Minimum Premium Workers' Comp Quote

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First, we’ll cover the basics.
Profession*
Enter your profession*
Business Structure*
- Sole Proprietor
- Partnership
- LLC
- S-Corp
- Other
How many employees do you have? (not including owners)
Include full-time, part-time and temporary W2 employees. Do not include owners or subcontractors (1099).

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Who is this quote for?
We need these details in order to give you a quote.
Owner's Legal Name*
First Last
Phone*
Email*
What's the name of the business?*
As it should appear on your policy. If you’re a sole proprietor, just enter your name or your trading name.
When would you like coverage to start?*
Date Format: MM slash DD slash YYYY

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Where is your business located?
Address*
Street Address City State ZIP Code
Any additional locations?*
This includes everywhere you or your employees work. Don’t forget warehouses, back offices or storage facilities. Also include locations for employees who work from home.
- Yes
- No

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Employees
Enter an employee group for each type of work your employees perform. Only W2 employees. Not including owners.
Type of work performed*
Enter the type of work this group of employees performs for your business.
Number of full-time employees*
Number of part-time employees
Estimated payroll for this employee group*
Enter the total salary amount you expect to pay this group of employees this year.
Add another employee group?*
Add another employee group if there's another group of employees that performs a different type of work. For example, you may own a landscaping company and most of your employees do landscaping work. But you might have employees that do clerical or outside sales, so you'll need to add an Employee Group for them.
- Yes
- No
Employee Group 2
Type of work performed*
Enter the type of work this group of employees performs for your business.
Number of full-time employees*
Number of part-time employees
Estimated payroll for this employee group*
Enter the total salary amount you expect to pay this group of employees this year.

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Does the owner wish to be included on the policy?*
The owner can only be included for workers' compensation coverage if you upgrade to a traditional workers' compensation policy.
- Yes
- No
Choose your Employer's Liability Limits (Each accident / Policy limit / Each employee)*
Select the amount of coverage you would like for each individual claim, along with the total limit for all claims in a given policy term, for each employee.
- $100,000/$500,000/$100,000
- $500,000/$500,000/$500,000
- $1,000,000/$1,000,000/$1,000,000
Do any of your contracts require a waiver of subrogation?*
- Yes
- No
- I'm not sure
FEIN*
Workers’ comp insurance companies require an FEIN or SSN to provide a workers’ comp quote. You can apply for an FEIN online at https://sa.www4.irs.gov/modiein/individual/index.jsp

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Owner/Officer Info
*
Owner Name Owner Payroll Owner Title
*
Owner Name Beneficiary name Beneficiary relationship Gender assigned at birth Date of birth

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General Liability Insurance
Does your business perform any design, construction, installation, removal, or physical repair of any property or tangible good?
- Yes
- No
Choose your policy limits (Each Occurrence / Aggregate)
Select the amount of general liability coverage you would like for each individual claim along with a total for all the claims in a given policy term. A general liability loss can include damage caused by you and/or your employees while doing business. It can also include accidents or injuries that happen at your workplace.
- $500,000 / $1,000,000
- $1,000,000 / $2,000,000
- $2,000,000 / $4,000,000

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High-value item(s)
Would you like to cover any equipment or other high-value items on your policy? (These items are typically at least $1000 each.)*
- Yes
- No
If you bought this same item today (used), how much would it cost? After checkout, you’ll have to provide things like the year, manufacturer, and serial number.
What is it? How much is it worth?

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Business Property Insurance
Primary Business Address*
Street Address City State ZIP Code
Do you own or rent this location?
- Own
- Rent
Would you like coverage for this building?
- Yes
- No
How much building coverage would you like?
Think of the total replacement value of the building.
Business contents coverage
Think of all the things inside this location that you’d like to cover.
Business Personal Property:
The total replacement cost of your business contents. If you turned the building upside down and shook it, everything that falls out is what you'll want to include in this total.
Personal Property of Others:
The total replacement cost of things stored at your location that belong to your clients. Give the maximum value of property you would have at any given time.
Tenants Improvements and Betterments:
The total replacement value of any improvements or changes you made to your leased property. Think of any enhancements, permanent fixtures, or equipment you installed in order to do business there.

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Minimum Premium Workers’ Comp Quote

Owner Name	Owner Payroll	Owner Title

Owner Name	Beneficiary name	Beneficiary relationship	Gender assigned at birth	Date of birth

What is it?	How much is it worth?