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Skip the typing — snap a photo of your driver's license
We'll fill in your name, address, date of birth and license number wherever this form asks for them. You can still edit anything.
Drag & drop or click to upload a photo of your driver's license
CT We Care LLC
Home Care Agency Insurance Intake — powered by Safeshield
Business Information
Tell us about your home care agency
Business Address *
Start typing and pick your address from the list — city, state and ZIP fill in for you.
Services & Operations
Underwriting needs to understand exactly what care you provide
Any prior claims or incidents in the last 5 years?
Commercial Auto Information
Vehicles used for the business and caregiver driving practices
Agency-Owned Vehicles
Employee Information
For Workers Comp, EPLI, and staffing exposure
Key Employees / Caregivers
General Liability Details
Standing GL exposure for the agency itself
GL Limits Needed
Any client injury, property damage, or abuse-related incidents / allegations?
Medical Malpractice / Professional Liability
Only matters if any clinical or medical care is provided
Desired / Current Malpractice Limits
Prior malpractice claims or allegations (dates + outcome)
Coverage Needs
Check every coverage you want us to quote
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Upload Current Declarations Page (Optional)
PDF or a photo of the page. We’ll read the carrier, premium, limits, deductible and the property details, fill them in below, and tuck them out of your way — you can reopen and edit anything. No dec page? Just answer the questions below instead.
Drag & drop or click to upload the declarations page
When do you need coverage? *
How did you hear about us?
Anything else we should know?
Your information is secure and will only be used to provide an insurance quote.