Request a Directors and Officer Quote

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Request a Directors and Officers Quotation

Please complete the questions below and submit to Hahn Agency for a preliminary quotation. Also, please let us know if you would like a free analysis of your current directros and officers coverage.

GENERAL INFORMATION

Name of non-profit Organization
Name of contact person
Address
Address (continued)
City
State:
Zip Code

Telephone Number
E-mail Address:
Fax Number:

GENERAL QUESTIONS

State of Incorporation
Number of years in business
Limit requested
Deductible requested
Nature of operation
If "other" please describe
Do you wish to include all subsidiary organizations?
Are you exempt from all Federal and State income taxes?
Do you publish and magazines, periodicals or newsletters?

NON PROFIT ASSOCIATIONS:

Do you provide a referral service, legal aid service or computer service to your members?
Do you promote, sponsor or provide any form of insurance to your members?
Do you evaluate or set standards for the qualification of, or performance of others or their products?
Do you conduct peer review?
Does the Association take disciplinary actions against its members?

PRIOR LOSS HISTORY

has any loss payment been made under any prior or current directors and officers, (association), liability policy or similar insurance?
Has any insurer declined, cancelled or non-renewed any prior policy or application for this type of coverage?
Do you currently carry Directors and Officers, (association) liability insurance?
If so, what is the expiration/renewal date?

REMARKS

How would you like to receive this quotation?

Please select as many as you like

By Mail

By Fax

By E-Mail

By Phone

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