Sanctuary Plus Quote Request Form - BrokerForce Insurance

Contact Information

Name*

Prefix First Last

Phone*

Email*

Provide full quote information

Name of Church / Ministry*

Type

Registered Charity #*

Year Established*

Denomination*

Website

Overview of Operations*

Mailing Address*

Street Address City Province Postal Code

Location Address*

Street Address City Province Postal Code

Do you have any additional locations?

No
Yes

Additional Location #1

Street Address City Province Postal Code

Additional Location #2

Street Address City Province Postal Code

Additional Location #3

Street Address City Province Postal Code

Insurance Information

Present Insurer*

Expiry Date*

Claims History For Last 5 Years (date, detail, payout)*

Attach a Copy of Your Present Policy*

Liability Information

Average Attendance*

# of Full Time Staff*

# of Part Time Staff*

# of Board Members / Officers / Trustees*

Operations / Ministries (please check all that apply)*

If you selected 'Other', please complete the following field*

Description of Operations on Premises*

Description of Operations off Premises*

Details of Operations Outside of Canada*

Does the Organization Have a Written Abuse & Harassment Protocol?

Yes
No

What Protocol Do You Use?*

Reduce the Risk
Plan to Protect
Safe Church
Other

Please Specify 'Other' Protocol*

Have Any Allegations or Abuse Claims Ever Been Made?

Yes
No

Does the Organization Do Background / Criminal Checks on All Workers?

Yes
No

Property Information

Building is*

Owned
Rented
Condominium Unit
Other

If you selected 'Other', please specify*

Year Built*

Storeys*

Total Area (sq.ft.)*

1st Floor Area (sq.ft.)

2nd Floor Area (sq.ft.)

Basement Area (sq.ft.)

Wall Construction

Fire Resistive
Masonry
Brick Veneer
Frame

Roof Construction

Wood Joist
Steel
Concrete

Roof Covering

Please Specify 'Other' Roof Covering*

Heating System

Forced Air
Hot Water / Steam
Baseboard
Other

Please Specify Water/Steam Pressure (PSI)*

Please Specify 'Other' Heating System*

Heating Fuel

Please Specify 'Other' Heating Fuel*

Electricity

Breakers
Fuses

Fire & Crime Protection Information

Hydrant & Firehall

Within 300 Metres of a Hydrant
Within 8 km of a Firehall
Unprotected

Reservoir

Yes
No

Reservoir Size*

Sprinkler System

Yes
No

Central Monitored Alarm

Fire
Burglary