Minimum Premium Workers’ Comp Quote Step 1 of 15 6% Let's Get Started First, we’ll cover the basics. Profession*Select0042 Landscaping0917 Residential Cleaning2585 Carpet Cleaning2802 Carpentry Shop Only3040 Ornamental Ironworks3365 Welding3724 Mechanical/Equipment Erection5020 Ceiling Installation5022 Masonry NOC5102 Door/Window Installation5183 Plumbing5188 Automatic Sprinkler Installation5190 Electrical Wiring within buildings5191 Office machine installation5215 Concrete work5221 Concrete work - driveways/pathways5223 Swimming Pool Installation5348 Tile Work5445 Drywall Installation5467 Glazier5474 Painting5535 Sheet Metal Installation5537 HVAC5539 Metal Building Erection6217 Excavation6400 Fence Erection7600 Satellite TV Installation7605 Burglar & fire Alarm installation7611 Cable TV Installation8017 Store NOC8380 Auto Service and Repair8393 Auto Body Repair8602 Surveyor8720 Inspection of Risks for Insurance8742 Salesperson8803 Auditor/computer programmer8810 Clerical8831 Pet Groomer8835 Home Health Care9014 Commercial Janitorial Services9082 Restaurants9083 Restaurants (fast foods)9102 Park NOC9519 Household appliance installation9521 House furnishing installation9586 Barber ShopOtherEnter your profession*Primary business location*SelectAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingBusiness Structure*Only one-person businesses are eligible for minimum premium workers' comp policies.Sole ProprietorPartnershipLLCS-Corp Additional Coverages Add another coverage to your minimum premium workers' comp quote? General LiabilityHelps protect your business from lawsuits or claims involving your business operations or products. Business PropertyProtects the place where you do business- whether you own it, lease it, or work out of your home. Also covers personal property (like tools and equipment) used in your business. Business Owner’s PolicyA package that saves money by combining business property insurance and general liability insurance together. Business AutoProtects the vehicles your business owns, rents, or leases from auto liabilities. Also helps protect personal vehicles used for work-related purposes. Inland MarineHelps cover business property, assets and equipment while it’s away from you business premise, in transit, or at temporary storage locations. No Thanks Business BasicsFEINHow many years have you been in business?*The number of years this business has been operating under current ownership.I’m new in business1 year2 years3 years4 or more yearsPlease describe what your business does:*What type of work do you do?*InteriorExteriorBothAny work over 15 feet?*YesNoIs any window cleaning over one story performed?*YesNoIs any service such as asbestos or lead abatement, mold remediation, pest control, fire or flood restoration, hospital or surgical room cleaning, or crime scene clean-up performed?*YesNoDo you perform any tree trimming services?*YesNoFinancial InformationWhat's the total annual payroll for your business?*This includes things like salaries, commissions, bonuses, and overtime.What's your projected revenue for the next fiscal year?* Workers' Compensation Information How many employees do you have?<br><i>(not including owners)</i>*How many are full-time?Any part-time? If so, how many?Do you subcontract work to others?*YesNoDo you require that all subcontractors provide a Certificate of Insurance?*YesNoWhat percentage of your subcontractors are uninsured?*Projected cost of uninsured subcontractors:*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.YesNo<b>Choose your Employer's Liability Limits</b> <br>(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/$1,000,000Do any of your contracts require a waiver of subrogation?*YesNoI'm not sure Who is this quote for? We need these details in order to give you a quote.Owner 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?* Where is your business located?Address* Street Address City StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State ZIP Code Is this your home?*YesNoAny 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.YesNoHow many additional business locations do you have?* Owner Information GenderMaleFemaleBeneficiary Name*We need this information for the Accident Policy. First Last Beneficiary Relationship*Add another owner?YesNoOwner 2Owner Name First Last GenderMaleFemaleBeneficiary Name First Last Beneficiary RelationshipClass Code* WC Questionnaire Is applicant engaged in any other type of business?YesNoAny work performed on barges, vessels, docks, bridge over water?YesNoIs a written safety program in operation?YesNoAny group transportation provided?YesNoAny employees under 16 or over 60 years of age?YesNoAny seasonal employees?YesNoIs there any volunteer or donated labor?YesNoAny employees with physical handicaps?YesNoDo employees travel out of state?YesNoAre athletic teams sponsored?YesNoAre physicals required after offers of employment are made?YesNoAny prior coverage declined / cancelled / non-renewed in the last three (3) years?YesNoAre employee health plans provided?YesNoDo any employees perform work for other businesses or subsidiaries?YesNoDo you lease employees to or from other employers?YesNoAny tax liens or bankruptcy within the last five (5) years?YesNoAny undisputed and unpaid workers' compensation premium due from you or any commonly managed or owned enterprises?YesNoDo any employees predominantly work at home?YesNo General Liability Insurance Does your business perform any design, construction, installation, removal, or physical repair of any property or tangible good?YesNo<b>Choose your policy limits</b> <br>(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 Inland Marine InsuranceWhat's your estimated travel radius?*0-50 miles50-100 miles100-250 miles250-500 milesOver 500 milesSelect your desired deductible*The amount you have to pay out of pocket before your insurance company starts helping. $250$500$1,000$2,500$5,000 High-value item(s) <b>Would you like to cover any equipment or other high-value items on your policy? </b> <br> <i>(These items are typically at least $1000 each.)</i>*YesNoIf 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? Additional Items <b>Would you like to cover any additional items in transit?</b><br><i>(These are typically under $1000 each.)</i>* Papers and records (such as fine arts, papers and drawings) Equipment (computers, medical equipment, high-end cameras, supplies and tools) Software and electronic assets (accounting software, lead-tracking data, policies and procedures) Other valuables (work items that leave the business premises) Not really Added up together, these items are worth around… Business Property Insurance Primary Business Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State ZIP Code Do you own or rent this location?OwnRentWould you like coverage for this building?YesNoHow much building coverage would you like?Think of the total replacement value of the building.Business contents coverageThink 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. Business Property Insurance We need some details about the building.Year Built:*What’s the total square footage of the building?How much square footage does your business use?You can measure this, or take a look at your lease. If you work from your home, this would be the square footage of the space used in your home for your business.Number of Floors:How was the building framed?The 'framing' of a wall is the structure that is required for support. Sometimes called 'studs' or '2x4's. Residential buildings are usually constructed with wood framed walls.Block framed exterior wallsMetal framed exterior wallsWood framed exterior wallsI’m not sure right nowAre the exterior walls covered with a masonry veneer?A masonry veneer is a single layer of masonry material that does not provide any structural support. It’s usually decorative materials like brick, cement, stone, or stucco. Answer "yes" if masonry veneer covers more than 2/3 of your building.YesNoDoes the building have wood joists/rafters in the roof?Unless the building has a metal roof supported by metal studs, answer ‘yes’.YesNoI'm not sureDo you use any of these safeguards at this location? Sprinkler System Smoke Detectors Burglar Alarms Dead-bolt locks on exterior doors Safes for valuable items None of the above Add Another Location?YesNo Add location Secondary Business Location Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State ZIP Code
