Call Us at: 1 (800) 624-0912

State of California Coverage

State Coverage
  1. Review the coverage outlined in the application, then choose a plan and optional coverages
  2. Calculate your total plan cost. Transfer these figures to the application (pages 3 and 4)
  3. Answer all questions and sign the application (pages 3 and 4)
  4. Read the Mandatory Government Notice (page 5)
  5. Keep pages 1, 2, and 5 for your records
  6. Mail pages 3 and 4 with a copy of your childcare license or registration and premium payment to:

Day Care Insurance Services

6345 Balboa Blvd Suite 251
Encino, CA 91316
FAX: (818) 501-7612

Automatic Payment Arrangement Form

This form is optional. It is for those customers who wish to set up automatic withdrawals from a debit or credit card for installment payments.