VIS - Volunteers Insurance Service®

Volunteer / Employee Dishonesty Coverage

Not available for work release or court-referred volunteers, or for any organization that has experienced a crime loss in the past three years.

This coverage protects your organization against I) volunteer/employee dishonesty, II) forgery or alteration,  III) theft, disappearance or destruction of money and securities both on premises and in-transit. This coverage includes an omnibus ERISA endorsement to comply with fidelity requirements of the Employee Retirement Income Security Act of 1974.

I) Volunteer/Employee Dishonesty
II) Forgery or Alteration
III) Theft, Disappearance and Destruction

 

NAME OF ORGANIZATION:
-
- -
- -
TITLE:
Yes No
Yes No

PREMIUM COMPUTATION IS AS FOLLOWS:


COVERAGES I & II ARE OFFERED AT A $50,000 LIMIT/$500 DEDUCTIBLE

COVERAGE III IS OFFERED AT A $5,000 LIMIT/$250 DEDUCTIBLE
1 Count the total number of people in your organization. Include all employees, volunteers, directors, officers, trustees, committee members and chairman whether compensated or not.
2 See chart for your premium:

Number of Active
Volunteers/Employees
on Roster
Annual Premium
   0-10 $203.00
   11-25 $235.00
   26-50 $391.00
   51-100 $521.00
   101-150 $842.00
   151-200 $1,052.00
   201-300 $1,180.00
   301-400 $1,351.00
   401-500 $1,395.00
   501-600 $1,859.00
   601-700 $1,896.00
   701-800 $1,933.00
   801-900 $1,964.00
   901-1000 $1,996.00



MONTH YOU WISH COVERAGE TO START:

January July
February August
March September
April October
May November
June December
YEAR:

Basic Charge $ (See Chart)
Annualized Premium $
Prorated Premium $

VIS Membership Fee $ 140.00
Amount Due Now: $

To submit your application online: Note the amount that is due now, so you can write a check to follow up the application. On the memo line of your check, write the name of the sponsoring organization, just as it appears on the application. Then just press the SUBMIT button, and send your check to us at the address below.

To submit your application by mail: Press the PRINTER FRIENDLY VERSION button, print your application, and sign it (IMPORTANT). On the memo line of your check, write the name of the sponsoring organization, just as it appears on the application. Then send the application and the check to the address below.

Volunteers Insurance Service®
2750 Killarney Drive, Suite 202,
Woodbridge VA 22192



  

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