Thank you for completing this short, confidential questionnaire.

Your answers will only be seen by CWA staff members who are bound by a confidentiality agreement. This information will only be used for the purpose of negotiating the terms of a CWA insurance program for the benefit of our members in Canada. If any information is distributed to program applicants or finalists, it will only be shared in an anonymized and aggregated format for the purposes of demonstrating the potential profitability of an association insurance program.

Thank you for your time and your assistance.

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* 1. Please complete the company information below.

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* 2. Please list the provinces in which you have facilities.

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* 3. What was your gross revenue for each of the past four years plus 2019 year-to-date (YTD)?

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* 4. How many participant days in your facility over the past four years plus 2019 YTD? To simplify this question you may estimate the number of participant days per year (total number of days of operation x the average number of participants per day).

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* 5. How much have you paid for commercial general liability insurance premiums each of the past four years plus 2019 YTD?

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* 6. How much have you paid in umbrella and excess insurance premiums in each of the past four years plus 2019 YTD?

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* 7. How much have you paid in property insurance premiums in each of the past four years plus 2019 YTD?

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* 8. How many SETTLED commercial general liability claims over $25,000 CAD have you experienced in each of the past four years plus 2019 YTD? Please do not include open claims. If you have had none, insert 0.

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* 9. Please provide a brief summary of each claim over $25,000. For example: slip and fall in locker room, settlement 30K or bouldering fall, leg fracture, settlement 50K.

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* 10. What is your most pressing insurance need?

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