Complete and sign the Visa or Mastercard section at the bottom of the form

Transcription

1 St-Hubert, February 25, 2016 Subject: Insurance Renewal Liability Insurance and Home-Based Business Insurance Dear customer, The time has come to renew or to subscribe your insurance policy offered by Regroupement des centres de la petite enfance de la Montérégie and Andrée Bernier & Filles inc. Only one premium is applicable for 1 to 9 children Renewal or subscription in 4 easy steps: 1) Please complete and sign the attached form 2) Make your cheque or money order payable to : RCPEM (No postdated cheque will be accepted) Complete and sign the Visa or Mastercard section at the bottom of the form 3) Submit the form with your payment at : Mail: 1861, rue Prince Saint-Hubert (Québec) J4T 0A5 assurancesrsg@rcpem.com (only if the payment is by Visa) Fax: (only if the payment is by Visa) Upon reception of your payment, we will forward your insurance certificate (Processing time: allow 3 weeks) or 4) You must send a copy of your certificate to your coordinating office and your home insurer by April 1, 2016 We wish to inform you that administration fees of $17 are charged and included on your enclosed invoice. Those fees are charged to finance the time related to the mandate. In case of a non-renewal (sick leave, maternity leave, etc.), it is mandatory that you complete the attached form and indicating that neither option 1 nor option 2 are selected. Finally, please sign and return us the attached form by mail, or fax. If you have a claim open and pending, you can t cancel your renewal. Please contact Assurances Andrée Bernier & Filles Inc. We hope everything will be found entirely to your satisfaction. Best Regards, Carole Leclerc Regroupement des CPE de la Montérégie 1861, rue Prince Saint-Hubert (Québec) J4T 0A5 Phone: Fax:

2 RENEWAL OR INSCRIPTION FORM Liability insurance and home-based business insurance First name Last name Address City Postal Code Phone Name of your coordinating office address * *Only if you want to receive information from RCPEM by Apartment These insurances options of «Assurances Andrée Bernier et Filles inc.» are offered by Regroupement des CPE de la Montérégie for the period of April 1 st, 2016 to April 1 st, Option 1 Option 2 Compulsory as per article n 51.9 Home-based business protection Commercial General Liability limit $ Commercial General Liability limit $ Property Coverage Contents: property related to the operations home childcare provider limit $ Possibility to increase the limit Business Interruption Insurance Actual Loss Sustained Profits Form Comprehensive Dishonesty, Disappearance and Destruction Policy Employee Dishonesty (Form A) limite $ Premium = $79.50 fees and tax included Premium = $ fees and tax included OPTION 1 yes no answer required OPTION 2 : yes no answer required I do not wish to renew : Please note that if you do not renew your contract now, you should contact the RCPEM to rejoin the insurance at the reopening of your daycare Closing Disease Maternity Other DO YOU HAVE AN OPEN AND PENDING CLAIM? YES NO SIGNATURE Please send this form by post with your payment (cheque or money order payable RCPEM) at the following address # VISA # MASTERCARD DATE Regroupement des centres de la petite enfance de la Montérégie 1861, rue Prince Saint-Hubert (Québec) J4T 0A5 Phone: Fax: Note that no transaction will be made by phone Expiration date Expiration date AUTHORIZATION TO DEBIT THE AMOUNT INDICATED IN OPTION 1 OR 2 AT YOUR CHOICE / / Name on card Name on card (SIGNATURE) IF WE DO NOT RECEIVE YOUR PAYMENT BY APRIL 1 ST, 2016 WE WILL CONSIDER THAT YOU DO NOT WISH TO RENEW YOUR CONTRACT AND A NOTICE WILL BE FORWARDED TO YOUR COORDONATING OFFICE.

3 Coverage summary Childcare Services Program Policy - OPTION 1 (MANDATORY) Global Deductible clause of 250 $ on property damage if not specifically mentioned otherwise 780.2e Difference in coverages COMMERCIAL GENERAL LIABILITY: CIVICA SUPERIOR 091.0e, 094.9e, 098.9e & 890.6e FORMS Each occurrence limit Coverage A : Bodily injury, Mental injury and Property damage / Limit of insurance $ Products-completed operations aggregate limit $ Coverage B : Personal and Advertising Injury liability $ Coverage C : Medical Payments $ per pers Coverage D : Tenants Legal Liability Employees and «volunteer workers» and unit owners of condominiums as additional insureds $ Additionnal insured global guarantee Abuse Coverage $ Contingent error and omission Criminel defence cost reimbursement (must be acquitted or charges withdrawn) $ DIRECTORS AND OFFICERS LIABILITY- NON-PROFIT ORGANIZATION LIABILITY: 350.2e FORM Retention 500$ Directors and Officers coverage - amendatory endorsement : 375.8e form Profit-organization according to general endorsement 890.6e: Amendment : Prior loss Loss of business income resulting from the interruption due to the criminal charges against you (must be acquitted or charges withdrawn) $ $ Policy - OPTION 2 (optional) Deductible clause of 300$ if not specifically mentioned otherwise PROPERTY COVERAGE MY BUSINESS AND ME + SUMMARY OF COVERAGES 034.0e, 035.9e & 890.6e FORMS Replacement cost Sewer backing up coverage $ Deductible 159.2e Extension of coverage : 035.9e and childcare services program - amendments 890.6e in policy limit Consequential loss Temperature change In addition to policy limit Property away from the premises $ BUSINESS INTERRUPTION INSURANCE - ACTUAL LOSS SUSTAINED - PROFITS FORM: 238.0e & 238.9e FORMS Indemnity period 18 months My business and me - coverage extension - business interruption insurance actual loss sustained form Coverage Extension 238.0e Prohibited access to the describe premises Actual loss sustained Actual loss sustained 4 weeks EQUIPMENT BREAKDOWN COVERAGE - BUSINESS INTERRUPTION INCLUDED 168.1e COMPREHENSIVE DISHONESTY, DISAPPEARANCE AND DESTRUCTION POLICY - EMPLOYEE DISHONESTY (FORM A) 110.1e FORM The information stated above is only a summary of the applicable Limits of Insurance in the Policy and will not be interpreted as increasing, modifying or varying any other terms or Limits of Insurance specified in the Coverage Schedule. In the event of any inconsistency between the information set in this summary and the Coverage Schedule, the Coverage Schedule will govern. Version 02/20/2015

4 COMMUNIQUÉ QUESTIONS AND ANSWERS PLEASE NOTE THAT THIS DOCUMENT COMPARES THE POLICY OFFERED BY B YOUR PERSONAL INSURER WITH THE REGROUPEMENT EGROUPEMENT S ONE. Below is a list of questions you should ask your personal Insurer regarding insurance coverage for a home childcare provider: It is really important that your insurer answers yes to all the following questions because ASSURANCES ANDRÉE BERNIER ET FILLES INC. insures you except for the Home-based business which is optional. 1. Am I insured for my daycare? What is the Civil Liability insurance limit and what is the coverage of my insurance policy? $, if you are insured with Assurances Andrée Bernier et Filles Inc. Only one premium is applicable for 1 to 9 children. See all the coverage included on the attached insurance schedule. The premium is $55 per year plus tax and fees. 2. Who insures the professional properties of my home childcare services and my loss of income in case of damage? It can be added to your policy with the regroupement at a cost of $80 per year (home-based business). 3. Are educational outgoings insured?(most of the insurers cover only on premises) 4. Are the employee(s), the assistant(s) and the emergency and occasional substitute(s) insured? 5. Are volunteers insured? 6. Am I covered if I have a child with allergies or a disabled one at my home childcare service? 7. Am I covered if I give medication or first aid assistance? 8. Am I covered in case of food poisoning? 9. Am I covered for legal costs and loss of income in case of accusation for abuses (act of violence or sexual abuse)? 10. What should I do if an accident occurs at the home childcare service? Complete the accident reports supplied and forward it to us by fax. 11. Who am I insured with in case of a car accident with the children? Bodily injuries are insured by the S.A.A.Q. Material damages are insured by your own automobile insurance contract. 12. Where do I file my claims? At our office (see our phone number and address below) 13. Can I have a pet? Yes, you can with Assurances Andrée Bernier et Filles Inc. See attached insurer s communiqué which reminds you to be extremely cautious. 5600, boul. des Galeries, bur. 350, Québec (Qc) G2K 2H6 Tél. (418) Téléc.: (418)

5 INCIDENT REPORT INCIDENT DATE: / / POLICY NO: CUSTOMER NUMBER: BC/CPE/DAYCARE/REGROUPEMENT: NAME OF HOME CHILD CARE PROVIDER: ADDRESS: TEL: ( ) CITY: POSTAL CODE: DIRECTOR/COORDINATOR: INJURED: DATE OF BIRTH: / / PARENT: ADDRESS: TEL: ( ) CITY: CODE POSTAL: REPORTED TO: DATE: / / TIME: SCENE OF THE INCIDENT: CENTER ROOM: PLAYGROUND: OTHER: BRIEFLY DESCRIBE THE INCIDENT : DESCRIBE AND INDICATE THE INJURY (IES): NAME OF THE PROVIDER IN CHARGE AT THE TIME OF THE INCIDENT: IMMEDIATE MEASURES (FIRST AID): TRANSPORTATION TO HEALTH SERVICES: HOSPITALISED: YES NO NAME OF HOSPITAL: ROOM NO: ADDRESS: EXAMINED AT EMERGENCY: WITNESS 1. NAME: TEL: ( WITNESS 2. NAME: TEL: ( ) ) I (PARENT/GUARDIAN) ACKNOWLEDGE HAVING BEEN INFORMED OF THE INCIDENT AS DESCRIBE IN THIS DOCUMENT. SIGNATURE DATE : / / PARENT/GUARDIAN SIGNATURE DATE : / / DIRECTOR/COORDINATOR/PROVIDER ***It is important to inform without delay the insurer when a claim or a possibility of pursuit or a pursuit occurs.*** 02/18/2016 AABF

6 Group Power It pays to work together! Group Home and Automobile Insurance Program Exclusively for daycare centres Take advantage of many benefits, including additional coverage and competitive premiums. Auto insurance Home insurance Up to a $250 reduction of the deductible. Up to a $300 reduction of the deductible. Up to $60,000 coverage for damage to a rented or borrowed car, anywhere in Canada or the United States. Replacement cost without obligation to rebuild in case of total loss. No deductible in case of hit-and-run damage or total loss. Intact Insurance Assistance offers housekeeping, child care, nursing assistance and a legal information line. All these services are included in your policy at no extra charge. Find out more! YOU COULD WIN $5000 IN CASH WITH Co nt est INTACT INSURANCE Cabinet en assurance de dommages M e (02-16) To enter : Just tell us the renewal date of your home or auto insurance! *Certain conditions, limitations and exclusions apply. Contact your insurance broker for details. The contest begins December 1, 2015 and closes November 30, The draw will be held on December 19, The prize consists of one (1) cheque for CAN$5,000. Certain conditions, limitations and exclusions apply. This contest is open only to Quebec residents who are members of an eligible group. The winner will be required to correctly answer a mathematical skill-testing question. For full contest rules, write to: Intact Insurance Company, 2450 Girouard Street West, Saint-Hyacinthe QC J2S 3B , Intact Insurance Company. All rights reserved.