Insurance-Mandated Technology Review
Technology & Infrastructure
Information Request
To: Current Managed Services / IT Provider
Notice to Recipient (IT Provider / MSP):
Our cyber liability insurance carrier has requested a comprehensive review of our technology environment as part of our annual policy renewal and risk assessment process. We are requesting that you complete or verify the information below within 10 business days of receipt. All information provided will be treated as confidential and used solely for insurance and internal risk-assessment purposes. Please return the completed document to the contact listed below. Your cooperation is required under our service agreement.
Our cyber liability insurance carrier has requested a comprehensive review of our technology environment as part of our annual policy renewal and risk assessment process. We are requesting that you complete or verify the information below within 10 business days of receipt. All information provided will be treated as confidential and used solely for insurance and internal risk-assessment purposes. Please return the completed document to the contact listed below. Your cooperation is required under our service agreement.
1
Company & Environment Overview
General business and infrastructure summary
2
Network & Connectivity
WAN, LAN, and connectivity details
WAN / Internet
LAN / Internal Network
Network Device Inventory
| Device Name | Type | Make / Model | IP / Management URL | Firmware / OS | Location | Managed? | Age / Warranty |
|---|---|---|---|---|---|---|---|
3
Servers & Active Directory
On-premises and cloud infrastructure
Server Inventory
| Server Name | Role / Purpose | OS | Physical / Virtual | IP Address | RAM | CPU | Storage | Age / Warranty | Location |
|---|---|---|---|---|---|---|---|---|---|
Active Directory
4
Security
Security tools, policies, and posture
5
Backup & Disaster Recovery
Backup solution, frequency, and DR plan
6
Email & Cloud Services
Email platform, M365, Google Workspace
7
Line-of-Business Applications & Vendor Contracts
Key software and vendor agreements
Key Applications
| Application Name | Vendor | Purpose | User Count | Hosted | License Type |
|---|---|---|---|---|---|
Vendor Contracts
| Vendor / Provider | Service | Account / Contact | Monthly Cost | Annual Cost | Contract End |
|---|---|---|---|---|---|
8
Domain & Windows Admin Credentials
Active Directory and local admin accounts
🔑 CONFIDENTIAL — Credential Information.
Ensure this document is handled and transmitted securely. Never send via unencrypted email or SMS.
9
Network Device Credentials
Firewall, switches, wireless controller
🔑 CONFIDENTIAL — Credential Information.
Ensure this document is handled and transmitted securely. Never send via unencrypted email or SMS.
10
Microsoft 365 / Entra ID Credentials
M365 admin, Defender, Exchange Online
🔑 CONFIDENTIAL — Credential Information.
Ensure this document is handled and transmitted securely. Never send via unencrypted email or SMS.
11
Google Workspace Admin Credentials
Google Workspace admin access
🔑 CONFIDENTIAL — Credential Information.
Ensure this document is handled and transmitted securely. Never send via unencrypted email or SMS.
12
Other Platform & Application Credentials
VPN, DNS, backup portals, virtualization, SSL, other
🔑 CONFIDENTIAL — Credential Information.
Ensure this document is handled and transmitted securely. Never send via unencrypted email or SMS.
13
Certification & Signature
MSP representative sign-off
By completing and returning this document, the undersigned IT Provider / MSP representative certifies that the information provided is accurate and complete to the best of their knowledge, and that this document has been returned via a secure, encrypted channel.