Alliance of Schools for Cooperative Insurance Programs
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Request A Quote
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Risk Management Prevention Services
Guidelines & Best Practices
Sample Agreements & Forms
Abuse Prevention Resources
Special Education Resources
Risk Alerts & Bulletins
Lessons Learned – Sharing Experiences
Safety Spotlight Resources
Additional Resources
FAQs
Calendar
Training
2019 Annual Membership Meeting
Online Training
Seminars & Webinars
Resources
Forms & Tools
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Property & Liability
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Download the PDF version of this form
Name
*
Phone
District
Email
Exposure Information
1. General Liability Exposure
P2 Average Daily Attendance (ADA) or Full-Time Equivalent Student (FTES). If you are responsible for insuring students in a special program, students should be included in count (i.e. ROP):
Actual P-2 or Student FTES
Estimated Student Count for Next Year
District Type
K-8
K-12
CCD
JPA
Charter School
Grade Levels
Grade Levels
Liability Deductible Options
Dollar One
$10,000
$25,000
$50,000
$100,000
$250,000
2. Automobile Liability Exposure
Number of Buses:
Number of Passenger and Other Vehicles:
3. Property (Building/Content) Exposure
Building Replacement Value:
Contents Replacement Value:
Date of Last Property Appraisal:
MM
DD
YYYY
Property Deductible Desired:
$5,000
$10,000
$25,000
$50,000
$100,000
$250,000
4. Employee Crime Exposure
Estimated Number of Full Time Employees for Requested Coverage Year:
Estimated Number of Part Time Employees for Requested Coverage Year:
5. Total Payroll
Actual Current Payroll:
Estimated Total Payroll for Requested Coverage Year:
6. Requested Date of ASCIP Coverage:
MM
DD
YYYY
7. Do you have excess coverage?
Yes
No
Please provide the name of your carrier and your current retention level.
Name of Excess Carrier
Coverage Limits
Additional Comments
Please provide your detailed liability loss run (open and closed claims) in an Excel spreadsheet or similar electronic format for the past 10 coverage years, valued within the past 60 days.
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