Appendix C

                             SURVEY
                     NON PROFIT ORGANIZATION



     Organization Name:  
     Address:  
               

     Person Completing Form:  ___________________________________
     Title:  ____________________________________________________
     Telephone:  ________________________________________________




1.   How many paid employees does your organization have?


2.   Does your organization rely on volunteers?   Yes     No

     If so, approximately how many?


3.   What is the nature and scope of activities performed by
     volunteers?




4.   How are volunteers supervised?




5.   Does your organization have a risk prevention or safety
     program to minimize risk with volunteers?   Yes     No


6.   Has your organization ever been sued or threatened with suit
     because of an action of a volunteer?   Yes     No


7.   If so, what was the nature of the alleged action?  What was
     the outcome?  What was the amount of liability incurred, if
     any?






8.   Do you know of any organization in Hawaii that has been sued
     or threatened suit because of the action of a volunteer?
     Yes     No

     If so, please specify the organization.




9.   Does your organization have liability insurance that covers
     the actions of your volunteers?   Yes     No


10.  Does this policy cover injuries to a volunteer?   Yes     No

     If not, are they covered under another insurance policy?
     Yes     No

     If so, please specify.




11.  Are there major exclusions to the liability insurance
     policy, such as employment-related claims, professional
     services, non-owned auto accidents, or accidents occurring
     off-site?   Yes     No

     If so, please specify.




12.  Are these exclusions covered under another type of insurance
     policy?   Yes     No

     If so, please specify.




13.  Does your organization have directors and officers liability
     coverage?   Yes     No

     If not, why not?




14.  Has your organization experienced a large increase in
     insurance premiums during the last five years?   Yes     No

     If so, what was the reason given for the increase?




15.  Has an insurer ever refused to renew a policy for your
     organization while it was in force?   Yes     No

     If so, why?




     If so, what did your organization do as a result?




16.  Has your insurer ever reduced your coverage?   Yes     No

     If so, in what way?




17.  Has your organization ever had an insurance claim filed
     because of the action of a volunteer?   Yes     No

     If so, please specify the nature and the amount of the
     claim.




18.  Is your organization a member of a risk retention group?
     Yes     No

     If so, please identify.




19.  If not, do you know what a risk retention group is?   Yes
     No

     If so, has your organization ever considered joining one?
     Yes     No

     Why or why not?




20.  Is your organization self-insured?   Yes     No


21.  If your organization has no liability insurance protection,
     why not?




22.  Has your organization ever been unable to obtain insurance
     coverage?   Yes     No

     If so, why?

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LRB Studies