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Certificate of Insurance Request
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Certificate of Insurance Request
Request A Church Quote
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Church Property Insurance
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Church Property Insurance
Church Insurance Coverages
Abuse and Molestation Insurance for Churches
Business Auto Insurance for Churches
Directors and Officers Insurance for Churches
Employment Practice Liability Insurance
General Liability Insurance for Churches
Group Health Insurance
Life/Annuities/Disability
Mexico Mission Trip Insurance
Religious Expression Coverage
Best Workers’ Compensation Insurance for Churches
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Church Quote
Form
Church Insurance Quote Form
Please enable JavaScript in your browser to complete this form.
-
Step
1
of 7
Legal Name of Organization
*
DBA: If Applicable
Your Name
*
First
Last
Email
*
Phone
*
Website / URL
Next
Property Address
*
Address Line 1
Address Line 2
City
--- Select state ---
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Is Billing Address the Same as Property Address
Yes
No
Mailing Address
*
Address Line 1
Address Line 2
City
--- Select state ---
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Next
Requested Effective Date
*
Is Your Current Policy Being Cancelled Or Non-Renewed?
*
Yes
No
Reason For Cancellation
*
Are you Currently Insured
*
Yes
No
Name of Current Insurance Carrier
*
Expiring Insurance Premium
Any Church Insurance Claims (Past 5 Years)
*
No
Yes
Please provide details of all claims (Past 5 Years)
*
Next
FEIN Number (Federal Identification Number)
Number of Members
*
0 - 50
51 - 100
101 - 200
201 - 350
351 - 500
501 - 1,000
1,001 - 2,000
2,000 +
Rent or Own
*
Rent
Own
Number of Church Owned Buildings
0
1
2
3
4
5
6
7
8
9
10
Approximate Year Built of Building
*
Building Construction Type (Check All That Apply)
Frame Construction
Joisted Masonry
Non-combustible (Steel on Concrete Construction)
Approximate Square Footage of Building
*
Square Footage of Rental Space (Not Entire Building unless you are using the entire Facility)
*
Next
Building Limits
*
Contents Limit
*
Liability Limits Requested
*
$1,000,000 /$2,000,000
$2,000,000 /$4,000,000
Directors and Officers Coverage Requested ($1,000,000 In Coverage)
*
Yes
No
Religious Belief / Expressions Coverage Requested ($1,000,000 In Coverage)
*
Yes
No
Abuse & Molestation Coverage
*
$50,000
$100,000
$250,000
$500,000
$1,000,000
Employment Practice Liability Insurance (Covers Wrongful Termination & Discrimination Law Suits)
*
Decline - No Employees
$100,000
$250,000
$500,000
$1,000,000
None Owned / Hired Auto Coverage Requested ($1,000,000 In Coverage)
*
Yes
No
Crime Coverage
*
$2,500
$5,000
$10,000
$25,000
$50,000
$100,000
Next
Business Auto Policy (Church Owned Vehicle)
*
No
Yes
VIN Number
Year of Vehicle
*
Make of Vehicle
*
Model of Vehicle
*
Number of Passengers
*
Driver Name
First
Last
Drivers License Number
Date of Birth
Next
Umbrella Policy
*
No
Yes
Umbrella Limits Requested
*
$1,000,000
$2,000,000
$3,000,000
$4,000,000
$5,000,000
$10,000,000
Earthquake Insurance Coverage
*
Yes
No
Flood Insurance Coverage
*
Yes
No
Checkboxes
First Choice
Second Choice
Third Choice
Message
Submit
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