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  1. Religious Organization Quote Continued

Religious Organization Quote Form (Continued)

  1. Religious Organization Quote Continued

Religious Organization Quote Form (Continued)

Providing specialized insurance programs for Churches and Religious Organizations.

Religious Organization Quote Continued
Religious Organization Quote ContinuedAnton Thornquist2023-04-04T11:49:16-04:00
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Thanks for submitting the initial discovery information.

If you would like to continue with your application so we can start quoting right away, please continue below to keep going. The remaining questions should only take about 10-15 minutes to complete.

Leased Property

Do you have a trailer or church-in-a-box?

Buildings and Property

Basement
Commercial Kitchen
Please provide year of last updates to the following:
HVAC
Electrical
Plumbing
Roof
 
What are the building's safety features?
(Check all that apply)
Aside from your main location, does the ministry own or lease any other buildings or property?

Property #2

What is the address?
Is this property owned or leased?
Basement
Commercial Kitchen
Please provide year of last updates to the following:
HVAC
Electrical
Plumbing
Roof
 
What are the building's safety features?
(Check all that apply)
Does the ministry own or lease any other buildings or property?

Property #3

What is the address?
Is this property owned or leased?
Basement
Commercial Kitchen
Please provide year of last updates to the following:
HVAC
Electrical
Plumbing
Roof
 
What are the building's safety features?
(Check all that apply)
Does the ministry own or lease any other buildings or property?

Property #4

What is the address?
Is this property owned or leased?
Basement
Commercial Kitchen
Please provide year of last updates to the following:
HVAC
Electrical
Plumbing
Roof
 
What are the building's safety features?
(Check all that apply)
Does the ministry own or lease any other buildings or property?

Building(s) Usage, Updates, & Significant Items

Are any building used for something other than what they were originally built for?
Are any buildings on a historical register?
Do any buildings have aluminum wiring?
Has the building(s) been retrofitted by a licensed electrician?
Do any buildings have stained glass?
Is there an organ or other musical instrument?
Do you lease any space to outside organizations?
Does lease contain an indemnification and hold harmless clause in favor of the ministry?
Do you obtain a Certificate of Insurance from lessee's policy?
Is sanctuary or any other house of worship building left unlocked when no staff is present?

Programs and Services

Do you have a youth group program?
Youth group run by
Are any minors in the ministry's care overnight?
Is a nursery available during worship activities?
Nursery staffed by
Are parents encouraged to visit the premises unannounced and observe children's activities?
Does your ministry operate any shelters?
How is the shelter staffed?
Do you have a security team?
Does your security team carry concealed weapons?
Are you planning any missions travel within the next 12 months?
Do you have any insurance in place for the trip(s)?
Does the ministry sponsor any athletic leagues?
Do require all participants, or guardians, or sign a waiver of liability prior to participating?
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Does Applicant obtain on Accident and Health policy?
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Does the ministry use, or plan to use, swimming facilities?
The pool is
Is at least one staff member certified in CPR present at swimming areas?
Pool Safety Features
(Check all that apply)
Does the minsitry own or have access to a playground area?
Is playground fenced?
Are trampolines present?
Do any of the following apply?

Counseling

What types of counseling performed by pastors or clergy?
(Check all that apply)
Have all pastors and clergy completed their degree at an accredited theological seminary?
Does the ministry verify license, education, and other credentials for all counselors?
Is the ministry aware of any act, error, omission, fact, circumstance, or situation that might afford grounds for a future claim, suit, or action under professional liability?
Does the ministry use contracted counselors?
Are certificates of malpractice liability insurance obtained and maintained for all contracted counselors and health care providers?
Is staff required to report all incidences that may result in a claim?
Is a written record kept?
Are procedures in place to protect confidentiality of clients?
Have any past or present ministers, employees, or volunteers ever been accused, charged, or convicted, had a claim for damages submitted against, or sued in civil court for any type of sexual misconduct?
Has the ministry ever had an incident which resulted in an allegation of sexual abuse?
Was a claim made against the organization?
Was a claim made against any employee(s)?
Was the case settled?
Does the ministry's current insurance program provide Abuse and Molestation coverage?
It's ok to skip this question if you don't know.
Coverage Provided Is
It's ok to skip this question if you don't know.
It's ok to skip this question if you don't know.
MM slash DD slash YYYY
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Does Applicant have current Professional Liability coverage?
This field is hidden when viewing the form
This field is hidden when viewing the form
Professional Liability is
This field is hidden when viewing the form
MM slash DD slash YYYY

School Details

Type of School
Does Applicant's school permit corporal punishment?
Does school have dormitories?
Dormitories Sprinklered?
Dormitories have hard-wired smoke detectors?
Dormitories have scheduled fire drills and testing?
Dormitories have emergency lighting?
Check any of the following allowed in dorm rooms
Any special classes provided?
Examples: Gymnastics, Dance, Karate, Tumbling, Horseback Riding, etc.
Are any classes taught by independent contractors?
Where are classes taught by independent contractors?
Does Applicant require a Certificate of Insurance from all sub-contractors?
Are waivers obtained by parents?
Does Applicant offer field trips?
Are instructors / coaches trained in physical education?
Is someone trained in first aid always present during practices or games?
Does Applicant have a Student Accident insurance policy
Does school have any bleachers or grandstands on premises?
Type(s) of bleachers / grandstands
Please check all types of sports played

Daycare Details

Based on the maximum number of children enrolled on the busiest day OR busiest season, enter the number of staff and children in each of the following age groups. (Do not duplicate before and after school children if they stay all day).
Is anyone on staff under 18 years old?
Is a minimum of one staff member certified in first aid present at all times?
Is the Applicant's center exit directly to the outside?
To level ground?
Do the bathroom door lock?
Can bathroom doors be unlocked from the outside?
Does Applicant provide sick child, drop-in, latch-key, boarding, or camp services?
Do any children require special care or treatment?
Please indicate the following maintained on each child
(Check all that apply)
Does Applicant have an Accident Insurance Policy?
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Is coverage mandatory for all children?

Vehicles and Transportation

Year Make Model Physical Damage Actions
       
There are no Vehicles.

Maximum number of vehicles reached.

Do you require employees and volunteers to carry and show evidence of personal auto insurance?
Do you provide transportation services?
Do you have a formal driving policy in place?
Is driving policy communicated in writing to all employees and volunteers?
Is a signed acknowledgement form kept on file?
Do employees or volunteers use their own vehicles for ministry purposes?
Do driving standards include the following?
(Check all that apply)
How often are ministry vehicles inspected?
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Does Applicant utilize GPS fleet telematics devices?
This field is hidden when viewing the form
Fleet Telematics Utilized
This field is hidden when viewing the form
This field is hidden when viewing the form

Staff and Volunteers

Please provide annual compensation amounts for each type of employee/sub contractor the ministry has.

Workers Compensation

Please provide total annual compensation for each type of employee and subcontractor.
Please include housing allowance, if applicable.
Does your employment process (for employees, contractors, volunteers, etc.) include verification if individual has ever been convicted of any crime, including sex-related or child abuse offenses before an offer is made?
Do you use an application for volunteers?
Does it include questions about whether the person has ever been convicted of any felony, including sex-related and/or child abuse related offenses?
Do you conduct criminal background and reference checks for all employees?
Do you conduct criminal background and reference checks for all volunteers?
Do you conduct criminal background and reference checks for all independent contractors who interact or have access to children?
Is there a new employee / volunteer orientation program that includes training in abuse awareness?
Do you require that no minor is ever alone with only one adult in any house of worship sponsored activity except in a counseling situation?

Ministry Financials

Total Assets
Current Fiscal Year
Previous Fiscal Year
Fund Balance
Current Fiscal Year
Previous Fiscal Year
Annual Revenue
Current Fiscal Year
Previous Fiscal Year
Please check any revenue sources that apply.
Are there any seasonal needs for increased money and securities limits?
Other than Christmas, Easter, or Mother's Day.
Has the ministry been the subject of, or involved in, any of the following in the past five (5) years?
Has the ministry merged or anticipate merging with another organization?

Wrapping Up

Please include your most recent policy declaration pages, as well as five year loss runs.
Drop files here or
Max. file size: 12 MB.
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    This field is for validation purposes and should be left unchanged.
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