Underwriting Portal

Nonprofit Management Liability Quote

Contact Details

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indicates an answer is required.

	Last Name:
	First Name:
	Contact Phone:	() -
	Email:

Insured Details

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	Organization:
	Address 1:
	Address 2:
	Zip Code:
	City:
	State:
	Phone:	() -
	Fax:	() -
	Web Site:
	Association:

Submission Details

Please answer all questions below:
1.	What is the Insured Entity's nature of operations?
2.	Describe the Insured Entity's nature of operations (please describe in 25 words or less):
3.	What is the Insured Entity's tax exempt status under the U.S. Internal Revenue Service Code?

4.	During the last 5 years, has the Insured Entity or any of the Individual Insureds received any demands for monetary or non-monetary relief, been involved in, or had any knowledge of any civil or criminal action, administrative or arbitration proceedings?
5.	Are any of the Directors, Trustees and Officers proposed for this insurance aware of any fact, circumstance or situation involving any Insureds that he or she has reason to believe might result in a future Claim?
6.	How many subsidiaries does the Insured Entity have?
7.	What are the Insured Entity's Total Assets as of the most recent year-end?	$,000
8.	What is the Insured Entity's Fund Balance? (leave blank if unknown)	$,000
9.	What is the current number of Full Time Employees for the Insured Entity? (include Independent Contractors)
10.	What is the current number of Part Time Employees for the Insured Entity?