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Toll Free:
888.ARMofNY (276-6369)

IMPORTANT INFO:
IN ADDITION TO SUBMITTING THIS FORM ONLINE, THIS FORM CAN BE PRINTED AND FAXED TO (212) 937-3923.

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HEADQUARTERS
90 Broad Street, Suite 1503
New York, NY 10004
T: 646.459.2400 / 888.ARMofNY
F: 212.937.3923



BASIC COVERAGE DEFINITIONS

PROPERTY

Building
 Applies to more than just the buildings and structures at the premises structure itself. Other items covered under the building coverage may include:

  • Completed Additions
  • Permanently installed machinery and equipment
  • Indoor and outdoor fixtures
  • Personal property used to maintain or service buildings, structures or premises
  • Personal property furnished by the insured in apartments, rooms or common areas that are rented to others
  • Additions under construction
  • Alterations or repairs to the buildings or structures
  • Materials, equipment, supplies and temporary structures that are on or within 100 feet of the premises and being used for additions, alterations or repairs

Contents
 There are five (5) classes that are covered when it is located at the described premises and in or on a building, in a vehicle or in the open within 100 feet of the premises:

  1. Property owned and used by the insured in the business
  2. Property of others in the insured's care
  3. Tenants improvements and betterments
  4. Leased personal property that the insured has a contractual responsibility to insure
  5. Exterior Building glass (not including stained glass)
IMPORTANT NOTE: Coverage will vary from carrier to carrier and exclusion and limitations apply.

Deductible
The maximum amount you as the policy holder will pay in the event of a loss.

LIABILITY
Liability
 Covers the insured's legal liability that arises from bodily injury, property damage and personal and advertising injury.

Church / Synagogue
Insurance Quote

You can save insuring through ARM-Capacity
 Find Out Now - Get a quote!

ARM-Capacity - Leading the way in Church and Religious Organization insurance coverage!

Complete the following information to obtain an Insurance Quote.

 GENERAL INFORMATION
Name of Church / Religious Organization:

Corporation Name (if applicable):

Street Address:

City:

County:

State:      Zip:
  

Web site Address
Year Founded
# Current Members
Members Last Year
# Pastors / Priests / Rabbis
# Employees
# Board Members
Is the Building Owned by the Church? YES NO
Church Buses Owned? YES NO
Has Coverage Been Declined,
Cancelled or Nonrenewed in Last 3 Yrs?		 YES NO
Is the Church the only Building Occupant? YES NO
     Describe Occupants
Please Describe all
Church activities.
(Preschool, Day Care, Etc)

 COOKING INFORMATION
Any Cooking Facilities? YES NO
Deep Fat Fryer? YES NO
Fire Suppression System on
All Cooking Equip?		 YES NO
Any Grilling? YES NO
Does Fire Suppression System / Duct Work
Have a Semi-Annual Inspection
by a Service Contractor?		 YES NO

 PROPERTY INFORMATION
Is There a Steeple? YES NO
     If Yes, Grounded Lightning Protection? YES NO
     Is It UL Approved? YES NO
Is Building on the Historical Register? YES NO
Originally Built as A Church/Synagogue? YES NO
Bankruptcies, Tax/Credit Liens Past 5 Yrs.? YES NO
Total Sq. Ft. of Building
Total Sq. Ft. Church Occupies
Other Structures on Premises to Insure? YES NO
     Describe Other Structures
# of Stories
Construction Type
       Other Construction Type
Year Built
Roof Type
       Other Roof Type
Central Heating & Air Conditioning? YES NO

BUILDING UPDATES
ROOF
(year updated)		 ELECTRIC
(year updated)		 HEATING
(year updated)		 PLUMBING
(year updated)
Yes No Yes No Yes No Yes No
(If yes, year)
 (If yes, year)
 (If yes, year)
 (If yes, year)

 BASIC FIRE SAFETY PROTECTION INFORMATION
Distance from Fire Protection (Hydrant)
Distance from Fire Station
Is Your Area A "Brush" Area? YES NO
Is Storage More Than 1500 Sq Ft? YES NO
Smoke Detectors At This Location? YES NO
Smoke Alarm Location? YES No
Fire Extinguishers? YES NO
Interior Automatic Fire Sprinklers? PARTIAL FULL NONE
Fire Alarm
Theft Alarm

 COVERAGE REQUEST
Church Building
Church Contents
Manse / Parsonage
Rented Dwelling
DEDUCTIBLE
Liability Coverage
     Medical Payments YES No
     Clergy Professional YES No
     Directors & Officers YES No
     Sexual Molestation YES No
     Hired & Non-Owned Auto YES No
Losses-Claims in the Last 5 Years? YES No
If Losses and/or Claims
List - Date, Amount Paid and
Description of Each Loss

 CURRENT COVERAGE INFORMATION
Current Insurance Carrier
Current Expiration Date
Current Premium

 CONTACT INFORMATION
First Name:

Last Name:

*Email:

Phone:                        Fax:
  
Questions/Comments

When Do You Need Quote?

How Did You Hear About Us?


Thank you for completing this form

ARM-Capacity's Policy on sharing information:

  1. We will only use information provided to assist in obtaining appropriate insurance quotes and coverage.
  2. We will not distribute information to other parties other than for insurance underwriting purposes.

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2008 (c) ARM-Capacity of New York, LLC., All rights reserved.  T: 888.276.6369  F: 212.937.3923