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SaskCulture: Cultural Organization Member Liability Insurance Application

**NOTE: All fields are required unless indicated otherwise.

Organization

Tell us about your Organization.

Organization Name Your Legal and/or Operating Name

Address

Unit Number ^optional

City

Province

Postal Code

Website URL ^optional

Contact

Who should we contact regarding this application?

First Name

Last Name

Title or Role with Your Organization

Phone

About Your Organization

We need to understand about the nature of your Organization.

Is your Organization a:

Member Group

Eligible Cultural Organization (ECO)

Describe Your Organization & Operations

How many events do you host each year?

Describe the events and provide dates

Do any of your events include a sporting activity?

Yes

Do you serve alcoholic beverages at your events?

Yes

At how many events does your organization serve alcohol (excluding those at third party restaurants, bars or venues)?

Annual Operation Budget New revenue to the organization through funding, grants, sponsorships, and any other income

Current Number of Directors

Number of Employees Employees are defined as staff members receiving payroll and your organization pays CPP and EI on their behalf.

Current Number of Volunteers

Commercial General Liability (CGL)

Choose the maximum CGL coverage you are applying for.

Commercial General Liability Limit Requested

$2M CGL

$5M CGL

Optional Coverage: Property

We also offer Property coverage.

Coverage	Option A	Option B
Contents	$10,000	$25,000
Misc Property Floater (Laptops Included)	$5,000	$10,000
Temporary Locations	$25,000	$25,000
Transit	$10,000	$10,000
Crime (money)	$10,000	$10,000
Deluxe Plus Extensions	Included	Included
Deductible	$500	$500
Premium	$265	$525
	per location	per location

Would you like to purchase or renew property coverage?

Option A

Option B

Decline

Do you require property coverage at a higher limit than $25,000?

Yes

Location 1

Address

City

Province

Postal Code

Construction

Square Footage

Location 1 Year Built

Location 2

Address

City

Province

Postal Code

Construction

Square Footage

Location 2 Year Built

Optional Coverage: Member/Volunteer Accident

Benefits are as follows:

$10,000 Accidental Death, Dismemberment and
Specific Loss Indemnity (2X Paralysis)
$5,000 Accidental Dental Reimbursement Benefit
$15,000 Accidental Medical Reimbursement Benefit
Emergency Transportation Benefit
Fracture, Dislocation, Tendon Severance and Miscellaneous Indemnity
Private Tuition Expense
$5,000 Rehabilitation Benefit

Would you like to purchase or renew accident coverage?

Yes

Quantity of Covered Persons Include the total quantity of Directors, Employees and Volunteers to be covered

Any out of country travel?

Yes

Privacy, Data Breach and Electronic Risk

This year, we've transitioned cyber liability coverage to an optional status. While it remains a critical area of exposure for all non-profits, we strongly recommend and encourage your organization to uphold this protection. Our coverage is now facilitated by Coalition, offering enhanced protection and broader coverage options. Please see below for the highlights of the coverage. Premium estimated below includes $250,000 in cyber liability coverage.

3rd Party Liability Coverages

Network & Information Security Liability Regulatory Defense & Penalties Multimedia Content Liability PCI Fines & Assessments	We cover the expenses to defend you and any damages resulting from your liability to a 3rd party, or for regulatory fines & penalties, multimedia wrongful acts (such as infringement, defamation, piracy, etc.), and PCI fines & assessments resulting from a failure in your security, data breach, or privacy violation.
Bodily Injury & Property Damage Technology Errors & Omissions	We pay for the costs of defense and damages from your liability to a 3rd party when a failure in your security results in physical damage or injury.

Network & Information Security Liability

Regulatory Defense & Penalties

Multimedia Content Liability

PCI Fines & Assessments

We cover the expenses to defend you and any damages resulting from your liability to a 3rd party, or for regulatory fines & penalties, multimedia wrongful acts (such as infringement, defamation, piracy, etc.), and PCI fines & assessments resulting from a failure in your security, data breach, or privacy violation.

Bodily Injury & Property Damage

Technology Errors & Omissions

We pay for the costs of defense and damages from your liability to a 3rd party when a failure in your security results in physical damage or injury.

1st Party Loss Coverages

Bodily Injury & Property Damage Pollution	In the event of a security failure (i.e., physical cyber attack), we’ll even cover losses resulting from bodily injury or damage/impairment to your tangible property, as well as damages resulting from any liability you may have to a 3rd party, including regulatory fines & penalties and pollution.
Computer Replacement	We cover the costs to replace your computer systems that are permanently impacted by malware.
Fund Transfer Fraud	We pay for funds transfer losses you incur from a failure in your security or social engineering.
Service Fraud	We pay for the additional amounts you’re billed by a cloud or telephone provider when you incur fraudulent charges.
Digital Asset Restoration	We pay for the costs to replace, restore, or recreate your digital assets that are damaged or lost following a failure of your security.
Business Interruption & Extra Expenses	We cover financial losses resulting from a failure in your security, data breach, and even systems failure (including contingent/dependent BI), as well as the extra expenses you incur to bring your company back online.
Cyber Extortion	We cover the costs to respond to an extortion incident, including money, securities, and even virtual currencies paid.
Breach Response Crisis Management & Public Relations	We pay for the costs to respond to a breach including 3rd party incident response and public relations experts, customer notification costs and credit monitoring, media purchases, and legal fees; and advise in connection with the incident, among others.

Would you like to purchase or renew Cyber Liability Coverage?

Yes

I require a higher cyber liability limit than $250,000. Please provide a quotation.

Yes

Requested Cyber Limit Amount

Can you confirm that you and all of the Partners, Directors, Principals, and Consultants after having made full inquiries, including of all staff, are NOT aware of any event that has or could have given rise to a loss, claim or circumstance, including but not limited to any hacking incident, virus or malicious code attack, cyber extortion attempt, breach of confidential data, wrongful disclosure of personal data or interference with rights of privacy?

Yes

If the answer to above is "No", please specify the reasons below:

Estimated Premium

Based upon the answers detailed above, we estimate your insurance premium to be:

Submit Your Application

THE UNDERSIGNED HEREBY ACKNOWLEDGES THE TRUTH OF THE STATEMENTS CONTAINED HEREIN.

IF THE INFORMATION PROVIDED IN THIS APPLICATION SHOULD CHANGE BETWEEN THE DATE OF THE APPLICATION AND THE EFFECTIVE DATE OF THE POLICY, THE UNDERSIGNED WARRANTS THAT THEY WILL IMMEDIATELY REPORT SUCH CHANGES TO THE INSURER.

THE COMPLETION AND SIGNING OF THIS APPLICATION DOES NOT CONSTITUTE A PROMISE TO PROVIDE COVERAGE OR A BINDER OF INSURANCE. HOWEVER, IF A POLICY IS ISSUED, THIS APPLICATION SHALL SERVE AS THE BASIS OF SUCH CONTRACT AND WILL BE ATTACHED TO, AND FORM PART OF THE POLICY.

I AUTHORIZE YOU TO COLLECT, USE AND DISCLOSE PERSONAL INFORMATION AS PERMITTED BY LAW, IN CONNECTION WITH YOUR COMMERCIAL INSURANCE POLICY OR A RENEWAL, EXTENSION OR VARIATION THEREOF, FOR THE PURPOSES NECESSARY TO ASSESS THE RISK, INVESTIGATE AND SETTLE CLAIMS, AND DETECT AND PREVENT FRAUD, SUCH AS CREDIT INFORMATION, AND CLAIMS HISTORY.

For purposes of the Insurance Companies Act (Canada), this document was issued in the course of Lloyd’s Underwriters’ insurance business in Canada.

Click below to submit your application. We'll send an email confirmation to the address you provided.

For the purpose if this application, the following definitions apply:

Electronic Communications System shall mean the Insured’s wired, wireless, radio, electromagnetic, photo-optical or photo-electronic facility for the transmission of electronic communications; any electronic data processing system, network or related electronic equipment for the storage of such communications; and any computer.

Data Breach Law means the following, as well as similar statutes and regulations as they currently exist and as amended and replaced from time to time, associated with the confidentiality, access, control and use of Private Data including, but not limited to the Personal Information Protection and Electronic Documents Act (PIPEDA), the Privacy Act, the Ontario Personal Health Information Protection Act, or other similar provincial or federal legislation or other similar privacy laws worldwide.

Private Data means data containing an individual's:

driver's license or other government-issued identification number; unpublished telephone number; savings account, current account, credit card or debit card number each when in combination with the security code, access code, password or pin for such account or card number;
personal information as defined under PIPEDA and the regulations thereto or similar federal or provincial legislation;
personal health information as defined under the Ontario Personal Health Information Protection Act and the regulations thereto or similar provincial legislation; or
private personal information as defined under the law of a country other than Canada, which law is intended to provide for the protection of such private personal information; not including any lawfully available data accessible by the general public.

Service Provider shall mean any natural person or entity that the Insured contracts with for a fee to hold, process or control any data or systems on behalf of the Insured.