Verisk Strategic Alliances Vendor Information Form

Please complete a separate form for each vendor.

Step 1 of 3

1. This vendor will be developing: *

2. Your company (the insurer) will be providing the following Verisk products and services to this vendor 
(Note: Please check the products/lines for this project only.):

Policy Administration/Rating
Extreme Event Modeling

Step 2 of 3

3. For LOCATION, please check the services your company licenses:
4. This vendor requires access for the following lines of business on your behalf for this project:
5. How will your company deliver Verisk's ISO materials to this vendor or establish the connection? *
8. The product is:*
9. Where will the work be done? *

13. How long will you be working on this project with this vendor? *

Step 3 of 3

I am an authorized representative from the above insurer or MGA to certify that this is a complete and accurate statement of the work we are requesting from the above vendor. We require the vendor to use ISO products only as permitted by the terms and conditions of our license. We understand that we are responsible to Insurance Services Office, Inc. and its subsidiaries and affiliates for any vendor use or misuse of ISO products.