Chemical Educators


Applicant Information
Chemical Educators Application




Please check the box below that adequately reflects your activities as an educator.

Faculty and instructional staff with responsibility for conduct or supervision of high school and freshman-level undergraduates instructional labs, but no responsibility for supervision of individuals research activities involving manipulations of chemical substances. No coverage for use of pyrophoric or high energy or high toxicity substances or acutely bio-hazardous materials.

Faculty and instructional staff with responsibility for conduct or supervision of instructional labs at any undergraduate level, but no responsibility for supervision of individual research activities involving manipulation of chemical substances. No coverage for use of pyrophoric or high energy or high toxicity substance or acutely bio-hazardous materials.

Faculty and instructional staff with responsibilities that include supervision of individual research activities involving manipulation of chemical substances but not involving pyrophoric or high energy or high toxicity substances or acutely bio-hazardous materials. Such individuals would also be covered for instructional labs at all levels.

Faculty and instructional staff with responsibilities that include responsibility for supervision of individual research activities involving or potentially involving manipulation or pyrophoric or high energy or high toxicity substances or acutely bio-hazardous materials. Such individuals would also be covered for instructional labs at all levels.





Prior Coverage History

Do you currently have Educator's Professional Liability Insurance?

Other Professional Liability Carrier












Prior Knowledge/Warranty

Submission

THE APPLICANT DECLARES THAT, AFTER INQUIRY, TO THE BEST KNOWLEDGE OF ALL PERSONS TO BE INSURED THE STATEMENTS SET FORTH HEREIN AND IN ANY ATTACHMENTS MADE HERETO ARE TRUE, AND NO MATERIAL FACTS HAVE BEEN SUPRESSED, OMITTED, OR MISSTATED. UNDERWRITERS RESERVE THE RIGHT TO AMEND THE TERMS, CONDITIONS AND LIMITATIONS OF ANY POLICY ISSUED AS A RESULT OF THIS APPLICATION, IF SUBSEQUENT TO THE DATE OF THIS APPLICATION, BUT PRIOR TO THE INCEPTION OF SUCH POLICY, THERE ARE ANY MATERIAL ALTERATIONS TO THE INFORMATION CONTAINED HEREIN. COMPLETION OF THIS APPLICATION DOES NOT BIND THE UNDERWRITER TO PROVIDE COVERAGE, BUT IT IS AGREED THAT THE STATEMENTS AND PARTICULARS CONTAINED HEREIN WILL BE RELIED UPON BY UNDERWRITERS IN THE EVENT A POLICY IS ISSUED. THIS APPLICATION IS SIGNED ON BEHALF OF ALL OWNERS, PRINCIPALS, PARTNERS, SHAREHOLDERS, DIRECTORS AND EMPLOYEES. BY SUBMITTING THIS APPLICATION, THE APPLICANT AGREES THAT IN THE EVENT THE APPLICATION CONTAINS MISREPRESENTATIONS OR FAILS TO STATE FACTS MATERIALLY AFFECTING THE RISK ASSUMED BY THE INSURING COMPANY UNDER A POLICY ISSUED, THE POLICY MAY BE DEEMED NULL AND VOID.