Religious, Non-Profit and Human Services

ACORD Forms and Insurance Applications

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What is Required / Forms Complete ACORD Applications
Supplemental Applications – when applicable (Ask your FCII Account Mgr.)
Statement of Property Values per location
Current Valued Loss Runs with a minimum of 3 years (5 years preferred)
Drivers list if auto or umbrella coverage is being quoted 
Current MVR will be reviewed for all listed drivers
Direction for Submissions New Submissions Requirements:
  • Complete ACORD Applications
  • Energy Business Supplemental Applications – when applicable (Ask your FCII Account Mgr.)
  • Statement of Property Values per location
  • Current Valued Loss Runs with a minimum of 3 years (5 years preferred)
  • Drivers list if auto or umbrella coverage is being quoted
If Available:
  • Workers Comp Experience Mod Worksheet
  • Copy of current policy or explanation of the type of coverage currently provided.
  • Expiring premium or target premium
  • Prior stock reports for a period of 12 months – if value reporting applies
  • Copy of Auto Safety and Maintenance Program
  • Photos
  • Financial Statements
Insurance Company Rating All A Rated Carriers
Territory All States
Coverage Comm’l Package, E&O, EPLI, Workers Compensation, Umbrella, Special Events Coverage, Comm’l Auto, Cyber Security
Classes Adoption Agencies
Adult Day Care Centers
Child Care Centers
Community Centers
Group Homes
Home Health Care
Home Medical Equip Dealers
Homeless/Battered Shelters
Hospices
Mental Health Organizations
Non-Profit Organizations
Religious Organizations
Sheltered Workshops
Sleep Centers and Laboratories
Social Service Organizations
Substance Abuse Rehab Facilities
Thrift Stores
YMCA / YWCA
Youth Services Organizations (Boys Scouts/Girl Scouts, Boys and Girls Club, etc.)
Deductibles $1,000 & Up
Marketing Material Available Upon Request to Your Account Executive
Premium Financing Available
Notes:
Coastal, Hail , Wind & Hurricane Prone Areas will have some property coverage restrictions by carrier
ACORD Forms and Insurance Applications

Contact Us for more information about our services!