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RELIGIOUS ORGANIZATION SUPPLEMENTAL APPLICATION …

RELIGIOUS ORGANIZATION SUPPLEMENTAL APPLICATION Pages 1 - 4 must be completed on all submissions. Applicant owns or provides Child Care services complete page Applicant owns or operates a Camp, complete page Applicant operates a School, complete page Applicant sponsors Fund Raising Events, complete page Applicant has Security Guards, complete pages 8 & Applicant has any Contracting Operations, complete pages 9 & Applicant has any building > 100 years old, valued > $500,000 complete pages 11 & 12 for each REQUIREMENTS ACORD applications , including Crime (2000) and Umbrella Statement of values if blanket or agreed value on property Currently valued insurance company loss runs for the current policy period plus (3) prior years Photograph of house of worship (front and rear) If the Applicant has more than 10 drivers, MVR s for each Latest audited financials or latest approved financial budgetApplicant Name: Specific Denomination: Number of Members / Parishioners: Mailing Address: City: State: Zip: 501(c)3?

RELIGIOUS ORGANIZATION SUPPLEMENTAL APPLICATION Pages 1 - 4 must be completed on all submissions. 1. If Applicant owns or provides Child Care services complete page 5

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  Applications, Organization, Religious, Supplemental, Religious organization supplemental application

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