Group Home Insurance Quote

Insurance for a Group Home can be complicated, out simple form allows us to rate your coverage request simply and easily to assist you in obtaining insurance for your Youth Group Home, Abused Adults Home, Alzheimer’s & Dementia Home, Home for the Developmentally Disabled, Home for the Mildly Handicapped, Senior Citizen Home, Rehab or Post Detox Facility or Homeless Shelter Operation.

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Group Home Insurance Quote

Insurance for a Group Home can be complicated, out simple form allows us to rate your coverage request simply and easily to assist you in obtaining insurance for your operation.

Name*

First Last

Full Legal Business Name*

DBA, if any.

Your entity is*

Is the Operation a registered Not for Profit Organization?*

Yes

Email*

Phone Number*

Fax Number

Alt Phone Number (cell, home)

What is Your Entity's Mailing Address*

Street Address Address Line 2 City State ZIP Code

Website

Date Business Started*

Please provide a detailed description of the operation.*

Property Information

Is the physical address of your operation different from your mailing address?*

Yes

Physical Address of Your Operation*

If the location address differs from your mailing address, enter the location address below.

Street Address City State ZIP Code

Occupancy*

What classifications of residents to you provide services to?*

Check all that apply.

Abused Adults

Homeless

Alzheimers/Dementia

Mildly Handicapped

Children

Moderately to Severely Handicapped

Developmentally Disabled

Post Detox

Family Shelter

Senior Citizens

Schizophrenia, bi-polar disorder, psychosis

Cerebral palsy

Autism

IQ scores under 40

The inability to ambulate or live independently

Prison Release Programs

Sexual Offender Programs

None of the Above

Does your organization own the building?*

Yes

What is the rebuild cost of the structure*

Year Built*

Date Purchased or Leased*

MM slash DD slash YYYY

Number of stories*

Total square feet of interior space*

Number of residential units (rooms)

What is the maximum occupancy of the building?

In number of people.

Number of commercial units in the building, if any.*

Residential square footage*

Commercial square footage

Square footage of basement*

Enter 0 if zero

Is Basement Occupied

Yes

Are there 2 means of basement egress

Yes

Number of elevators*

Enter "0" if none

Approximately what % of the building is occupied?*

Please enter a number from 0 to 100.

Parking / Garage*

Approx Sq Ft Parking Area/Garage

Do You Operate the Parking/Garage

Answer "No" if you have a valet service, or outsource the parking operations.

Yes

Stairwells Inside or Outside Building*

None

Inside - Open

Inside - Closed

Outside

Both - Inside & Outside

Is there a Fire Escape*

Yes

Foundation Type*

Construction*

Exterior Covering*

Roof Type*

Heat Source*

Coal

Gas

Oil - Underground Tank

Oil - Above ground Tank

Oil - Basement Tank

Solar

Wood Burning

Operational Information

What are the total annual revenues, including grants, funds raised and donations?*

Enter the number zero - if None

How Many Staff Members does the Organization Have?*

How many staff members will live on-site?*

Enter 0 for zero

Do you permit co-ed (multi sex) occupancies?*

Yes

Does the management of this facility have at least three prior years experience managing a Group Home for the mildy handicapped?*

Yes

Do you provide 24/7 supervision by on-site staff*

Yes

Do you provide medical detoxification or medical treatment services?*

Yes

Do you allow stays at the shelter that exceeding 2 years?*

Yes

Are responsible for obtaining “Medical Treatment” for the residents?*

(“Medical Treatment” can be defined as treatment other than first aid that is administered by a physician or any other professional treatment provider).

Yes

Do you have written policies for pre-screening and selecting “safe homes” as well as keeping the shelter’s location secret*

Yes

Do you provide services to and house those who are known sexual offenders or individuals who have been released from prison in the last 6 months or those serving a portion of their prison term under house supervision?*

Yes

Do you screen residents for previous histories of violence, aggression or sexual-related offenses*

Yes

Do you accept anyone under the age of 18 if not accompanied by a parent?*

Yes

Do you operate as a crisis center or hot line for recent incidents concerning rape or suicide?*

Yes

Do you keep complete records on all residents?*

Yes

Do you house residents under the age of 18?*

Yes

Is smoking prohibited INSIDE the building?*

Yes

Do you permit residents to cook meals in their own rooms?*

Yes

Do you have a building evacuation plan that is posted and illuminated emergency exits that are clearly marked and free of obstructions?*

Yes

Do you equip bathroom facilities with grab bars, non-slip surfaces & water temperature control devices*

Yes

Do you provide Foster Care Services?*

Yes

Do you have a Child Care Operation?*

Yes

What are the hours of your child care operation?*

How may days a week is the child care operation?*

Advise the maximum number of children on premises within the past 12 months?*

Building Updates

This is VERY important! If no updates, enter the year of construction

Roofing Updates*

Partial

Complete

None

If updated, what year?*

Electrical System Updates*

Partial

Complete

None

If updated, what year?*

Heating System Updates*

Partial

Complete

None

If updated, what year?*

Plumbing System Updates*

Partial

Complete

None

If updated, what year?*

Circuit protection*

Circuit Breakers

Fuses

Both

Protective Devices, Safety & Security

Distance to Fire Hydrant*

Distance to Fire Station*

Is there Emergency Lighting*

What percent of the building has sprinklers*

Are Exit Signs Illuminated?*

How often are safety drills performed?*

Weekly

Monthly

Quarterly

Other

Burglar Alarm*

Fire Alarm*

Smoke Alarm*

Camera System*

Temperature Alarm*

Pool Information*

Fences apply to the pool, not the yard.

Does the pool have a slide*

Yes

Does the pool have a diving board*

Yes

Loss / Claim Information

Have there been any claims or losses in the last 5 years*

Yes

Claim Details

If you have had any claims in the last 5 years, please provide the date, the cause of the loss, and the amount paid out for each one.

Current Insurance Information

Are you currently insured*

Current Carrier (if any)*

Current insurance expiration date*

MM slash DD slash YYYY

Current annual insurance premium*

General Liability

Premises Liability Coverage*

This provides coverage for bodily injury and property damage

None

$100,000

$300,000

$500,000

$1,000,000

$2,000,000

Professional Liability Coverage*

This provides coverage for errors or omissions on behalf of your organization.

None

$100,000

$300,000

$500,000

$1,000,000

$2,000,000

Sex Abuse & Molestation*

This provides coverage for allegations of sexual abuse or molestation against your organization.

None

$100,000

$300,000

$500,000

$1,000,000

$2,000,000

Umbrella/Excess Liability Coverage*

Building, Property & Business Income Coverage

Building Coverage

Only select this if you own the building or are required to insure it. This needs to be the REPLACEMENT COST of the building, or REBUILD COST, not the market value.

Please enter a number from 0 to 10000000.

Building Improvements

This provides coverage for improvements or betterments you have made to the space. (renovations)

Please enter a number from 0 to 10000000.

Business Property Contents

This provides coverage for your possessions your business owns. (desks, chairs, tables, books...) I.E. thing in the building that are not part of or attached to the building.

Please enter a number from 0 to 10000000.

Business Income

This provides monetary coverage in the event your business is closed because of a covered loss (fire, storm, smoke damage)

Please enter a number from 0 to 10000000.

Property Deductible

What deductible would you prefer for the property coverage? Higher deductibles have lower insurance costs.

Finance Information

Ever filed Bankruptcy or Reorganization*

Yes

If so, why?*

Do or did you currently have insurance for this operation?*

Yes

Has coverage been Declined, canceled or non-renewed in last 5 years*

Yes

What date does or will the insurance expire?*

MM slash DD slash YYYY

Who is the current/prior insurance carrier*

Please provide the insurance company name, not your broker or agent.

What is your current/prior annual premium.

Please enter your total annual premium, not your monthly bill.

Final Details

How soon do you need this quote*

Date quote needed by

MM slash DD slash YYYY

What date do you need this coverage by?*

MM slash DD slash YYYY

How did you hear about us?

If you were referred, who can we thank with a nice gift?

What other coverages are you interested in?*

None

Workers Comp

Disability

Group Health

Employment Practices Liability

Hired & Non-Owned Auto Liability

Sex Abuse & Molestation

Directors & Officers

Cyber Liability

How many employees operation their personal vehicles on company tome?*

Are driving records screened prior to hiring employees?*

Do you require employees that drive to maintain personal auto insurance?*

Requested Cyber Liabilty Limit*

Please estimate total number of customer and employee records you store either electronically or in physical files?*

Approximately what percentage of the total annual revenue is attributed to e-commerce*

Requested Sex Abuse & Molestation Limit*

How many female employees do you have*

Enter 0 if none

How many male employees do you have*

Enter 0 if none

What is your total annual gross payroll?*

What is the Organization's Federal Tax ID Number?*

Are there any specific insurance requirements that you need to comply with?

I'll paste them below

I'll upload them below

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Paste or enter any specific insurance requirements that you need to comply with here*

Please upload any specific insurance requirements that you need to comply with here*

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Accepted file types: pdf, jpg, png, doc, docx, Max. file size: 15 MB, Max. files: 5.

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