Form 2962, Verification of Liability Insurance

Instructions

Updated: 12/2020

Purpose

These instructions apply to Form 2962, Verification of Liability Insurance, and Attachment A, Parental Notification of Lack of Liability Insurance.

When to Prepare

Every year after your permit is issued, you must verify your liability insurance coverage with Child Care Regulation (CCR) by completing a verification though your online Child Care Licensing account or by completing and sending Form 2962 to CCR. The verification must be completed by the time frame outlined below:

• Licensed operations: The anniversary date of when CCR issued your initial license;
• Registered operations: The anniversary date of when CCR issued your registration; or
• Listed operations: The anniversary date of when CCR issued your listing.

What if my operation is unable to secure liability insurance? An operation does not have to carry the insurance or may discontinue coverage if the operation is unable to obtain coverage because of financial reasons, cannot find an underwriter willing to issue a policy or has exhausted the limits of the policy. However, the operation must notify in writing the parent of each child in care, if the operation does not provide the liability insurance.

You may use Attachment A to notify all parents of children at the operation of the unavailability of liability insurance for the operation. While the operation is not required to use this form, the operation must keep any notification to parents on file.

Transmittal

Mail Form 2962, a copy of your certificate of insurance and Attachment A (if applicable) to your local CCR office.

Detailed Instructions

Operation Name – Enter the name of the operation that the verification refers to. If the verification is for a registered child care home or a listed family home, enter the first and last name of the caregiver.

Operation Number – Enter the operation number.

Operation Address – Enter the operation’s address, including street address, city, state and ZIP code.

Does your operation have liability insurance...? – If you indicate “yes,” provide a copy of the certificate of insurance including the start and expiration dates. If you select “no,” you must indicate a reason from the options provided:

• Financial reasons;
• Coverage not available from an underwriter; or
• The limitations of the current policy have been exhausted.

If known, indicate the date the policy will be available.

Certification and Signature – The permit holder, designee or director signs and dates the form.

Attachment A

Parent/Guardian Acknowledgement of the Operation’s Lack of Insurance – The parent/guardian signs and dates the form and provides their printed name, the name(s) of the child or children in the operation’s care and the name of the operation.

Maintain this form on file if used.