Animal Welfare Organization Quote Request Animal Welfare Organization Quote Request Request a formal proposal from our exclusive program for Animal Welfare Organizations Step 1 of 3 33% Name of Your OrganizationYour NamePrimary Location Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Website What is your Business telepone number?*What is your email address?* Describe any claims over $2,500 in the previous 5 yearsYour current insurance carrier and current premiumsWhat is your current or desired limit of General LiabilitySelectNot Sure$1,000,000$3,000,000$5,000,000Does your Organization have tax exempt status as defined by the IRS? Yes No Year your Organization was foundedTax ID# (FEIN)2. Has Organization has any bankruptcies, tax or credit liens against it in the past 5 years? Yes No Has Organization had its license suspended or revoked in the past three years or is it currently under investigation for wrongdoing by any licensing agency or other authority? Yes No Number of Employed VeterinariansNumber of EmployeesNumber of Active Volunteers (excluding fosters)Number of Active Foster HomesNumber of kennel compartments (if you have a facility)Total Revenues for the previous 12 months Does Organization provide Accident Insurance or Workers Compensation insurance for employees and volunteers? Yes No Does Organization require background checks on employees or volunteers (which include sex related or child abuse claims)? Yes No Does Organization employ or accept the services of persons with a criminal background? Yes No Does Organization employ or accept the services of persons with a criminal background? Yes No Does Organization have a formal orientation program for new hires/volunteers which includes a review of the Organization’s sexual abuse policy? Yes No Does Organization monitor staff’s day to day interaction with volunteers and clients, both on and off the premises? Yes No Does organization provide services as a shelter or pound for stray or abandoned animals for or on behalf of municipal, county or local authorities? Yes No 10. Does organization have procedures in place to evaluate/temperment test animals? Yes No Does organization provide services for any wild or undomesticated animal or reptile species, whether native or exotic, including but not limited to wolves, coyotes, foxes, alligators, turtles and snakes? Yes No Does organization permit public access to animals without supervision? Yes No Are all animals immunized and given health evaluations prior to placement with the adoptive owners. Yes No Does organization require adoptive families to sign a waiver hold organization harmless for all acts, behavior and conditions of the animal once it has left the shelter? Yes No 20. If organization utilizes the services of foster homes, are all foster parents required to sign a waiver holding the organization harmless? Yes No Does organization employ or contract armed humane police officers? Yes No h. Does Applicant place animals with known (current or historical) biting issues into homes (foster or adoption)? Yes No Number of off site adoptions held annually If you need Property Insurance, please provide requested limits of insurance by locationIf you have a business auto exposure, provide vehicle identification numbersIf you require Workers Compensation, provide payrolls by employee classificationAny additional comments or information you believe would help us underwrite your insuranceUpload Applications, Loss Runs and Drivers List Drop files here or Select files Max. file size: 0 bytes. Upload Photos of your FacilityAccepted file types: jpg, jpeg, png, gif.By submitting this application for insurance you are attesting that the information provided is factual to the best of your knowledge at the time. Any person who knowingly and with intent to defraud presents, causes to be presented, or prepares with knowledge or belief that it will be presented to or by an insurer, or self insurer, any information containing any false material statement or conceals any material fact shall be guilty of a crime and subject to substantial fines and/or imprisonment.CaptchaUntitledUntitled