Application Form - Not-for-Profit Insurance Funding Program

Application Form - Not-for-Profit Insurance Funding Program
Deadline for Submission: October 23, 2026

Prior to completion of this application, click on the website links below to review each document.
1) Policy-Not-for-Profit Insurance Funding Program

2) Guidelines- Not-for-Profit Insurance Funding Program

3) Financial Reporting-Grants to Non-Profit Organizations

The information below is required to be submitted with your application. There is a section at the end of this form where you can attach documents.
- Detailed insurance policy documents showing the exact cost to your organization separated for each Directors & Officers coverage, Commercial General Liability coverage and Property coverage. Contact your provider for cost breakdown if this in not on your policy documents and attach their letter/email showing the total cost to your organization breakdown for each coverage. *Property insurance is not eligible for funding.
- Most recent financial statement, balance sheet, income/expenses statement & fiscal year budget.
- List of current Board of Directors.
- Overview of group activities.
- Insurance policy quote(s) if applicable.
Name of Registered Non-Profit Organization
Mailing Address (for correspondence and cheques)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Civic Address (if different from mailing address)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Organization Website/Facebook Page
Contact Person (Primary)

First NameLast Name
Phone Number (Primary Daytime)
Please enter a valid phone numberFormat: (000) 000-0000.
Phone Number (Secondary Daytime)
Please enter a valid phone numberFormat: (000) 000-0000.
Email
example@example.com
Contact Person (Secondary)

First NameLast Name
Phone Number (Primary Daytime)
Please enter a valid phone numberFormat: (000) 000-0000.
Phone Number (Secondary Daytime)
Please enter a valid phone numberFormat: (000) 000-0000.
Email
example@example.com
What geographic area is serviced by your organization?
Provide an overview/summary of your organization's activities
(Example: community work, sports related and what your organization does)
a) Non-Profit Registered with the Nova Scotia Registry of Joint Stock Companies
1.0 Non Profit or Charitable Status Registration Information
Provide information on the status that is applicable to your organization. Your organization MUST be registered as a Non-Profit or Charitable Status with "Active" status to qualify.
a) Non-Profit Registered with the Nova Scotia Registry of Joint Stock Companies
Provide 7 digit registration number above (Example: 0000000)
b) Registered Charity with the Canada Revenue Agency
Provide CRA Number (Example: 0000000000 RR 0001)
Is your organization affiliated with any of the options below?
Click on the box that pertains to your organization. Contact us with any questions.
Is there anything you would like us know about your Non-Profit or Charity registration?
2.0 Insurance Details
If approved, the Municipality will support requests for funding by contributing up to 50% of total premium costs up to $1,000.00 per organization. Applications will be accepted for Commercial General Liability, Directors & Officers Liability only – Property Insurance is not eligible for funding.
Commercial General Liability Insurance Premium (price/cost to organization)
This amount must be ONLY Commercial General Liability Insurance Premium (price/cost). Ask your provider for a cost breakdown letter or email.

Commercial General Liability (CGL) Insurance for non-profits provides financial protection against claims arising from bodily injury, property damage, or personal injury that occur during the course of the organization's operations, events, or on its premises.
Directors & Officers Insurance Premium (price/cost to organization)
This amount must be ONLY Directors & Officers Insurance Premium (price/cost). Ask your provider for a cost breakdown letter or email.

Directors and Officers (D&O) Insurance for non-profits in protects board members and executives from personal financial loss due to lawsuits alleging wrongful acts or mismanagement while serving in their capacity as directors or officers. This insurance covers legal defense costs, settlements, and judgments arising from such claims, ensuring the organization's stability and attracting qualified individuals to serve on the board.
TOTAL combined $ amount if applying for both premiums above (price/cost to organization)
Commercial General Liability combined with Directors & Officers Insurance premiums. ADD UP THE TWO TOTALS ABOVE.
Property Insurance Premium (price/cost to organization) - not eligible for funding with this grant
This amount must be ONLY Property Insurance Premium (price/cost). Ask your provider for a cost breakdown letter or email.
Do you have written insurance quote(s)
Check if this applies to your organization below under "Categories"

If yes, provide copies of quote(s) with your application

Categories:

*First time applicants are requested to submit more than one quote for a new policy, including their current policy.

*When insurance provider will not provide a quote, the organization must obtain confirmation of "no quote" and submit the confirmation to Recreation Services.

*Organizations are required to submit new quotes for insurance every three years.
Name of Insurance Provider/Brokerage
Contact Person - Insurance Provider/Broker

First NameLast Name
Phone Number (Primary Daytime)
Please enter a valid phone numberFormat: (000) 000-0000.
Email
example@example.com
Policy Number
Policy Start Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Policy Expiry Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Policy Number #2 (if you have two)
Policy Start Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Policy Expiry Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
If your organization has multiple insurance providers and policies, provide any extra information below.
Does your organization own or lease the facility you have insured?
If own or lease specify the owner(s) of the property and provide a copy of the lease or deed (if we have not already received these)
Click next to the grant(s) that you have received from the Municipality of the County of Colchester in the last 5 years:
3.0 Financials - Include the following with your application as per the policy:
a) Current financial statement

b) Balance sheet

c) Income statement that indicates revenue sources for the organization

d) Budget for the upcoming fiscal year and or/project budget

If your organization does not have the above financials prepared, refer to the following options that can be submitted with your application form:

Option 1: Click on the link to our website where you can find the electronic Financial Reporting - Not-for-Profit Insurance Funding Program Grants & Funding - Municipality of Colchester

A PRINTABLE version that you can fill in manually can be sent to you BY REQUEST. The printable version can be sent by fax, email, mail, or dropped off to us.

OR

Option 2: A copy of the most recent financials that were submitted to one of the below:

a) Nova Scotia Registry of Joint Stock Companies

Example: Financial Report and Balance Sheet/Statement of Income and Expenditures, website link: Joint Stock Companies Financial Reports

b) Canada Revenue Agency (Registered Charity)
Is there anything you would like us know about your financials in addition to the documents you are submitting?
4.0 Acknowledgement
I, the undersigned hereby state that, to the best of my knowledge, all information contained in this application form and any attachments are a true representation of our organization.
Signature
Name

First NameLast Name
Position in Organization
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Please submit this completed ELECTRONIC application form by October 23, 2026 by clicking SUBMIT below.

To submit a PRINTABLE APPLICATION FORM, CONTACT US AND WE WILL PROVIDE YOU WITH ONE. DO NOT USE THE OLD APPLICATION FORM.

Mail, in-person, email or fax to:

Recreation Services (3rd Floor)

Municipality of the County of Colchester

1 Church Street

Truro, Nova Scotia, B2N 3Z5

Email: recreation@colchester.ca

Fax: (902) 843-4065

If you have any questions, contact Craig Burgess at: Phone: (902) 897-3181 Email: cburgess@colchester.ca
UPLOAD REQUIRED DOCUMENTS HERE (maximum 8 documents at 5MB size each)

Cancelof
To send documents by email instead: recreation@colchester.ca

If you are emailing us, please call to confirm we received your email

The information below is required to be submitted with your application:

*Detailed insurance policy documents showing the exact cost to your organization separated for each Directors & Officers coverage, Commercial General Liability coverage and Property coverage. Contact your provider for cost breakdown if this in not on your policy and attach their letter/email showing the cost to your organization breakdown for each coverage. *Property insurance is not eligible for funding.

*Most recent financial statement, balance sheet, income/expenses statement & fiscal year budget.

*List of current Board of Directors.

*Overview of group activities.

*Policy insurance quote(s) (if applicable).
Should be Empty:

Application Form - Not-for-Profit Insurance Funding Program

Deadline for Submission: October 23, 2026