Form SO-46 Council Comprehensive Insurance Coverage

Knights of Columbus 2025-2026 Insurance Application

Council Number and Name: *

Mailing Address including City, Province & Postal Code: *

Address for Council (Meeting Place) including City, Province & Postal Code: *

Address of Council (Meeting Place) including City, Province & Postal Code *

Name of Grand Knight: *

Grand Knight Email Address and Telephone Number: *

Name of Financial Secretary: *

Financial Secretary Email Address and Telephone Number: *

By Checking any of the following boxes, I hereby apply for Insurance coverage Effective January 1, 2025

Our Invoice requesting payment will be sent to councils by the end of January 2025. Please Do Not send payment prior to receiving our invoice.

** Billable Members Only

(Pays Council Dues)

Division 1

Division 2

Division 3

Division 4

Division 5

Division 6

Basic Coverage
● 25,000 Property / 100,000 Extra Expense
● 25,000 Crime / Fraud (Dishonesty)
● 3,000,000 General Liability including Liquor
● 1,000,000 Abuse
(2,000,000 Program Aggregate Limit)
● 1,000,000 Directors & Officers (D&O) Liability
(10,000,000 D&O Program Aggregate Limit)

$815 + 8% Provincial Tax = $880.20 Total

$795 + 8% Provincial Tax = $858.60 Total

$770 + 8% Provincial Tax = $831.60 Total

$695 + 8% Provincial Tax = $750.60 Total

$575 + 8% Provincial Tax = $621.00 Total

$470 + 8% Provincial Tax = $507.60 Total

Enhanced Coverage
● 25,000 Property / 100,000 Extra Expense
● 50,000 Crime / Fraud (Dishonesty)
● 5,000,000 General Liability including Liquor
● 1,000,000 Abuse
(2,000,000 Program Aggregate Limit)
● 2,000,000 Directors & Officers (D&O) Liability
(10,000,000 D&O Program Aggregate Limit)

$934 + 8% Provincial Tax = $1,008.72 Total

$911 + 8% Provincial Tax = $983.88 Total

$883 + 8% Provincial Tax = $953.64 Total

$805 + 8% Provincial Tax = $869.40 Total

$685 + 8% Provincial Tax = $739.80 Total

$575 + 8% Provincial Tax = $621.00 Total

Please Select Either Basic or Enhanced - Do Not Select More than One Box

Division 1 = 250 or More Billable Members Division 2 = 150 - 249 Billable Members Division 3 = 95 - 149 Billable Members

Division 4 = 75 - 94 Billable Members Division 5 = 50 - 74 Billable Members Division 6 = 49 Or Less Billable Members

Note Cyber Liability is not available through the program. If you would like us to obtain a quotation, please contact our office.

Abuse Information:

“Vulnerable persons” means individuals who, because of age, disability, or other circumstances, whether temporary or permanent, are in a position of dependence on others or are otherwise at a greater risk than the general public of being harmed by a person in a position of authority or trust relative to them. This includes children, youth, senior citizens, people with physical, developmental, social, emotional or other disabilities, as well as people who are victims of crime or harm. Such vulnerability may be a temporary condition or permanent.

“Abuse” means any act or threat of molestation, harassment or any other form of physical, sexual or mental abuse.

1) Have you reviewed the new Ontario KofC Abuse Protocol with your Members at a Council meeting?
**Reviewing & Acknowledging the abuse Protocol with your Active Members is a Mandatory Insurance Requirement *

Yes

If No, when will this be discussed and acknowledged with the Members of your Council? *

2) Will all Members who are involved in programs with “vulnerable persons” formally (directly involved in each activity) obtain the necessary screening and background criminal checks (such as via the Office of Youth protection/Praesidium) every 3-5 years? *

Yes

3) Are all incidents of inappropriate behavior and alleged incidents of Abuse required to be promptly reported to designated person(s) in your organization (State Office) and to the appropriate authorities (Police)? *

Yes

4) Are all Member applications, abuse protocol acknowledgments, criminal checks & incident reports (if applicable) kept secured indefinitely? *

Yes

Not Applicable

5) For the most recent consolidated fiscal year-end, please provide the following information:

Total # of Billable Members for Council *

Total Annual Revenues *

Privacy Disclosure & Consent: The undersigned, on behalf of their Council, declares that it has obtained the necessary consent for the collection, use & disclosure by the Insurer of any personal details provided above or in connection with this application for the purposes of placing & providing coverage (details of our privacy policy can be provided upon request). I understand that all coverage indicated on this document is subject to the terms & conditions of the policy.

I declare that the statements made above are in every respect true and hereby apply for a contract of insurance to be based upon the said statements. I request that you please forward proof of coverage as well as an invoice for the total amount owing however I understand that coverage is not bound until confirmation is provided.

Signature of Grand Knight/Financial Secretary: (click and sign with your mouse like it is a pen) *

clear

Print Full Name of Grand Knight/Financial Secretary & Please indicate your position ex. "John Smith - Financial Secretary": *

Date Signed: **Please click on Calendar icon** * +

** Please note: If you would like a copy of your application, please print prior to pressing submit or send a request to kocinsurance@jdimi.com** (Right Click your mouse, than click print)