HOW Volunteer Security

Member Information

First Name *

Last Name *

Street Address *

Street Address 2

City *

State *

Zip Code *

How did you hear about us?

Phone *

Fax

Email *

Verify Email *

Policy Information

What date would you like to start coverage?

Have you ever been convicted of a felony?

Yes

Any additional incidents that have occurred which may result in a claim made against the applicant?

Yes

Armed/Training

Armed/Unarmed?

Certified/Trained?

FLE Employer/School

Training Facility

Additional Services

Do you want to add personal concealed coverage to make coverage 7 days/24 hours for carrying concealed? (+$100)

Yes

Disclosure/Authorization/Declarations

WARNING NOTICE: Any person who, with intent to defraud or knowing that he is facilitating a fraud against an insurer, submits an application or files a claim containing a false or deceptive statement, is guilty of insurance fraud.

The undersigned Applicant authorizes the Company, its agents, and representatives to secure claims information from my current and previous insurance carriers.

Acknowledgement, consent and waiver: Upon purchase coverage will be placed with Conifer Insurance company which is rated by A.M. Best Company as B++. The agent, employees, independent contractors, directors and officers make no representation as to the financial status of the insurance carrier. The undersigned requests and grants authority to place coverage as described above.

The undersigned declares that to the best of their knowledge and belief the statements set forth herein are true. The signing of this application does not bind the undersigned to purchase insurance, nor does review of the application bind the insurer to issue a policy. It is agreed, however, that this application shall be the basis of the contract should a policy be issued.

Signature

Typed name constitutes signature for application/disclosure purposes

Date

Individual Volunteers	Unarmed $175 Annual (Certified) $225 Annual (Not Certified) Armed $250 Annual (Certified) $300 Annual (Not Certified)
Security Teams	Rated per above with one policy that covers all volunteers.
House of Worship	Is specifically named on policy as insured.
Expand Firearms coverage to 24 hours/7 days	Volunteers that have a state concealed carry permit or HR218 can expand coverage to outside of religious institution. Additional Premium - $100 Annual ($250,000 Criminal & Civil coverage)

Individual Security Volunteer

Program Premiums as follows: $250,000 Limit of Liability

Member Information

Member Information

Policy Information

Armed/Training

Additional Services

Operations

Operations

Overall Operations

Finish

Disclosure/Authorization/Declarations

Submitting Application...