Transcription of Church Religious Organization Application
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Church Religious Organization Application
Page 1 of 5 Church / Religious Organization ApplicationType of coverage being requested: General Liability Property Non Profit D&O I. QUOTE INFORMATIONName of organizaton: _____Location address: _____ City: _____ State: _____ Zip: _____Mailing address: (if different) _____ City: _____ State: _____ Zip: _____Web address: _____Description of operations:Does Organization have tax exempt status by the IRS? Yes NoProperty Section (complete for each building) Construction: Frame Joisted masonry Non-combustible Masonry non-combustible Modified fire-resistive Fire-resistive Other _____ Protection class: Requested cause of loss: Basic SpecialRequested valuation: Replacement cost Actual cash valueDeductible: $1,000 $2,500 $5,000 Coinsurance: 80% 90% 100%Business personal property limit $ _____Business income and extra expense limit $ _____Building owner Yes No (If No , skip a-c)a.
Church / Religious Organization Application Type of coverage being requested: General Liability Property Non Profit D&O ... (If “Yes”, please forward a completed USLI supplemental claims application.) 45. Is any person proposed for this insurance aware of any fact, circumstance or situation which may result in a Yes No ...
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