Insurance Renewal Questionnaire - Parish

- All Offices

The maximum number of form submissions has been reached. This form is currently not available.
- Please complete the insurance renewal survey no later than Friday, Feb. 7, 2020. If you have any questions, please contact Mike Scarpato.
- Parish, City: REQUIRED Please fill out this field.
- Number of registered parishioners: REQUIRED Please fill out this field. Please enter an integer (number).
- Number of Fine Arts/Artifacts owned by parish: REQUIRED Please fill out this field.
  
  Item 1
  
  Description Please enter valid data.
  
  Estimated value Please enter valid data.
  
  Item 2
  
  Description Please enter valid data.
  
  Estimated value Please enter valid data.
  
  Item 3
  
  Description Please enter valid data.
  
  Estimated value Please enter valid data.
  
  Item 4
  
  Description Please enter valid data.
  
  Estimated value Please enter valid data.
  
  Item 5
  
  Description Please enter valid data.
  
  Estimated value Please enter valid data.
  
  Item 6
  
  Description Please enter valid data.
  
  Estimated value Please enter valid data.
  
  Item 7
  
  Description Please enter valid data.
  
  Estimated value Please enter valid data.
  
  Item 8
  
  Description Please enter valid data.
  
  Estimated value Please enter valid data.
  
  Item 9
  
  Description Please enter valid data.
  
  Estimated value Please enter valid data.
  
  Item 10
  
  Description Please enter valid data.
  
  Estimated value Please enter valid data.
  
  Item 11
  
  Description Please enter valid data.
  
  Estimated value Please enter valid data.
  
  Item 12
  
  Description Please enter valid data.
  
  Estimated value Please enter valid data.
  
  Item 13
  
  Description Please enter valid data.
  
  Estimated value Please enter valid data.
  
  Item 14
  
  Description Please enter valid data.
  
  Estimated value Please enter valid data.
  
  Item 15
  
  Description Please enter valid data.
  
  Estimated value Please enter valid data.
  
  Item 16
  
  Description Please enter valid data.
  
  Estimated value Please enter valid data.
  
  Item 17
  
  Description Please enter valid data.
  
  Estimated value Please enter valid data.
  
  Item 18
  
  Description Please enter valid data.
  
  Estimated value Please enter valid data.
  
  Item 19
  
  Description Please enter valid data.
  
  Estimated value Please enter valid data.
  
  Item 20
  
  Description Please enter valid data.
  
  Estimated value Please enter valid data.
- Does your parish operate a day care center? REQUIRED Yes No Please fill out this field.
- If yes, how many children are currently enrolled? Please enter an integer (number).
- If yes, how many full-time teachers are employed? Please enter an integer (number).
- If yes, how many part-time teachers are employed? Please enter an integer (number).
- Number of drones owned by parish: REQUIRED Please fill out this field.
  
  Drone 1
  
  Please describe the intended use of the drone. Please enter valid data.
  
  Make and model Please enter valid data.
  
  Weight Please enter valid data.
  
  Drone 2
  
  Please describe the intended use of the drone. Please enter valid data.
  
  Make and model Please enter valid data.
  
  Weight Please enter valid data.
  
  Drone 3
  
  Please describe the intended use of the drone. Please enter valid data.
  
  Make and model Please enter valid data.
  
  Weight Please enter valid data.
  
  Drone 4
  
  Please describe the intended use of the drone. Please enter valid data.
  
  Make and model Please enter valid data.
  
  Weight Please enter valid data.
- Number of vehicles owned by parish REQUIRED Please fill out this field.
  
  Vehicle 1
  
  Type of Vehicle REQUIRED Please fill out this field.
  
  Year Please enter valid data.
  
  Make Please enter valid data.
  
  Model Please enter valid data.
  
  Estimated value REQUIRED Please fill out this field. Please enter valid data.
  
  Vehicle 2
  
  Type of Vehicle REQUIRED Please fill out this field.
  
  Year Please enter valid data.
  
  Make Please enter valid data.
  
  Model Please enter valid data.
  
  Estimated value REQUIRED Please fill out this field. Please enter valid data.
  
  Vehicle 3
  
  Type of Vehicle REQUIRED Please fill out this field.
  
  Year Please enter valid data.
  
  Make Please enter valid data.
  
  Model Please enter valid data.
  
  Estimated value REQUIRED Please fill out this field. Please enter valid data.
  
  Vehicle 4
  
  Type of Vehicle REQUIRED Please fill out this field.
  
  Year Please enter valid data.
  
  Make Please enter valid data.
  
  Model Please enter valid data.
  
  Estimated value REQUIRED Please fill out this field. Please enter valid data.
  
  Vehicle 5
  
  Type of Vehicle REQUIRED Please fill out this field.
  
  Year Please enter valid data.
  
  Make Please enter valid data.
  
  Model Please enter valid data.
  
  Estimated value REQUIRED Please fill out this field. Please enter valid data.
  
  Vehicle 6
  
  Type of Vehicle REQUIRED Please fill out this field.
  
  Year Please enter valid data.
  
  Make Please enter valid data.
  
  Model Please enter valid data.
  
  Estimated value REQUIRED Please fill out this field. Please enter valid data.
  
  Vehicle 7
  
  Type of Vehicle REQUIRED Please fill out this field.
  
  Year Please enter valid data.
  
  Make Please enter valid data.
  
  Model Please enter valid data.
  
  Estimated value REQUIRED Please fill out this field. Please enter valid data.
  
  Vehicle 8
  
  Type of Vehicle REQUIRED Please fill out this field.
  
  Year Please enter valid data.
  
  Make Please enter valid data.
  
  Model Please enter valid data.
  
  Estimated value REQUIRED Please fill out this field. Please enter valid data.
  
  Vehicle 9
  
  Type of Vehicle REQUIRED Please fill out this field.
  
  Year Please enter valid data.
  
  Make Please enter valid data.
  
  Model Please enter valid data.
  
  Estimated value REQUIRED Please fill out this field. Please enter valid data.
  
  Vehicle 10
  
  Type of Vehicle REQUIRED Please fill out this field.
  
  Year Please enter valid data.
  
  Make Please enter valid data.
  
  Model Please enter valid data.
  
  Estimated value REQUIRED Please fill out this field. Please enter valid data.
- Survey submitted by:
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Email REQUIRED Please fill out this field. Please enter an email address.
Submit