Workers' Compensation Insurance Quote We would like to provide you with a free, no-obligation workers' compensation insurance quote. Please provide as much information possible for the most accurate quote. This information will be kept confidential and will be used for quote purposes only. General Information Name of Business: Contact Name: Address: City:   State:   Zip: Business Status: Individual Corporation Partnership Joint Venture     Other: Business Tax ID Number: Business Phone:   Fax: Best Time To Call:   AM   PM Contact Email Address: Current Insurance Information Company Name (not agency): Policy Expiration Date:   Premium Amount: $ NCCI Number: NCCI Experience Modification #: What type of coverages do you currently have: Bond Commercial Auto Commercial Liability Commercial Property Commercial Umbrella Directors & Officers Liability Disability Group Health Group Life Professional Liability Other   About Your Business # of full-time employees # of part-time employees How long in business How many locations Estimated Annual Payroll years $ Please give a brief description of your business(below): Employee Information Employee# Classification code Estimate Yearly Payroll 1 2 3 4 5 Please list additional employees in the "Additional Comments" section below Business Information Please select all that apply to Business: Operate or Lease aircrafts/watercrafts Store, treat, dispose or transport      hazardous waste Work Underground Work above 15ft. Work on vessels, docks or bridges      over water Require out of State travel Use Subcontractors Delivery Service Pre-employment Physicals Offer Safety and Incentive programs Other   Additional Comments Please give any additional comments you feel appropriate for this quotation. If you have additional information where there was not enough space, please enter them here. Please click on the "Submit Quote" button to send your quote request. One of our representatives will respond to your submission as soon as possible.     This Workers' Compensation Quote Form Copyright © 1999 - by ENHANCED Web Services   Our Companies   |   Workers' Comp   |   Saftey & Loss Control Personal Insurance   |   Equine/AgriBusiness   |   Contact Us   |   Return Home

138 E Huntington Drive Arcadia, CA 91006 Email: info@morningstarinsure.com

Phone:  Toll Free:  Fax:

626-294-2323 888-700-7123 626-294-2324

CA License #: OC04856

Important Note: This website provides only a simplified description of coverages and is not a statement of contract. Coverage may not apply in all states. For complete details of coverages, conditions, limits and losses not covered, be sure to read the policy, including all endorsements.