Driver Training School (Private) Questionnaire

Applicant's Name:*

Address:*

Mailing Address

Address (cont):*

Mailing Address - continued

Contact:*

Email*

Telephone:*

Website

Fax:

Applicant is:

Current Carrier:

Expiration Date:

Limits: ($)

Premium: ($)

Deductible: ($)

NOTE: The following types of driver training schools are not eligible for this program:

CDL	Professional drivers	Motocross
Buses	Races or rally stunting	Snowmobiles
Trucks	Performance vehicles	ATVs or four-wheelers
Go-karts	Watercraft	Contractor’s equipment

1. Is the Driver Training School licensed/certified as needed with state regulators?

YesNo

1a. If yes, check all licenses/certifications that apply:

CDLPrivate PassengerMotorcycleOther (Describe below)

Please describe other licenses:

2. Are all vehicles clearly marked as driving training vehicles?

YesNo

2a. Please complete chart below or provide a separate vehicle/fleet schedule with the following info.)

	Vehicle Make	Vehicle Model	Cost New ($)	Year	Vehicle ID #
Vehicle 1
Vehicle 2
Vehicle 3
Vehicle 4

3. Do all vehicles have passenger side brakes?

YesNo

4. Total number of instructors?

4a. Do any hired instructors use their own vehicle for driver training?

YesNo

4b. If yes, please list (or attach separate sheet listing hired instructors and their vehicles used.)

	Instructor's Name	Personal Vehicle - Make	Personal Vehicle - Model	Personal Vehicle - Year
Instructor 1
Instructor 2
Instructor 3

5. Has any instructor had their driver-training license or certification revoked or suspended in the last 5 years?

YesNo

5a. If yes, please provide details:

6. Are Motor Vehicle Records obtained before hiring instructors?

YesNo

7. Does the applicant perform a criminal background investigation, including sexual abuse or child abuse-related offenses:

7a. On prospective employees and volunteers?

YesNo

7b. On existing employees and volunteers?

YesNo

7c. How often?

8. Does the applicant verify employment/volunteer-related references?

YesNo

8a. If yes, how?

8b. How often?

9. Does the applicant conduct personal interviews?

YesNo

10. Does the applicant discuss the following items at staff orientation:

	Yes	No
10a. Abuse and Molestation?
10b. How to recognize the signs of abuse?
10c. What to do if an individual reports someone molested him/her?

11. Does the applicant have a supervision plan to monitor staff in day-to-day relationships with clients/children?

YesNo

12. Does the applicant have knowledge of any incident which could give rise to, or result in, an allegation of sexual abuse?

YesNo

12a. If yes, please explain:

13. Has there ever been an allegation of sexual abuse made against the insured?

YesNo

13a. If yes, please explain:

14. Provide location address and square footage of all classroom facilities owned or rented to you:

OwnRent

Location 1:

Location 2:

Location 3:

Location 4:

15. Are any online courses offered?

YesNo

15a. Type of classes offered:

15b. States where classes are offered:

15c. Annual number of students enrolled for online work:

16. Describe garaging facilities:

17. Does the insured follow a written maintenance schedule of the vehicles? Please attach printed loss runs for both General Liability and Auto.

YesNo

	Building Age	Building Construction	Building Limit ($)	Content Limit ($)
Building 1
Building 2

	Year	Make	Model	Value to Insure For ($)
Item 1
Item 2
Item 3