Directors & Officers Insurance

Quick Quote
Is your nonprofit a current, paid member of NYCON?
Yes
No
Organization Name:

Address:

Phone:

Email:

Website:
Date of Date of IRS
Incorporation: Determination:
Brief description
of services:
# of Volunteers
# of Employees:
(including board members):
# of Employees
terminated last
year:
Annual revenues: Annual Payroll:

Total Assets Fund Balance:

In the last five years have there been any civil, criminal or administrative proceeding brought
against the org, subsidiaries, board, staff or volunteers?
Yes
No
In the last five years have there been any

Yes
No
Merger, acquisition or similar reorganization
Are you aware of any fact, circumstance or situation that may result in a future claims?

Yes
No
Please Note: pending or prior claims or known circumstances that result in a claim will not be covered under a new D & O policy.
Please complete and submit this form for a non-binding “indication” of eligibility, terms and cost. Prior to binding coverage we will
require (a) proof of NYCON membership and (b) insurance company application signed by President or Executive Director.

Return this form via fax to Marshall & Sterling, a NYCON endorsed brokerage,
Attention: Genevieve Buckman, Fax: (518) 943-7440.
 Comprehensive Coverage
Both insurers include the following as *Fine Print
standard coverage: Both insurers require

• Duty to Defend; Defense Costs are in that nonprofits

Directors & Officers addition to the limit of the policy; maintain membership
in the New York
• Employment related practices (EPL)
Insurance Program coverage including wrongful Council of Nonprofits,
termination, sexual harassment, Inc. (NYCON); be
discrimination and unfair hiring/firing located in New York;
practices; be in operation for at
• Entity coverage (claims may be made least 12 months;
against the organization); separate incorporated as a
limits for D&O and EPL are available; nonprofit; have
• Access to a toll-free Employment individual IRS 501(c)
Practices Hotline. tax status; no D&O or
• And more. See program overview EPL claims/litigation
online for more details. activity within the past
Protect Yourself. Cover Your Assets. 5 years; be an eligible
Great American also offers:
Directors & Officers (D&O) Liability Insurance is class of business
a necessity for any nonprofit protecting the • First dollar defense (there are certain
vulnerability of their volunteer board members. • Financial information is not required restricted classes.)
for small nonprofits*
The NYCON-sponsored policies not only include
coverage for all directors, officers and • Financing options are available.
employees, it covers staff, volunteers, and (*Small Nonprofit means the organization is claims For more
free and has less than $500,000 in annual payroll
committee members as well. and less than $5 Million in Assets).
information
Types of claims covered by D&O Insurance that Please contact
may not be covered by other policies include: Rate Information
(Starting Rates*) Kay Bassey at
• Claims for administrative actions alleging the
nonprofit is acting outside its mission or (800) 515-5012
Chubb Program: Rates Based on
charter, or not using funds as donors ext. 124 or email
appropriated
Employee/Volunteer Count
kbassey@
• Self dealing and conflicts of interest
• $675 for $1 Million Limit of Liability councilservicesplus.com
• Discrimination in the hiring/firing process
• Matters involving tax exempt status or failure • $1,015 for $2 Million Limit of Liability Or Visit:
to secure payrolls taxes councilservicesplus.com
Great American Program: Rates Based
for more information &
NYCON is pleased to offer two comprehensive, on Annual Payroll
an application.
low-cost programs to our Members, one
underwritten by Chubb/Executive Risk and the • $700 for $1 Million Limit of Liability
other by Great American Insurance. • $1,085 for $2 Million Limit of Liability
Employees who cancel coverage for themselves
or their dependents during the year, employed by the same
agency, will not be eligible for coverage for two years and
only at open enrollment.
Turn Over Questions?
for a Contact: Kay Bassey
Provided in partnership with CS Plus, NYCON’s
Quick Quote! 1(800) 515-5012 ext. 124
insurance brokerage subsidiary and Marshall &
Email: kbassey@councilservicesplus.com Sterling, Inc., a NYCON Endorsed Brokerage.