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    Midwest Insurance Center

    944 U.S. Hwy 30
    Schererville, Indiana 46375
    Phone: 219-864-3333
    Fax: 219-864-9393
    Email: info@midwestic.com

    M-F 8:30am – 5pm CST

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Midwest Insurance Center Logo
  • Business

    Business Insurance

    We provide small businesses with a variety of different coverage & policy options that fit their needs.
    View All
    Need a policy recommendation?
    Answer 3 questionsAnswer 3 questions
    Builders Risk
    Business Interruption
    Business Owners Policy
    Cargo
    Commercial Auto
    Commercial Trucking
    Cyber Liability
    Directors & Officers
    Employment Practices Liability
    Equipment Breakdown
    Equipment Floater / Inland Marine
    General Liability
    Liquor Liability
    Products Liability
    Professional Liability E&O
    Property
    Umbrella
    Workers Compensation
    • General Liability
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    • Commercial Umbrella
    • Inland Marine
    • Liquor Liability
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    • Disability Insurance
    • Errors and Omissions
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    • Builders Risk
    • Mechanical Breakdown
    • Cargo
    • Bonds
  • Personal

    Personal Insurance

    We offer insurance for individuals and families, including customized coverage, to fit your lifestyle.
    View All
    Auto + Home
    Boat
    Classic & Exotic Cars
    Condo
    Course of Construction
    Earthquake
    Equine
    Flood
    High Net Worth
    Jewelry
    Landlords
    Life
    Motorcycle
    Powersports
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    RV / Trailer
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    Our team serves all types of businesses across the country specializing in a variety of industries. Here’s some of the most popular types of businesses.
    View All
    Get Insurance QuoteGet Insurance Quote
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    Consultants
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    Midwest Insurance Center

    944 U.S. Hwy 30
    Schererville, Indiana 46375
    Phone: 219-864-3333
    Fax: 219-864-9393
    Email: info@midwestic.com

    M-F 8:30am – 5pm CST

    Get DirectionsGet Directions
    • About Us
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Adult Foster Care Insurance Quote

Adult Foster Care Insurance QuoteTimothy Dekker2024-06-12T16:40:42-04:00

Step 1 of 11

9%
Contact Name
Mailing Address
Same as Physical Address?
Physical Address
Organization Type?

Current Insurance Information

Do you currently have insurance?
MM slash DD slash YYYY
Have you had any claims in the last 5 years?
Does your current insurance program include?
MM slash DD slash YYYY
Is it?
MM slash DD slash YYYY

General Information

Are all facilities licensed through the state?
Has your license ever been suspended, revoked, or placed under conditional status OR claims of negligence?
MM slash DD slash YYYY
Any violations noted?
Are counseling services offered for any of the following?
Check all that apply.
Do you operate any other locations not included on this application?
Is insurance in place at these other locations?

Property Details

Is this location? Street Address Square Footage Actions
     
There are no Properties.

Maximum number of properties reached.

Facility Information

Occupancy: Number of Beds by Resident Type: Annual Residents by Age: Actions
     
There are no Facilities.

Maximum number of facilities reached.

Resident unauthorized leave prevention?
Check all that apply.
Does a physician screen clients prior to admission?
Are residents responsible for their own basic personal care?
Example: Bathing, dressing, eating, restroom aide.
Do you allow physical restraint?
Resident Rooms
Inspection Freq.
By Who
How often?
Is there a written plan for supervising staff when interacting with clients on and off premises?
Are security cameras monitoring operations and residents?
Are resident's door ever locked from the outside?
Are residents allowed to cook their own meals?
How?
Is there a pool?
Who uses the pool?
Check all that apply.
Is the pool fenced with a self-locking gate?
Is there a diving board?
Is there trained staff on water safety?

Management Practices

Do you have sign in/out procedures for?
Check all that apply.
What is your client to staff ratio?
Day
Night

Abuse Prevention

Do you run criminal background checks, including sex/child abuse related crimes, before an employment offer?
This includes employees and volunteers.
Do you have a crisis plan for dealing with an incident of abuse?
Is there formal training on child/sexual abuse?
Are closed door one-on-one meetings prohibited?
Have any incidents resulted in an allegation of sexual abuse?
Was the case taken to trial?

Human Resources

Type: Employee - FT Employee - PT Contracted - PT Contracted - PT Annual Payroll Actions
           
There are no Staff.

Maximum number of staff reached.

Aprox. how many FT and PT employees two years ago?
Full Time
Part Time
Employee changes over the past twelve (12) months?
Left
Let Go
Laid Off
Demoted
Anticipated Employee changes over the past twelve (12) months?
Reductions
Layoffs
Demotions
Do you have written job descriptions for each employee?
Is drug testing conducted?
Do you train and require all staff to report incidents, in writing, and do you investigate each incident?

Workers Compensation

Which of the following contracted services are utilized?
Are there written agreements with those contractors?
Do you collect certificates of insurance from your contractors?

Financials

Annual Revenue:
Current Fiscal Year
Previous Fiscal Year
Annual Budget:
Current Fiscal Year
Previous Fiscal Year
Total Assets:
Current Fiscal Year
Previous Fiscal Year
Net Assets / Fund Balance:
Current Fiscal Year
Previous Fiscal Year
Do you offer a retirement plan?
Plan Details
Name
Established
Assets
Type
Participants
Administrator
Do you file a Form 5500 each year?
Request a copy of most recent filing.
Is your organization more than 25% owned by private equity?
Any mergers or operations under another name in the last five (5) years?

Vehicles and Transportation

Year Make Model Actions
     
There are no Vehicles.

Maximum number of vehicles reached.

Are all vehicles registered to the organization?
Do employees or volunteers use their personal vehicles for business?
How many use their own vehicles for business use?
Full Time - Driving over 20 hours per week Part Time - Driving up to 20 hours per week
Full Time
Part Time
Volunteers
Do you run MVRs on employees?
Do you require employees and volunteers to carry and show evidence of personal auto insurance?
Do you provide transportation services?
Do vehicles equipped for wheelchairs have tie-down belts?
Do you have a formal maintenance and safety training program in place?
Does Applicant utilize GPS fleet telematics devices?
Fleet Telematics Utilized

Get Insurance

Our knowledgable agents are experts at finding the right coverage for your family or business. Get your insurance quote now.

Get Insurance QuoteGet Insurance Quote

Midwest Insurance Center

944 U.S. Hwy 30
Schererville, Indiana 46375
Phone: 219-864-3333
Fax: 219-864-9393
Email: info@midwestic.com

Office Hours:
Monday – Friday, 8:30am – 5pm CST

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