1. What are the Renewal and Target Premiums?
2. What other Worker's Compensation policy options is the insured considering: (providing other quotes
may help us achieve the target)?
3. Would the insured consider an alternative market for coverage provided it was competitive and
beneficial to their business?
4. What PEO and/or traditional markets has this risk been submitted to?
5. How does the insured currently process payroll?(In house ,ADP,Paychex,etc.)
5a. Are there any employees using Tax Id#'s as opposed to SS#'s
5b. Are any employees 1099's?
6. Are any of the employees union members?
If yes, which union?
7. Do you control this account or is it a prospect?
8. Reason for quote?(Non-renewed,shopping,mid-term change lapse in coverage etc.)
9. Is there a deadline for the quote to be received?Is there or will there be a lapse in coverage as
of a certain date?What is that date?
10. Please list any other important criteria /considerations here.
11. Please attach the following:
Please check to be sure 130 has employee count by class code and loss runs are dated within 60 days.
28 Village Road North, 3R
Brooklyn, NY 11223
Phone: (212) 390-8772
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