Business Income Worksheet Page 1 of 2 10/2009
CHILD CARE PRODUCT
BUSINESS INCOME WORKSHEET
Named Insured:
Actual Revenue
for Past 12 Months
Estimated Total
Revenue
for Next 12 Months
A. Business Income exposures from following sources:
1. Total Annual Tuitions: $ $
2. Ordinary Payroll Expense* $ $
3. Continuing Expenses $ $
B. Total B/I exposure for 12 months: $ $
C. Less cost of:
1. If excluding or limiting “Ordinary Payroll”,
deduct all “Ordinary Payroll” expenses. (See
note below) If not excluding or limiting
“Ordinary Payroll”, leave blank.
$ $
2. Other Non-continuing Expenses (Describe): $ $
D. Total Deductions (Items 1-2) $ $
E. Total Business Income Value (B-D) $ $
Complete only if extra expense is requested**:
F. Method 1: 25% of Total Revenue** $ $
G. Method 2: Calculation by Category**
1. Rental for temporary Child Care location: $ $
2. Moving expenses: $ $
3. Overtime / other extra expense: $ $
4. Other: $ $
H. Total Gross Extra Expense: $ $
Deduct expenses discontinued at original location
because of loss:
($ )
($ )
I. Net Extra Expense: (from line F or line H) $ $
J. TOTAL INSURABLE BUSINESS INCOME / EXTRA
EXPENSE (E+i) (Agreed Amount)
$
$
* Ordinary Payroll expenses include payroll, employee benefits if directly related to payroll, FICA and
Medicare payments, union dues, and Workers Compensation premiums. Some points to consider
in deciding whether to exclude or limit Ordinary Payroll (i.e., other than officers, executives,
managers and employees under contract):
