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Morgan & Associates, Inc. Commercial Childcare BOP Application
PRESCHOOL/DAYCARE/MONTESSORI
APPLICATION-QUESTIONNAIRE
FOR MULTIPLE LOCATIONS, SEND US QUOTE FORM FOR EACH.
OWNERS NAME
CITY
STATE:
ZIP CODE
EMAIL ADDRESS
BUSINESS NAME
BUSINESS ADDRESS
COUNTY
MAILING ADDRESS (IF DIFFERENT)
PHONE NUMBER
PROPOSED EFFECTIVE DATE TO

I. PROPERTY (MANDATORY INFORMATION)
 
BUILDING LIMIT $ (IF OWNED OR TRIPLE NET LEASE)
REPLACEMENT COST / ACTUAL CASH VALUE
CONTENTS LIMIT $ REPLACEMENT COST
DEDUCTIBLE $ ($250 MINIMUM / $500, $1,000 & $2,500 ALSO AVAILABLE)
OTHER OCCUPANTS OF BUILDING
 
LOCATION IS:
IS THERE A:  
IF YES-NAME & ADDRESS
BUILDING CONSTRUCTION
BUILDING AGE BUILDING SQUARE FOOTAGE
YEAR OF LAST UPDATE CONDITION OF BUILDING
HEATING  
PLUMBING    
ELECTRICAL IF OTHER PLEASE EXPLAIN  
ROOF
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Morgan & Associates, Inc. Commercial Childcare BOP Application
II. LIABILITY
LIMITS OF LIABILITY $ ($300,00/$600,000 $500,000/$1,000,000 $1,000,000/$3,000,000)  
MAXIMUM NUMBER OF CHILDREN PERMITTED BY STATE LICENSE (IF REQUIRED)
MAXIMUM NUMBER OF CHILDREN ON PREMISES AT ONE TIME (IF PRESCHOOL/MONT.)
ABUSE/MOLESTATION LIABILITY (YES OR NO) NOT AVAILABLE TO 24HR. CENTERS
PROFESSIONAL LIABILITY (E&O) NOT AVAILABLE FOR 24HR. CENTERS
NON-OWNED AUTO OR NON-OWNED & HIRED AUTO COVERAGE (YES OR NO)
(NOT AVAILABLE IF COMMERCIAL AUTO POLICY IS IN EFFECT)
ADDITIONAL INSURED TO BE NAMED ON THE POLICY (NAME & ADDRESS)
INTEREST (i.e. LANDLORD/PROPERTY MGMT. CO., CITY OR COUNTY PROGRAM)

III. ADDITIONAL COVERAGES
 
EMPLOYEE DISHONESTY - INCLUDED AT $5,000 LIMITHIGHER LIMITS AVAILABLE TO QUOTE IF DESIRED $
MONEY & SECURITIES INCLUDED AT $5,000 LIMIT
HIGHER LIMITS AVAILABLE TO QUOTE IF DESIRED $
GLASS: GIVE DESCRIPTION, # OF PANES, AND TOTAL SQUARE FOOTAGE OF EACH PANE TO BE COVERED
(PLEASE INDICATE WHICH PANES ARE ABOVE THE 2ND FLOOR, IF ANY:
IV. LOSS HISTORY
ENTER ALL CLAIMS OR OCCURRENCES THAT MAY GIVE RISE TO CLAIMS FOR THE PRIOR FIVE YEARS:
DATE OF OCCURRENCE
DESCRIPTION OF CLAIM
AMOUNT PAID BY COMPANY
EXPLAIN ANY PAST LOSSES AND DOLLAR AMOUNT OF LOSSES:
CURRENT INSURANCE CARRIER
PREMIUM
RENEWAL BEING OFFERED? (IF NO EXPLAIN)        
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Morgan & Associates, Inc. Commercial Childcare BOP Application
PLEASE ANSWER ALL OF THE FOLLOWING:
IS BUSINESS LOCATED IN:
LIST OTHER OCCUPANCIES:
LICENSING AGENCY: NUMBER OF YEARS LICENSED:
  OWNER’S RELATED EXPERIENCE AND EDUCATION:
IS THERE A PRE-EMPLOYMENT BACKGROUND CHECK (INCLUDING PERSONAL REFERENCES, POLICE RECORD, EDUCATION, PHYSICAL/EMOTIONAL?
STAFF FOR CHILDREN 0-2 YEARS
STAFF FOR CHILDREN 2-6 YEARS
STAFF FOR CHILDREN 6 & OVER
THERE ARE CHILDREN ENROLLED WHO ARE EMOTIONALLY OR PHYSICALLY HANDICAPPED OR WHO REQUIRE SPECIAL TREATMENT DUE TO MEDICAL PROBLEMS.
HOURS OF OPERATION: MONDAY – FRIDAY AM TO PM / WEEKEND AM TO PM
ANY OVERNIGHT CARE?
NUMBER OF OFF-PREMISES FIELD TRIPS:
WHERE TO AND MODE OF TRANSPORTATION:
DO YOU UTILIZE SWIMMING FACILITIES ON OR OFF THE PREMISES?  
ARE THERE ANY PETS ON THE PREMISES IF SO, WHAT TYPE AND BREED:
ARE THEY SEPARATED FROM THE CHILDREN?  
IS THERE A PLAYGROUND?  
IF YES, DESCRIBE PLAYGROUND EQUIPMENT AND FACILITIES:
IS THE PLAYGROUND FENCED?  
DOES THE FENCE GATE(S) HAVE SELF-CLOSING DEVICES?  
DO PLAY EQUIPMENT AND TOYS MEET THE CONSUMER PRODUCT SAFETY CODE REQUIREMENTS?
  
IS ACCIDENT/HEALTH INSURANCE MANDATORY FOR ALL STUDENTS?  
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Morgan & Associates, Inc. Commercial Childcare BOP Application
PLEASE ANSWER ALL OF THE FOLLOWING:
IS A MINIMUM OF ONE STAFF MEMBER WHO IS CERTIFIED IN FIRST AID PRESENT AT ALL TIMES?
 
ARE MEDICAL EVALUATIONS OBTAINED AT ENROLLMENT?
  
ARE MEDICAL CARE RELEASES OBTAINED AT ENROLLMENT?  
IS THE DISPENSING OF MEDICATION ONLY BY THE WRITTEN INSTRUCTIONS OF A PHYSICIAN?
 
DOES THE INSURED HAVE EMERGENCY TRANSPORTATION AVAILABLE?  
DESCRIBE HOW ILLNESSES AND INJURIES ARE HANDLED:
DOES THE INSURED COOK HOT FOOD ON PREMISES?  
ARE THERE WORKING SMOKE DETECTORS? BATTERY ELECTRIC
  
ARE THERE WORKING FIRE EXTINGUISHERS? DATE LAST SERVICED?  
ARE ALL UNUSED ELECTRICAL OUTLETS COVERED?  
ARE CHILDREN KEPT AWAY FROM THE FOOD PROCESSING AREA?  
I HEREBY DECLARE TO THE BEST OF MY KNOWLEDGE AND BELIEF THAT ALL OF THE FOREGOING STATEMENTS ARE COMPLETE AND TRUE AND THAT THESE STATEMENTS ARE OFFERED AS AN INDUCEMENT TO THE COMPANY TO ISSUE THE POLICY FOR WHICH I AM APPLYING. IT IS UNDERSTOOD AND AGREED THAT THE COMPLETION OF THIS QUESTIONNAIRE DOES NOT BIND THE INSURANCE COMPANY.

I Agree I Do Not Agree
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