Tell us your legal company name unless you are a sole proprietor, then your first and last name will replace your business legal name. No PO Box numbers please. Speed tip: If you enter your street address and zip code, we will populate the rest!
When you look at the division of corporations, this would be the year from “the event date filed or event effective date”
Each workers comp class code will give you the ability to add any included owners, W2 employees and 1099 workers that do not have their own WC policies and need to be covered. Keep in mind that in order to be covered under the policy, all employees will need to be paid as W2.
Select yes or no on if you have had workers comp coverage under this entity currently or in the past
For "Above ground", if you are working in the interior it does not count, please select only if your workers are 15 feet or above on exterior.
Name | |
Phone |
Business Name | |
Business Add. |
Business Ownership Structure |
Founded in Year |
Employees | |
Owner Included |
Work | |
Weekly Payroll |
Workers Comp | |
Accident Last Year | |
Active Comp | |
Policy Revoked | |
Claims & Accidents | |
Claims Cost |