RELIGIOUS INTUTION QUOTE FORM
The Quote Form is our preliminary process of obtaining the necessary underwriting information. Be as thorough as possible. The current policy and claim history will also be required as part of the underwriting process.
List out buildings to be insured with building value and contents value
GENERAL LIABILITY INFORMATION (Complete if you are requesting a quote for this coverage)
THE RELIGIOUS INSTITUTION AND AFFILIATES (EXCLUSIVE OF SCHOOL OPERATIONS)
SEPARATE SCHOOL OPERATIONS OF THE INSURED (if applicable)
The following are insureds under this insurance: The educational affiliate, its board, committee, board of trustees, members of the board or committee, trustees, directors and all employees including student teachers and volunteers
Previous 4 years final enrollment count by year?
CLERGYPERSONS PROFESSIONAL LIABILITY
If you answered YES to either question, please explain
EMPLOYEE BENEFIT PROGRAMS LIABILITY (EBL) APPLICATION CLAIMS-MADE BASIS
If YES, please provide date, brief description and amount.
ABUSE OR MOLESTATION LIABILITY
If you responded YES to either of the prior questions, please provide details
CEMETERY LIABILITY (If applicable)
PLEASE LET US KNOW
How did you hear about us?
Is there anything else that you would like for us to know concerning your quote request?
I have provided all of the above information for insurance purposes and I state all information is true to the best of my knowledge. I also understand that I am to discuss with the agent at D. Ward Insurance my desired limits and coverage.
ADDITIONAL INFORMATION NEEDED
Please note - A copy of the policy and claim history will be required. They can be obtained from your current agent by requesting the documents to be sent electronically to you.
ENTER VALIDATION CODE
For Security of your personal information, enter code and press submit