Diane M., Homeowner — New Canaan CT
★★★★★
"COI to the GC in under 15 minutes. Every. Single. Time. Worth switching for if you're in the trades."
— Vinny A., Painting — Brooklyn NY
★★★★★
"Austin found gaps in my coverage I had no idea existed. For a high-value home, that matters."
— Robert K., Homeowner — Greenwich CT
★★★★★
"Old agent took 3 days for a certificate. Safeshield does it in minutes. Speed is money."
— Carlos R., Concrete — Yonkers NY
★★★★★
"Justin set me up with term life and disability. Sole proprietor — family needs to be covered."
— Mike T., Electrician — Trumbull CT
★★★★★
"Moved my restaurant's commercial package and liquor liability. Better coverage, lower premium."
— Anna P., Restaurant — Stamford CT
★★★★★
"He made me feel like a human being, not a policy number. All 4 of my businesses are here now."
— David N., Multi-Business — White Plains NY
★★★★★
"They shopped 73 carriers for our commercial property. We would've overpaid by $6K if we'd just renewed."
— Frank J., Property Mgmt — Bridgeport CT
★★★★★
"Eric handles our entire book. Whenever I need something, I text him and it's done. That simple."
— Sophia L., Client — Darien CT
★★★★★
"COI to the GC in under 15 minutes. Every. Single. Time. Worth switching for if you're in the trades."
— Vinny A., Painting — Brooklyn NY
★★★★★
"Austin found gaps in my coverage I had no idea existed. For a high-value home, that matters."
— Robert K., Homeowner — Greenwich CT
★★★★★
"Old agent took 3 days for a certificate. Safeshield does it in minutes. Speed is money."
— Carlos R., Concrete — Yonkers NY
★★★★★
"Justin set me up with term life and disability. Sole proprietor — family needs to be covered."
— Mike T., Electrician — Trumbull CT
★★★★★
"Moved my restaurant's commercial package and liquor liability. Better coverage, lower premium."
— Anna P., Restaurant — Stamford CT
★★★★★
"He made me feel like a human being, not a policy number. All 4 of my businesses are here now."
— David N., Multi-Business — White Plains NY
★★★★★
"They shopped 73 carriers for our commercial property. We would've overpaid by $6K if we'd just renewed."
— Frank J., Property Mgmt — Bridgeport CT
★★★★★
"Eric handles our entire book. Whenever I need something, I text him and it's done. That simple."
— Sophia L., Client — Darien CT
SAFESHIELD INSURANCE We Work For You. Not The Insurance Company.
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