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 *

Street *

City *

State *

ZIP / Postal Code *

Primary Phone Number *

Alternate Phone Number

E-Mail Address *

Business Type

Company Owner

First Name *

Last Name *

Gross Annual Sales

List all locations you offer childcare *

How long in business? *

How many years experience in this field? *

Prior Insurance

Length of Coverage (Months and Years)

Expiration Date

Describe any claims, lawsuits, administrative actions

Number of Owners

“Employees” include: Sole proprietor, Partner, Executive Officers, Seasonal employees, Part-time employees, Full-time employees.

Number of Full Time Employees *

Number of Part Time Employees

Annual Employee Payroll

Number of Full Time Volunteers

Number of Part Time Volunteers

Please explain pre-employment screening requirements *

Credentialing - Is center *

How many children is applicant licensed to care for? *

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?

Do you need pricing on commercial auto, buildings, business property? *

Do you need pricing on a surety bond? *

How did you hear about us?

Full Name of Person Entering Application *

Submission Validation

Required

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.

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