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:
Property Manager Company:
Address:
City:
State:
Zip:
Policy Effective Date:
Pension Plan Name (if any):

 

	Yes	No
Is the association crime claims-free for the last five years?
Are fee/mortgage payments always received as checks, not cash?
Are countersignatures required on all checks over $500?
Are vouchers/supporting records stamped "PAID" when checks are signed.
Are persons authorized to fire or hire association employees prohibited from distributing payroll?
If there is no payroll, click N/A.	N/A
Are bank accounts reconciled monthly by someone not authorized to deposit/withdraw?
If No, please explain.
Are volunteers (other than D&O's) prohibited from handling bank accounts or fee/mortgage payments?
If there are no volunteers, check here.

 

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

 

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.