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Worker’s Comp Quotes

Worker's Comp Quote Form

Worker’s Comp QuotesDaniel Summers2022-04-11T08:02:43-04:00

Step 1 of 5

20%

Do you currently have Worker's Comp?(Required)

Yes

No

What is the name of the insurance company who writes your current Worker's Comp policy?(Required)

Current Cost of Worker's Comp Policy?

Owner's Name(Required)

First Last

Phone(Required)

Email(Required)

Company Name(Required)

DBA Name

If applicable

Entity Type(Required)

DOT Number(Required)

Company Address(Required)

Street Address Address Line 2 City State ZIP Code

EIN(Required)

Year business was established?(Required)

Worker Classification: Not including yourself, do you currently pay any employees or contractors?(Required)

Neither

Employee(s) reported via W-2

Contractor(s) reported via 1099

Both

Will you hire any employees or contractors over the next 12 months?(Required)

Yes

No

Maybe

Do you want to include owners?(Required)

Owners can be excluded. If you include owners, it will cost more.

Yes

No

# of Full Time Employees(Required)

W-2 Employees only

# of Part Time Employees(Required)

W-2 Employees only

Estimated Annual Gross Revenue(Required)

This can be a conservative estimate.

Owner(s) Annual Payroll(Required)

Your company's total payroll for all owners. It's best to be conservative to start. We can increase payroll if needed during policy period.

Employee Annual Payroll(Required)

Your company's total payroll for W-2 Employees only, NOT including any owners. It's best to be conservative to start. We can increase payroll if needed during policy period.

Contractor Annual Payroll(Required)

What is the furthest any of your vehicles travel in any one direction from their home base?(Required)

Do any of your contractors drive company owned vehicles?(Required)

Yes

No

Do any owner operators or sub-haulers transport goods on your behalf?(Required)

Yes

No

Do you order and review MVRs for all drivers?(Required)

This is a compliance requirement with the FMCSA/DOT so you should be!

When was your last policy in effect?(Required)

In the past 3 years how many Workers' Compensation claims were reported?(Required)

Do you transport any hazardous materials?(Required)

Yes

No

Do any loads require manual tarping?(Required)

Yes

No

Do you or your drivers do any manual loading/unloading of materials?(Required)

Yes

No

Do you or your drivers use chains to secure equipment, logs, or other large loads for transport?(Required)

Yes

No

Do the business owner(s) of this business have a combined majority ownership in any other transportation business?(Required)

Yes

No

Do you have multiple locations in more than one state?(Required)

Yes

No

Comments

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Employers' Liability Limits: $1m / $1m / $1m

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