Information Needed for a Quote

If your company currently uses an Employee Leasing Company/PEO:

1. A copy of your most recent payroll billing report, showing Workers’ Comp codes or Job Titles.

2. A Loss Run report of Workers' Comp claims for no less than last 3 years, inclusive, or loss affidavit.

3. A 1-2 Paragraph description of your company (on company letterhead) that tells how long you have been in business, type of work done, Federal ID number, and any pertinent safety information.


If Not currently using an Employee Leasing Company/PEO:

1. A Copy of your current Workers’ Compensation Policy’s Declarations page.

2. A Copy of your most recent Quarterly State Unemployment Tax form. (UCT-6)

3. A Payroll breakdown by Workers’ Comp code or Job Title with gross payroll amounts for each.

4. A Loss Run report of Workers' Comp claims for no less than last 3 years, inclusive, or loss affidavit.

5. A 1-2 Paragraph description of your company (on company letterhead) that tells how long you have been in business, type of work done, Federal ID number, and any pertinent safety information

If you are a brand new company or have never had Workers’ Comp Insurance, Contact us at

(866) 392-5501