Get a quotation for churches and religious institutions from Haines & Haines Insurance TC Irons

Privacy Policy-We routinely collect personal and/or business information that is needed as part of the quoting and underwriting process. We also collect the same information as part of service and update activities. The Haines & Haines/T.C. Irons Agency will not share that information, or use it in any other way, with outside parties, vendors, etc.

Church/House of Worship 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

Is There a Deep Fat Fryer? YES NO

Are There Fire Suppression System(s) on
All Cooking Equip? YES NO

Is There 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, Is There Grounded Lightning Protection? YES NO

     Is It UL Approved? YES NO

Is Building on the Historical Register? YES NO

Was the Building Originally Built as A Church/Synagogue? YES NO

Any Bankruptcies, Tax/Credit Liens Past 5 Yrs.? YES NO

Total Sq. Ft. of Building

Total Sq. Ft. Church Occupies

Are There 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

Are There Smoke Detectors At This Location? YES NO

Is there Smoke Alarm(s) at This 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-Any 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 / Notes
Send my quotation via	E-Mail Fax Regular Mail Call me by Phone!

All quotes are based on the information that the applicant provides, and are subject to change based on final underwriting by the individual carriers.

Our Mission Statement

Dating back from 1872 our mission is clear:

To serve our clients with the utmost respect, integrity and professionalism while providing a comprehensive risk management program at competitive pricing

Policy Coverage
and Disclaimer

Contact

	Haines & Haines/ T.C. Irons
16 West Front Street Florence, NJ 08518 Phone: 609.499.0237 Fax: 609.499.4077	230 High Street PO Box 158- Burlington, NJ 08016 Phone: 609.387.0606 Fax: 609.387.5337	1-3 Bank Street Suite E Medford, NJ 08055 Phone: 609-953-2282 Fax: 609.953.7719
	Wesley Insurance Service Agency 1194 Parkway Avenue Trenton, NJ 08628 Phone: 609.883.4190 Fax: 609.538.0274