Trucking Worker's Comp Quotes - Charles String Insurance

Do you currently have Worker's Comp?(Required)

Yes

No

What is the name of the insurance company who writes your current Worker's Comp policy?(Required)

Current Cost of Worker's Comp Policy?

Desired Policy Effective Date(Required)

When would you like this policy to be effective?

Owner's Name(Required)

First Last

Phone(Required)

Email(Required)

Company Name(Required)

DBA Name

If applicable

Entity Type(Required)

DOT Number(Required)

Company Address(Required)

Street Address Address Line 2 City State ZIP Code

EIN(Required)

Year business was established?(Required)

Do you want to include owners?(Required)

Owners can be excluded. If you include owners, it will cost more.

Yes

No

# of Full Time Employees(Required)

W-2 Employees only

# of Part Time Employees(Required)

W-2 Employees only

Estimated Gross Revenue(Required)

This can be a conservative estimate.

Owner(s) Annual Payroll(Required)

Your company's total payroll for all owners. It's best to be conservative to start. We can increase payroll if needed during policy period.

Employee Annual Payroll(Required)

Your company's total payroll for W-2 Employees only, NOT including any owners. It's best to be conservative to start. We can increase payroll if needed during policy period.

Contractor Annual Payroll

Enter $0 if you do not hire subcontractors

What is the furthest any of your vehicles travel in any one direction from their home base?(Required)

Are there any drivers that drive trucks you own or lease but pay via 1099?(Required)

Yes

No

In the past 3 years how many Workers' Compensation claims were reported?(Required)

Do any owner operators or sub-haulers transport goods on your behalf?(Required)

Yes

No

Do you review MVRs for all employees with a driving exposure?(Required)

Do you currently have a Workers' Compensation insurance policy in effect?(Required)

Yes

No

When was your last policy in effect?(Required)

In the past 3 years how many Workers' Compensation claims were reported?(Required)

Do you review MVRs for all employees with a driving exposure?(Required)

Employers' Liability Limits: $1m / $1m / $1m

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