Day Care Quote 1

"*" indicates required fields

Step 1 of 2

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Name*

First Last

Business Entity is*

Full Legal Business Name or DBA*

Email*

Phone Number*

Fax Number

Alt Phone Number (cell, home)

Mailing Address*

Street Address Address Line 2 City State ZIP Code

Website

What date did your business start?*

MM slash DD slash YYYY

Description of Operations*

In-Home Daycare

Commercial Daycare Center

Nursery/Preschool

Sick-Child Day Care

Foster Care

Drop-Off Center

Before/After School Program

Other

If Other, please describe*

Is the location address different from your mailing address?

Yes

Location Address*

Please provide the Location address if it is different from the the Mailing address.

Street Address Address Line 2 City State ZIP Code

Does your entity own the building?*

Yes

Approx what year was the building built*

How many stories is the building*

What is the building constructed of?*

Safety & Security Features

Local Fire Alarm

Central Station Monitored Fire Alarm

Local Burglar Alarm

Central Station Monitored Burglar Alarm

Smoke Detectors

Fire Extinguishers

Sprinkler System

Fire Escape

Temperature Alarm

Security Cameras

None Of These

Check all that apply

Is your operation part of another Organization*

Yes

If so, explain.*

Do you provide Overnight Care*

Yes

Are you licensed*

Yes

We have applied for a license

Estimated total annual gross receipts*

Please enter a number less than or equal to 10000000.

What is the total gross amount of money you expect this operation to generate in the next 12 months?

Total Full Time Employees*

Please enter a number from 0 to 300.

Enter 0 if Zero

Total Part Time Employees*

Please enter a number from 0 to 300.

Enter 0 if Zero

Do you currently have workers compensation insurance?*

Yes

Max Number of children allowed by license*

Please enter a number from 1 to 300.

Average Daily Attendance*

Please enter a number from 1 to 300.

Number of children 0 - 12 Months*

Number of Staff for children 0 - 12 Months*

Number of children 12 Months to 3 years*

Number of Staff for children 12 Months to 3 years*

Number of children 3 - 6 years*

Number of Staff for children 3 - 6 years*

Number of children 6 years and older*

Number of Staff for children 6 years and older*

Total Number Of Children - Calcualted from above

This should equal your average daily attendance, if it does not, please adjust the child counts above

Total Number Of Attendees - Calculated From Above

This should equal your total Full and Part time employees, if this is not correct, please adjust the attendee counts above.

Are there any physically, medically or mentally challenged children or children with special needs currently enrolled?*

Yes

Description of Internal Operations:

Are criminal background checks completed on employees*

Yes

Have there been any actual or alleged child molestation or abuse incidents in the past or are there any currently under investigation?*

Yes

Do you own the building that the day care is located in*

Yes

Please select any of the Associations that the childcare facility is accredited by:*

None

NAA - National After School Association

NAEYC - National Association for the Education of Young Children

NAFCC - National Association for Family Child Care

NECPA - National Early Childhood Program Association

Other

Facilities & Equipment

Are there functioning and operational fire extinguishers readily available?*

Yes

Do you have a trampoline on the premises*

Yes

Any Inflatables, Moon Bouncers or Inflatable Slides*

Yes

Is the Outdoor Play Area Fully Fenced*

Yes

There is no outside play area

Is Playground Equipment Permanently Installed*

Yes

There is no playground equipment

Are there finger guards on all doors, cabinets and drawers?*

Yes

Is the kitchen area in a restricted separated from the play area?*

Yes

Are there any Animals on the Premises*

Yes

If there are animals, describe all types and breeds and number of each*

Do you provide field trips off of the campus?*

Yes

If there field trips off of the campus, describe the types of locations that are visited.

Describe how Injuries are handled*

Any medication dispensed*

Yes

If so, please describe how & whom by

Are any Special Classes Taught*

Yes

If so describe*

Are you transporting or responsible for transporting children?*

Yes

If so explain*

How are children transported?*

Owner's Personal Vehicle

Staff's Personal Vehicle

Company's Commercial vehicle

3rd Party Contracted Transportation

Select all that apply

If so, who is your Commercial Auto Insurance Carrier*

Do you have accident & health insurance covering students*

Yes

If so, who is the carrier and what limits do you have?*

Are children released only to custodial parent or guardian*

Yes

If no, describe authorization procedure*

Do you have any other business ventures outside of this Daycare*

Yes

If so explain*

Will children ever be left alone with attendees under 18 or over 60*

Yes

Swimming Pool & Swimming Recreation

Is there a swimming pool on the premises?*

None

Above Ground

In Ground

Total Number of Swimming Pools

Any Swimming pool slides or diving boards

None

Slides

Diving Boards

Both, Slides & Diving Boards

Any wading pools (under 24" deep)

Yes

Is there Life safety equipment at poolside

Yes

Are Swimming and/or pool rules posted

Yes

Is at least one of the attendants a certified lifeguard or CPR certified

Yes

Any natural bodies of water on property? (lakes, rivers, streams...)

Lake

River

Stream

Other

Ratio of attendants to children while swimming

General Liability

Premises Liability Coverage*

$100,000

$200,000

$300,000

$500,000

$1,000,000

Other

This provides coverage for bodily injury and property damage.

Daycare Professional Liability*

Must match or be less than the General Liability

Umbrella/Excess Liability Coverage*

Abuse & Molestation Coverage*

Employment Practices Liability*

Accident & Medical Coverage for Children*

Building, Property & Business Income Coverage

Building Coverage

Please enter a number from 0 to 10000000.

Only select this if you own the building or are required to insure it.

Building Improvements

Please enter a number from 0 to 10000000.

This provides coverage for improvements or betterments you have made to the space. (renovations)

Business Property ENTER "0" (ZERO) if None.*

Please enter a number from 0 to 10000000.

This provides coverage for your possessions your business owns. (desks, chairs, tables, books...)

Business Income ENTER "0" (ZERO) if None.*

Please enter a number from 0 to 10000000.

This provides monetary coverage in the event your business is closed because of a covered loss (fire, storm, smoke damage)

Property Deductible*

What deductible would you prefer for the property coverage? Higher deductibles have lower insurance costs.

Finance Information

Ever filed Bankruptcy or Reorganization*

Yes

Has coverage been Declined, canceled or non-renewed in last 5 years*

Yes

If so, why?*

Final Details

You indicated that this is an in-home daycare run by an individual. Do you currently have a home insurance policy at this location?*

Yes

By home insurance we mean, home, renters, condo, coop.

Are you currently insured*

Current Carrier (if any)

Current insurance expiration date

MM slash DD slash YYYY

Current annual insurance premium

How soon do you need this quote*

Date quote needed by

MM slash DD slash YYYY

What date do you need this coverage by?*

MM slash DD slash YYYY

How did you hear about us?

If you were referred, who can we thank with a nice gift?

What other coverages are you interested in?*

None

Workers Comp

Disability

Group Health

Employment Practices Liability

Cyber Liability/Data Breach

What is your total annual payroll?*

What is your federal Tax ID number?*

How many male employees do you have?*

How many female employees do you have?*

Other things I want to tell you that you didn't ask. Additional comments, concerns, circumstances, or coverages you have/want.

Attachments

Drop files here or

Accepted file types: jpg, gif, png, pdf, tif, Max. file size: 12 MB, Max. files: 10.

Please feel free to attach any files that might be useful in rating your coverages... Prior or current policies, loss runs, claims, photos of puppies, pictures your kids drew in kindergarten...

Phone

This field is for validation purposes and should be left unchanged.

Day Care Quote 1

Description of Internal Operations:

Facilities & Equipment

Swimming Pool & Swimming Recreation

General Liability

Building, Property & Business Income Coverage

Finance Information

Final Details

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