Workers Comp Quote
Type of Business?(Individual/DBA, Partnership, Corporation, Other)
Total Number of Employees? (Full time/ Part time)
Total approximate annual employee payroll?
Workers Comp claims in the past 3 yrs?
List officers/owners of the company and the % owned (100%, 50% etc), along with their title (Pres, Treasurer, Owner). Anyone under 15% ownership cannot be excluded.
Would you like to exclude all officers/owners from coverage? (This saves you money but forces them to use their own health coverage for any injuries on the job).
Please list all employee classifications in your work: (cashier, sales, admin etc) / QTY part time & full time / Total payroll for that category.
Example: Cashiers / 2 part time / 1 full time / $38,000 payroll /
Any Questions or Comments?
Doctor & Doctor Insurance Agency
10216 Reseda Blvd, Northridge, CA 91324
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