D and O other information

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IMPORTANT

To be eligible for additional credits on your rates, please complete this form, print and return with your application.

NAEYC-accredited child care centers, please complete this short additional form to determine additional credits on your rates.
Complete the proposal form. (If you would prefer to fill out the proposal form by hand, please type or print all answers in ink.)
Print out the completed form and application and mail, along with a financial statement or annual report, to
Forrest T. Jones & Company, Inc.
3130 Broadway, P.O. Box 418131
Kansas City, MO 64141-9131
We'll rush you a no-obligation proposal for your Child Care Center D&O-EPL policy.

(If you would rather complete manually, please type or print all answers in ink.)

Name of child care center:

Address:

City:

State:

ZIP:

Are you an NAEYC-accredited child care center?

Yes No

If yes, when did your child care center receive accreditation?

(Date)

Signed: _____________________________________
(Please print out and sign.)

Need Assistance?

Selected by NAEYC

Administered by:
Forrest T. Jones & Company
Kansas City, Mo.
An insurance partner with educational associations since 1953.

Underwritten by:
Great American Insurance Group
Schaumburg, Ill.
Strength with integrity for 125 years.

how to obtain a quote and proposal form

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