Florida Charter / Private School Insurance Quote Florida Charter / Private School Insurance Quote Step 1 of 7 - General Information 14% Name of School:Year School Opened:Current Sponsor:Business Manager or Principal's InformationName:Email Phone:Fax:Cell Phone:School Insurance Information:Renewal Date:Current Insurance Carrier:Current Property & Casualty budget/cost:Current Health Insurance Carrier:Current Health Insurance budget/cost:Physical Address of School Building(s):Type of School:SelectCharterPublicPrivateGrade Levels:Mailing Address of School Building(s) (if different than physical address):Approximate year of original building construction:Date of additions:Construction of buiding (i.e. wood frame, brick, stone, block, etc.):Number of stories in the building:Is Building:SelectOwnedLeasedPlumbing:Electrical:Heating / AC:RoofApproximate square footage of building (do not include basement):Approximate square footage of basement (if applicable):Does the building have a working boiler?SelectYesNoDoes the building have a working boiler?SelectYesNoIs the building sprinklered?Estimated 100% replacement cost of building of building (or current insurance value):Estimated 100% replacement cost of business personal property (desks, furniture, books, etc.) DO NOT INCLUDE COMPUTERS in estimate:Estimated 100% replacement cost of computer hardware:Estimated 100% replacement cost of computer software:Estimated 100% replacement cost of improvements and betterments made to the building for school occupancy (i.e. carpet, lighting, alarms, etc.): Law Enforcement Liability CoverageDoes your school have security guards?SelectYesNoIf yes, how many guards?Are guards armed?SelectYesNoAre they on premises during school hours?SelectYesNoAre they on premises before/after regular school hours?SelectYesNoSchool Leader Errors and Omissions Professional LiabilityIs your Board a Not-For_Profit 501-C3?SelectYesNoNumber of board members:ATTACH A COPY OF YOUR LAST BUDGET or LAST FINANCIAL STATEMENTAccepted file types: jpg, gif, pdf, doc, txt, docx, Max. file size: 96 MB.Accepted formats are .pdf, .doc, .txt, .jpg, or .gifATTACH A SAMPLE EMPLOYMENT APPLICATIONAccepted file types: jpg, gif, pdf, doc, txt, docx, Max. file size: 96 MB.Accepted formats are .pdf, .doc, .txt, .jpg, or .gifDo you have written procedures that facilitate prompt recording and reporting of claims, complaints, charges, and incidents that can be reasonable be expected to result in claims?SelectYesNoAre these procedures communicated to all your members, employees, student teachers and volunteer workers?SelectYesNoSexual Misconduct and Molestation CoverageDo you have a written statement of policy that any act of physical or sexual abuse is not tolerated?SelectYesNoDo you have written procedures that facilitate prompt recording, reporting and investigation of and restonse to complaints of sexual misconduct or molestation?SelectYesNoAre these procedures communicated to all staff, student teachers and volunteers?SelectYesNoHave any of your members, trustees, employees, student teachers or volunteer workers ever be accused, charged, convicted, or had claim for damages or suit broght against them for any type of sexual misconduct?SelectYesNoIf yes, please explain: Loss HistoryBriefly Describe any losses in the past 3 years ( We will eventually need "Hard Copy" loss information from your current insurer for us to release premium figures -- Please request loss runs from your existing agency or insurance company.) General LiabilityNumber of teachers:Number of teacher's assistants:Number of administrative staff:Number of students:Are bleacher/grandstand inspections NFPA 102 compliant?SelectYesNoNumber of bleachers:Food Service: Does your school prepare meals for students on premises and is equipment UL 300/NFPA 96 compliant?SelectYesNoSwimming Pool?SelectYesNoAre rules posted?SelectYesNoIs a lifeguard on duty at all times?SelectYesNoIs pool locked after school hours?SelectYesNoNumber of pools:Vocational Science Programs: Does your school provide Vocational Curriculum?SelectYesNoNumber of Children:Does your school have a written Human Resources Manual including Harassment/Sexual Abuse Policy and Grievance Policy, etc.?SelectYesNoCoverage Limits Desired?Limits of General Liability Required: General Liability Per Occurrence Limit: $1,000,000 General Liability Aggregate Limit: $2,000,000 Student Accident Insurance: $5,000 / $10,000 AutomobileDo you have owned or leased automobile(s) or bus(es)?SelectOwnedLeasedBothVehicle Info (please attach a list if more than one):Accepted file types: jpg, gif, doc, docx, pdf, txt, Max. file size: 96 MB.Acceptable formats: .pdf, .doc, .docx, .txt, .jpg, .gifYear:Make:Model:Is Vehicle:SelectOwnedLeasedCost of vehicle when it was brand new:Number of passengers vehicle can carry:Vehicle usage:SelectDailyField Trips / Special Occasions LimitsUmbrella Liability Limit:Select$1,000,000$2,000,000$3,000,000$5,000,000$10,000,000$25,000,000$35,000,000$50,000,000Crime & Employee Dishonesty Limit:Select$50,000$100,000$250,000$500,000$1,000,000Workers Compensation & Employee Liability Limit:Select$250,000$500,000$1,000,000$2,000,000FEIN (Federal ID#):Annual Teacher Payroll:Annual Administrative Payroll:Annual Custodial Payroll:Annual Drivers Payroll:Annual Security Payroll:ATTACH WORKERS COMP. CLAIMS or LOSSESMax. file size: 96 MB. Any other questions or concerns? Please type them here.Security Code: