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Childcare Quote Form


Please complete the form below and provide a current copy of your policy declaration pages showing current liability and property limits.

Company Information
Company Name
Required
First Name
Required
Last Name
Required
Street
Required
City
Required
State
Required
ZIP / Postal Code
Required
Primary Phone Number
Required
Fax #
Required
E-Mail Address
Required
Website address
Required
Best Time and Method to Call
Required
General Information
Is the Center
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If other, please state here
Optional
How many children is the business licensed for?
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What is your average daily attendance?
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What age ranges are the children?
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How long has the center been in business?
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In the past 12 months, have any complaints been filed with the Licensing Board against the applicant?
Optional

If yes, please explain and provide documentation
Optional
In the past 3 years has any of the applicant's licenses been revoked, suspended or placed under probation?
Optional

If yes, please explain and provide documentation
Optional
Does the business provide only before and after school care?
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Does the business provide 24 hour care?
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What are the center's hours of operation?
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Does the applicant perform a criminal background investigation, including sexual abuse or child abuse related offenses on prospective employees or volunteers (If no, Abuse and Molestation coverage is not available.)
Optional

If yes, how often?
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Does applicant have a Student Accident Insurance Policy in effect?
Optional

Employee Operations
Number of full time employees
Optional
Number of part time employees
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Has there ever been an allegation of sexual abuse made against the employee or volunteer?
Optional

If yes, please explain and provide documentation
Optional
Occupancies
Is the Center located in
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If located in a commercial building, are there any other occupants in this building?
Optional

If yes, please list all other occupants
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Does the applicant own the building?
Optional

Does the insured lease any space to other tenants?
Optional

If yes, what is the square footage of the area leased out?
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Are any residential apartments located within this building?
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Transportation
Does the applicant provide any transportation of registrants?
Optional

Do you transport children in
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Do you run Motor Vehicle Reports on drivers?
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Do you have a commercial auto policy? If yes, provide the name of insurance company
Optional
Water Activities
Does the applicant provide any on or off premises water activities?
Optional

Describe any water activities on the premises
Optional


If other, please state here
Optional
If there is a pool or wading pool, is it fenced?
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Is there a diving board?
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Is there a slide?
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Is there a certified lifeguard on staff at the premises where the water activities are held?
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Are children allowed to participate in off-premises water activities?
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If yes, please describe
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Are the children allowed contact with any animals?
Optional

Building Information
Construction Type
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Total square footage of building
Optional
Number of Stories
Optional
Total square footage leased out
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% Occupied
Optional
Year Built
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Building improvements: Wiring year
Optional
Roofing Year
Optional
Plumbing Year
Optional
Heating Year
Optional
Name of Fire Department servicing your location
Optional
Feet to hydrant
Optional
Miles to Fire Station
Optional
Indicate which of the following safety features your location has in place:
Optional



Property Coverages
Building (if owned)
Optional
Improvements & Betterments (if leased)
Optional
Contents
Optional
Signs
Optional
Property Deductible
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Any additional interests?
Optional

Mortgagee
Optional
Other Loss Payee
Optional
Other Additional Interest
Optional
Submission Validation
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Important Notice
Any submissions or payments made via this website do not constitute a binding agreement to your policy or coverages. Changes and payments to policies are not effective or binding until you, or any party involved, receive official notice from either your insurance agent, or your insurance company. If you have any questions, please feel free to contact us.

Per the terms of our online privacy policy we will not resell your information to any third-party.
 
 
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Security First Insurance Agency
3526 Miller Road
Flint, MI 48507
P: 810-732-5800
F: 810-732-4154
MISSION STATEMENT

The mission of Security First Insurance is to deliver professionally crafted and competitively priced insurance and risk transfer programs that safeguard our valued client’s financial futures.

Mon-Thurs: 8-5, Fri 8-4:30


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