Commercial Child Care Applicant Information
SECTION 2 – LIABILITY LIMITS & COVERAGE (per occurrence limit/aggregate limit)
General liability limits: $100,000/$300,000$300,000/$600,000$1,000,000/$1,000,000$1,000,000/$2,000,000Other-enter below
Abuse liability (INCLUDED) $25,000/$50,000
Abuse liability limits (OPTIONAL): $100,000/$300,000$500,000/$1,000,000$1,000,000/$1,000,000Other-enter below
SECTION 3 – CLAIM AND LOSS INFORMATION
1. Have you had any claims or losses in the past 5 years? YesNo
2. Have you ever had any incidents or allegations of sexual or physical abuse? YesNo
3. List all claims or losses in the past 5 years:
Only complete if interested in obtaining property and/or contents coverage.
SECTION 4 – PROPERTY INFORMATION
1. Contents coverage: YesNo
2. Is the building built specifically for child care operations? YesNo
3. Please list updates (month/year) to the building for each of the following:
4. Do you own the building at this location? YesNo
5. Wind coverage: IncludeExclude
5a. Wind deductible: 2%5%7%10%
6. More than 1 location? YesNo
6a. If yes, how many total?
How did you hear about FDCI? Magazine adReferralConvention/ConferenceInternet SearchOther
NOTE: Coverage cannot be bound until the Company approves your completed application. The Company’s receipt of premium does not bind coverage until a fully completed and signed application is received. Before electronically signing this document, verify your information is correct. Electronically signing will disable further editing of your application.
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