Crime for Community Associations Application.

If you are already joining our D&O Program, why not place your crime coverage with us as well? Just answer a few questions, decide on what limits you want and we will provide you a quote along with your D&O proposal.

 

Insuring Agreements: #1 Employee Dishonesty
#2 Forgery or Alteration
#3 Inside the Premises
#4 Outside the Premises
#5 Computer Fraud
 
Endorsements: Managing Agent
Employee Benefit Plans (when named)

Non-Compensated Officers and Members of the Board of Directors as Employer, Volunteers as Employer
 
Association Name:
Physical Address:
City:
State:
Zip:  
Property Manager Company:
                    (If Applicable)
Mailing Address:
City:
State:
Zip:  
Policy Effective Date:
Pension Plan Name (if any):
 
Mandatory Underwriting Criteria
  1. The Association has been crime claims-free for the last 5 years.
  2. Fee/mortgage payments are always received as checks, not cash.
  3. Countersignatures are required on all checks over $500.
  4. Vouchers/supporting records are stamped "PAID" when checks are signed.
  5. Anyone authorized to fire or hire association employees is prohibited from distributing payroll. If there is no payroll, this question does not apply.
  6. The association's bank accounts and credit card statements are reconciled monthly by someone not authorized to deposit, withdraw, initiate electronic funds transfer, or use an association's credit card.
  7. Volunteers (other than D&O's) are prohibited from handling bank accounts or fee/mortgage payments. If there are no volunteers, this does not apply.
  8. The association does not have more than 25 employees.

 By checking this box I acknowledge that I have read the above and the insured meets all underwriting criteria

If the insured does NOT met the underwriting criteria, please explain additional circumstances below:

 
Choose Limit and Deductible
Limit Deductible Ins. Agreement #1 Ins. Agreement #1-5
$50,000 $1,000 $310  $486 
$100,000 $1,000 $459  $716 
$150,000 $1,000 $517  $808 
$200,000 $1,000 $572  $894 
$250,000 $2,500 $582  $904 
Enter Limit
  		Enter Deductible
                   
 

 
Agent/Broker Information
Agent/Broker Name (Cannot contain: \ / : * ? " < > |)
Address
City
State
Zip  
Phone
Fax
E-mail  
E-mail Confirmation  
 
NOTICE:
THE POLICY FOR WHICH THIS QUESTIONNAIRE IS SUBMITTED IS WRITTEN ON A CLAIMS MADE AND REPORTED BASIS AND COVERS ONLY CLAIMS FIRST MADE AGAINST THE INSUREDS DURING THE POLICY PERIOD OR EXTENDED REPORTING PERIOD, IF APPLICABLE, AND REPORTED IN WRITING TO THE INSURER PURSUANT TO THE TERMS THEREIN. THE LIMIT OF LIABILITY AVAILABLE TO PAY JUDGMENTS OR SETTLEMENTS SHALL BE REDUCED AND MAY BE TOTALLY EXHAUSTED BY AMOUNTS INCURRED AS DEFENSE COSTS. PLEASE OBTAIN A COPY OF THE POLICY THROUGH YOUR BROKER AND READ IT CAREFULLY.

ANY PERSON WHO KNOWINGLY AND WITH INTENT TO DEFRAUD AN INSURANCE COMPANY OR OTHER PERSON FILES THIS QUESTIONNAIRE CONTAINING ANY MATERIALLY FALSE INFORMATION, OR CONCEALS FOR THE PURPOSE OF MISLEADING, INFORMATION CONCERNING ANY FACT MATERIAL THERETO, COMMITS A FRAUDULENT INSURANCE ACT, WHICH IS A CRIME AND WHICH MAY RESULT IN CIVIL OR CRIMINAL FINES OR PENALTIES.

 By checking this box the sender agrees with the above notice.

 
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