Easy Payroll Set-Up

Affordable "One-Time" Client Work Comp Deposits

Less Than 72 Hour Quote Process

Competitive Rates With Great Carrier

Automatic Renewal Process

Simple Monthly Premium Reporting

Contact Justin Bartmess for Quotes

Phone:  888.611.SHOP (7467) ext:  12

Fax:  888.583.3110

Our E-mail:  submissions@insuranceshopllc.com

Helpful Documents

• Payroll Comp Lead Referral Form- Fillable

• Cert Request Form (Word Doc)- Fillable

• Cert Request Form (PDF Doc)- Fillable

New Companies- Required information

• Acord 130 Application - (Form Fillable)

• Work Comp Loss Affidavit - (Form Fillable)

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• Owner Resume may be required

Existing companies- Required Information

• Acord 130 Application - (Form Fillable)

• Last 3 years loss runs from current carrier

• Current experience mod (if applicable)

• Copy of current Policy Declaration (if applicable)

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• A Work Comp Affidavit - (Form Fillable)  *acceptable for some risks in lieu of Loss Runs