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

(1)

1861, rue Prince Saint-Hubert (Québec) J4T 0A5 Phone: 450-672-8826 Fax: 450-672-9648

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) or

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

Email: [email protected] (only if the payment is by Visa) Fax: 450-672-9648 (only if the payment is by Visa)

Upon reception of your payment, we will forward your insurance certificate (Processing time: allow 3 weeks)

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, email 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

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First name

Last name

Address

Apartment

City

Postal Code

Phone

Name of your coordinating office

E-mail address *

*

Only if you want to receive information from RCPEM by email

These insurances options of « Assurances Andrée Bernier et Filles inc. » are offered by Regroupement des CPE de la Montérégie

for the period of April 1st_{, 2016 to April 1}st_{, 2017.}

Option 1

Compulsory – as per article n° 51.9 Home-based business protection Option 2

Commercial General Liability – limit $10 000 000 Commercial General Liability – limit $10 000 000 Property Coverage – Contents: property related to the operations home childcare provider – limit $10 000 Possibility to increase the limit Business Interruption Insurance – Actual Loss Sustained – Profits Form

Comprehensive Dishonesty, Disappearance and Destruction Policy –Employee Dishonesty (Form A) limite $10 000

Premium = $79.50 fees and tax included Premium = $166.70 fees and tax included OPTION 1

yes no answer required yes no OPTION 2 : 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 Maternity

Disease Other

DO YOU HAVE AN OPEN AND PENDING CLAIM? YES NO

S

IGNATURE

D

ATE

Please send this form by post with your payment (cheque or money order payable RCPEM) at the following address Regroupement des centres de la petite enfance de la Montérégie

1861, rue Prince Saint-Hubert (Québec) J4T 0A5 Phone: 450-672-8826 Fax: 450-672-9648

Note that no transaction will be made by phone #VISA

Expiration

date

/

Name on card

#MASTERCARD

Expiration

date

/

Name on card AUTHORIZATION TO DEBIT THE AMOUNT INDICATED IN OPTION 1 OR 2 AT YOUR CHOICE

(SIGNATURE)

IF WE DO NOT RECEIVE YOUR PAYMENT BY APRIL 1ST,2016_{WE WILL CONSIDER THAT YOU DO NOT WISH TO RENEW YOUR}

RENEWAL OR INSCRIPTION FORM

Liability insurance and home-based

business insurance

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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

10 000 000 $

Products-completed operations aggregate limit 10 000 000 $

Coverage B : Personal and Advertising Injury liability 10 000 000 $

Coverage C : Medical Payments 50 000 $ per pers

Coverage D : Tenants’ Legal Liability 2 000 000 $

Included

Additionnal insured global guarantee Included

Abuse Coverage 10 000 000 $

Contingent error and omission Included

Criminel defence cost – reimbursement (must be acquitted or charges withdrawn) 25 000 $ 1 000 000 $ Retention 500$

890.6 Amendment : Prior loss

25 000 $

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

Included

Extension of coverage : 035.9e and childcare services program - amendments 890.6e

Included in policy limit

Consequential loss – Temperature change Included

In addition to policy limit

Property away from the premises 50 000 $

Actual loss sustained

Indemnity period 18 months

Actual loss sustained

Coverage Extension

4 weeks

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.

Coverage A : Bodily injury, Mental injury and Property damage / Limit of insurance

Employees and « volunteer workers » and unit owners of condominiums as additional insureds

890.6 Loss of business income resulting from the interruption due to the criminal charges against you (must be acquitted or charges withdrawn)

DIRECTORS AND OFFICERS LIABILITY- NON-PROFIT ORGANIZATION LIABILITY: 350.2e FORM

Directors and Officers coverage - amendatory endorsement : 375.8e form

Profit-organization according to general endorsement 890.6e:

Sewer backing up coverage - 300 $ Deductible 159.2e

BUSINESS INTERRUPTION INSURANCE - ACTUAL LOSS SUSTAINED - PROFITS FORM: 238.0e & 238.9e FORMS

My business and me - coverage extension - business interruption insurance actual loss sustained form 238.0e Prohibited access to the describe premises

EQUIPMENT BREAKDOWN COVERAGE - BUSINESS INTERRUPTION INCLUDED 168.1e

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5600, boul. des Galeries, bur. 350, Québec (Qc) G2K 2H6 Tél . (418) 623-6070 1 800-563-6070 Téléc.: (418) 626-5676

CO COCO

COMMUNIQUÉMMUNIQUÉMMUNIQUÉMMUNIQUÉ

QUESTIONS AND ANSWERS QUESTIONS AND ANSWERS QUESTIONS AND ANSWERS QUESTIONS AND ANSWERS

P P P

PLEASE NOTE THAT THISLEASE NOTE THAT THISLEASE NOTE THAT THIS DOCUMENT LEASE NOTE THAT THISDOCUMENT DOCUMENT DOCUMENT COMPARESCOMPARESCOMPARESCOMPARES THE POLICY OFFERED BTHE POLICY OFFERED BY YOUR PERSONAL INSUTHE POLICY OFFERED BTHE POLICY OFFERED BY YOUR PERSONAL INSUY YOUR PERSONAL INSUY YOUR PERSONAL INSURER RER RER RER WITHWITHWITHWITH THE

THE THE

THE RRRREGROUPEMENTEGROUPEMENTEGROUPEMENTEGROUPEMENT’’’’SSSS ONEONEONEONE....

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 insure It is really important that your insureIt is really important that your insure

It is really important that your insurerrrr answers answers answers answers ““““yes”yes”yes”yes” to all the following questions because to all the following questions because to all the following questions because to all the following questions because ASSURANCES ASSURANCES ASSURANCES ASSURANCES ANDRÉE BERNIER ET FILLES INC

ANDRÉE BERNIER ET FILLES INCANDRÉE BERNIER ET FILLES INC

ANDRÉE BERNIER ET FILLES INC.... insures you except for the Homeinsures you except for the Homeinsures you except for the Home----based business insures you except for the Homebased business based business wbased business whichwwhichhichhich is optionalis optionalis optional.... 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? 10 000 000. $, 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(home(home(home----basedbasedbased business).basedbusiness).business).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

Bodily injuriesBodily injuries

Bodily injuries are insured by the S.A.A.Q. Material damages

Material damagesMaterial damages

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.

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INCIDENT REPORT

02/18/2016 AABF

INCIDENT DATE

:

____/_/____

POLICY NO

:

166-6500

CUSTOMER NUMBER

:

166-60

16

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

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*Certain conditions, limitations and exclusions apply. Contact your insurance broker for details.

Auto insurance

•Up to a $250 reduction of the deductible.

• Up to $60,000 coverage for damage to a rented or borrowed car, anywhere in Canada or the United States.

• No deductible in case of hit-and-run damage or total loss.

Home insurance

• Up to a $300 reduction of the deductible.

• Replacement cost without obligation to rebuild in case of 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.

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.

Find out more!

†

Con

tes

t

YOU

COULD WIN

$5000

IN CASH WITH

INTACT INSURANCE

To enter : Just tell us the renewal date of your home or auto insurance!

C a b i n e t e n a s s u r a n c e d e d o m m a g e s

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

1)

2)

3)

4)

Address

Apartment

City

Postal Code

Phone

Name of your coordinating office

E-mail address *

*

I do not wish to renew :

S

D

/

/

RENEWAL OR INSCRIPTION FORM

Liability insurance and home-based

business insurance

Coverage summary Childcare Services Program

Policy - OPTION 1 (MANDATORY)

Are educational outgoings insured ?(Most of the insurers cover only on premises)

INCIDENT REPORT

:

______/_____/______

:

166-6500

:

166-60

16

/

/

/

:

:

_____________________________________________________________

:

__________________________________________________________

:

(

)

__________________

:

_____________________________________________________________

:

_______________

/

:

____________________________________________

:

__________________________________________________

:

_______/_____/______

:

______________________________________________________________________________________

:

____________________________________________________________

:

(

)

________________

:

_______________________________________________________________

:

______________

:

______________________________________

:

______/_____/______

:

______________

:

_________________________________________________________________________

:

_____________________

:

___________________

:

____/_/____

_____/_/____

____/_/____

____/_/____

____/_/____