15455 Middlebelt Road · Livonia, MI 48154 · Tel: (800) 300-4143 · Fax: (734) 525-2466

Get a Quote for Child Care Centers Printer-friendly Version Please complete Section 1 and all of the sections for which you would like to receive a quote for, then press submit at the bottom of the page. Section 1: Contact Information Business Name: Your Name: Address: City: State:  Zip Code: Telephone: Fax: Email: Section 2: Liability Insurance How long have you been in business? What is the form of your business? Individual Partnership Corporation Non-Profit LLC Other What are your hours of operation? Are you licensed by the State of Michigan? Yes    No If yes, what is your license number? What is the maximum number of children you are licensed for? What is your average daily attendance? Do you have any swimming/wading pools? Yes    No How many field trips are taken a year? How is transportation provided for field trips? Any trampolines or gymnastic equipment? Yes    No Are background checks done on employees? Yes    No Do you provide employee health benefits? Yes    No Any special classes taught (music, art, dance, etc.) Is hot food prepared on the premises? Yes    No How are children blocked from the kitchen? What is your current liability insurance premium? What is your current liability insurance renewal date? / / What is your current insurance company? What is your limit of liability/aggregate for sexual molestation? (optional limits available) Please select... $25,000/$50,000 $50,000/$100,000 $100,000/$200,000 $250,000/$500,000 $500,000/$1,000,000 $1,000,000/$2,000,000 Not desired at this time Have you had any liability or sexual abuse claims? Yes    No If yes, please provide specific information: Section 3: Property Insurance Do you own your own building? Yes    No If yes, what is your current replacement cost value of the building? If yes, what name appears on your deed? Has your building always been a commerical building? Yes    No What is the construction of the building? Please select... Brick Frame Other How many floors does the building have? Please select... 1 story 2 story Other What is the square footage (excluding the basement)? In what year was the building built? When did was the roof updated last? When was the heating updated last? When was the air conditioning updated last? When was the electrical system updated last? When was the plumbing updated last? How much business personal property do you have (if you had to replace it at today's values)? What is the replacement cost value of your playground equipment? Do you have business interruption coverage? Yes    No If you would like a quote for business interruption coverage, what is your normal monthly gross income? Do you have a central station alarm monitored by an outside party? Yes    No What is your current property insurance premium? What is your current property insurance renewal date? / / What is your current insurance company? Section 4: Workers' Compensation Insurance What is your federal ID number? How many full-time employees do you have? How many part-time employees do you have? Are all of your employees over 18? Yes    No What is your teacher's/helper's monthly payroll? What is your drivers' monthly payroll? What is your cook's monthly payroll? What is your janitor's monthly payroll? What is your current workers' compensation insurance premium? What is your current workers' compensation insurance renewal date? / / What is your current insurance company? Have you had any workers' compensation claims? If yes, please provide specific information:

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