2025-2026 VFW DEPARTMENT OF COLORADO Club Manager & Bingo Manager Bond

Questionnaire for Club Employees & Bingo Persons
A.1 Employee/Volunteer Theft (Crime Coverage)

TRAVELERS CASUALTY AND SURETY COMPANY OF AMERICA

Coverage Term: October 1, 2025 to October 1, 2026
1. Name of Post*
Post*
Post Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
2. Name of Person Covered*
3. Position to be Covered*
4. Coverage Amount Requested*
5. Post Annual Income:*
YESNo
If yes, please contact your Department for a Loss Questionnaire. No coverage can be extended until approved by insurance carrier.
YesNo
If yes, explain.
8. If this is a replacement for a current position, please advise who you are replacing
Number of Persons Covered: 1 Number of Locations: 1
Printed Name of Covered Person*
Signature of Covered Person*

Clear
Date*

MonthDayYear
Date
Contact Phone*
Format: (000) 000-0000.
NOTE : Questionnaire is not valid unless all questions are answered. Coverage may be postponed if not completed in FULL.

IF COVERAGE IS NOT RENEWED, TERMINATED, OR CANCELLED AT EXPIRATION DATE OF 10-1-2025, THE POST HAS ONLY 90 DAYS TO SUBMIT A PROOF OF LOSS FOR PRIOR TERM, AFTER 90 DAYS, PRIOR COVERAGE CEASES.

Form 4B - Revised 2025

Club Manager & Bingo Manager Bond Payment Amount*

USDPlease use the Bond Calculation Table Above for Cost (Amount to Pay)

Credit Card

Apple Pay

Google Pay

Cash App Pay

ACH Bank Transfer

Afterpay

Questionnaire for Club Employees & Bingo Persons