Zavagn 440-884-2530, Pavarini 216-374-4500

Childcare Business Insurance

Fill out the following form as completely as possible. Once you have completed the form, click the Submit button to send your information. Your request will be handled promptly.

Company Information
Company Name Required
Street Required
City Required
State Required
ZIP / Postal Code Required
Primary Phone Number Required
Alternate Phone Number Optional
E-Mail Address Required
Business Type Optional
Company Owner
First Name Required
Last Name Required

Gross Annual Sales

Optional

List all locations you offer childcare

Required

How long in business?

Required

How many years experience in this field?

Required

Prior Insurance

Optional

Length of Coverage (Months and Years)

Optional

Expiration Date

Optional

Describe any claims, lawsuits, administrative actions

Optional

Number of Owners Optional
	“Employees” include: Sole proprietor, Partner, Executive Officers, Seasonal employees, Part-time employees, Full-time employees.
Number of Full Time Employees Required
Number of Part Time Employees Optional
Annual Employee Payroll Optional
Number of Full Time Volunteers Optional
Number of Part Time Volunteers Optional
Please explain pre-employment screening requirements Required

Credentialing - Is center Required
How many children is applicant licensed to care for? Required
Any past losses, claims, allegations, lawsuits, or administrative actions relating to sexual abuse or molestation allegations, discrimination, or negligent hiring by any owner, employee, client, parent or volunteer? Optional

Do you need pricing on commercial auto, buildings, business property? Required
Do you need pricing on a surety bond? Required
How did you hear about us? Optional

Full Name of Person Entering Application Required
Submission Validation Required	Enter the Validation Code from above.

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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Zavagno 440-884-2530 and Pavarini 216-374-4500