School District Program Application March 18, 2025 School District Program Application Step 1 of 6 – School District Program Application 16% To receive a quote, please complete and submit this application and related documents by April 21, 2025.Entity Name:FEIN:Address: Street or Mailing Address City ZIP / Postal Code Superintendent or Charter School Principal: First Name Last Name Title:Phone:Email: Who should APRA contact to discuss your coverage? First Name Last Name Title:Phone:Email: Will you be working with a broker? Yes No If so: First Name Last Name Firm:Phone:Email: Address: Street Address City State ZIP / Postal Code Member will compensate Broker in the form of: A flat fee to be paid directly to broker by the member Commission If paying commission, what percentage of gross contribution?If the broker's compensation is in the form of a percentage commission, would you like APRA to include it in the quoted premium contribution? Yes No Members working with a broker will receive a discount of 5% or $50,000, whichever is less, on their premium contribution. If you have questions on how to complete this questionnaire or the materials needed to be submitted, please contact your broker, or one of the APRA underwriting staff at *protected email* or 907-523-9400 or 907-258-2625. General Information1.) Description of EntityA.) Entity is a: School District Charter School Other: (describe)Note: the term “school district” or ” district” as used below in this document refers to school districts, charter schools, and other education entities completing this form.B.) Number of schools comprising educational entity?C.) Are any school openings or closing anticipated within the next 12 months? Yes No 2.) Student Enrollment:Estimated student count for the upcoming school year:Correspondence Students (all grades):On-site students (including boarding students)(The total of these should match the XXX number above)Pre-k & Kindergarten:Grades 1-8:Grades 9-12:Does the school district operate a boarding school? Yes No If Yes, number the boarding students (include these in the on-site count above)?Describe the boarding school, its location, focus, and how many months of the year it operates:3.) Employment Practices and legal ConsultationAPRA’s employment practices coverage for wrongful termination is contingent upon conferring with an attorney before terminating or non-retaining an employee, and then following the advice given by the attorney. Please initial here to acknowledge an understanding of this requirement.Initial:4.) School District AttorneyName: First Last Firm:5.) Other InsuranceDoes your school or school district have any insurance policies issued by an insurer other than APRA that apply to property or liability exposures? This includes coverage for property (including flood or earthquake), workers’ compensation, aviation, marine, and liability, but not health insurance. Yes No If yes, describe the policies and insurers: 6.) Scheduled Buildings or Other StructuresAPRA’s property coverage requires that buildings and other structures be scheduled (insured) for their full replacement value. Members may schedule particular buildings for an amount less than their full replacement value if those buildings are listed on an Agreed Value Endorsement, which limits the coverage in the event of a loss to the stated value.A.) Do you wish to cover any of your scheduled buildings or other structures for an Agreed Value less than their full replacement cost? Yes No If yes, list the buildings and the desired values:B.) Are all buildings or other structures on the schedule, other than the ones listed in A above, scheduled for their full replacement cost? Yes No If no, explain:Exposure Questions1.) AircraftDoes your school or school district permit employees to pilot any aircraft when travelling on school district business? Yes No Does your school or school district own or lease any aircraft? Yes No Note: The APRA General Liability Policy does not extend to any aircraft operation.2.) Background ChecksA.) Do you complete background checks on current or prospective employees? Yes No If yes, describe the checks that you do:B.) Is the school district a member of the National Association of State Directors of Teacher Educator and Certification (NASDTEC) Education Identification Clearinghouse? Yes No If yes, Do you run NASDTEC background checks on prospective new hires? Yes No Do you run NASDTEC background checks on existing staff? Yes No Note: Contact one of APRA’s Risk Specialists at *protected email* for more information about NASDTEC background checks and how APRA can help cover the cost of this service. 3.) Building SecurityDescribe the security equipment and procedures your school or school district has in place in your buildings:4.) Concussion ProtocolDoes your school or school district have a concussion protocol in place? Yes No If yes, describe the source of the protocol and the training provided to coaches and school staff:5.) DriversDescribe the procedures your school or school district follows to verify that employees and volunteers who drive vehicles for work have valid driver’s licenses. How frequently are licenses re-verified to confirm they are still valid?6.) DronesDoes your school or school district use drones? Yes No If yes, describe how they are used, for what purpose, and who operates the drone(s):7.) ErosionIs any property currently under imminent threat of damage due to erosion? Yes No If yes, Describe:Note: APRA coverage does NOT include loss due to erosion 8.) PermafrostIs any property currently under imminent threat of damage due to thawing permafrost? Yes No If yes, describe:Note: APRA coverage does NOT include loss due to the thawing of permafrost. 9. Professional BoundariesA. Has your District adopted the AASB model policy BP-5141.42 and related regulation AR 5141.42 dealing with "Professional Boundaries of Staff with Students”? Yes No Don’t Know B.) Please describe how you are providing training to staff on professional boundaries and sexual abuse prevention:10.) Sports programsDoes your district or school have an interscholastic tackle football program? Yes No 11.) Summer programs or campsDoes your school or school district provide summer programs or camps? Yes No If yes, provide a description of the program or camp, including location, focus of study or activities, number of students and teachers participating, and duration:12.) Swimming PoolsDoes your school or school district own or operate a Swimming Pool? Yes No If yes, describe the pool(s) and any sharing of pool management or operations with another party. CertificationCERTIFICATION The person submitting this form is authorized to act for the member in the application for insurance coverage. They have read and understand this application and confirm that all statements, schedules, and documents provided are true, complete, and accurate. If any event occurs before July 1, 2025, that makes any statement here untrue or incomplete, the member representative will report it in writing to APRA immediately. Submitting this application does not obligate the member to buy insurance from APRA, nor does reviewing it require APRA to issue a policy. This application will form the basis of the contract if a policy is issued. This must be submitted by Board President, Superintendent, or similarly authorized representative of the educational entity. . Name of person submitting this form First Last Title Phone:Email: Signature Δ