1 1 Policy Options

2 2 Application Form

3 3 Additional Insureds

4 4 Payment, Review & Submit

Sorry, we don't have availability to purchase it online, but we are working on it! In the meantime, please submit quote for underwriting and we’ll reach out with any remaining questions!

Policy start date

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Policy end date

This policy will go into force on the start date and stay in force for 12 months.

Payments for this policy will stay in effect until cancelled.

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Please enter valid email address

Confirm Email

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Please enter valid email address

Email address should match

Password

An account with this email address already exists. Click here to go to login page.

Password

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Invalid password

Password must be at least 8 characters long and should contain at least one capital character, one lowercase character and one number.

Confirm Password

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Password should match

Physical Address

First name

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Name can be between 2 and 70 characters long and can contain letters, hyphens, commas, dots, apostrophes and spaces

Last name

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Name can be between 2 and 70 characters long and can contain letters, hyphens, commas, dots, apostrophes and spaces

Street address

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WE CANNOT ACCEPT A PO BOX AS A PHYSICAL ADDRESS. KINDLY ENTER A PHYSICAL ADDRESS FOR YOUR BUSINESS.

Address line 2

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City

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State

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Please click here to be directed to an application that is specifically for those whose business is in .

This state is not available for this program.

Due to the current natural disaster in your area, we are unable to provide all Inland Marine options associated with this program at this time. All Inland Marine options will be available soon.

Note: If you are trying to add a policy from your customer dashboard and your current policy is expired, please change your State selection above, and then change it back to your correct state. This will allow you to continue to step two. We apologize for any inconvenience this has caused. (i.e., North Carolina > Texas > North Carolina)

Zip code

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Invalid physical ZIP code

Mailing Address is the Same as the Physical Address

Mailing address

Street address

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WE CANNOT ACCEPT A PO BOX AS A PHYSICAL ADDRESS. KINDLY ENTER A PHYSICAL ADDRESS FOR YOUR BUSINESS.

Address line 2

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City

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State

This field is required

Please click here to be directed to an application that is specifically for those whose business is in .

This state is not available for this program.

Due to the current natural disaster in your area, we are unable to provide all Inland Marine options associated with this program at this time. All Inland Marine options will be available soon.

Zip code

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Invalid ZIP code

Business information

Business type

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Business Name

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Business name - Only letters (A-Z), numbers (0-9), & (ampersand), and - (hyphen) are allowed.

Please provide your full name under mailing address.

A business you own and operate, not a business that employs you.

DBA

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Fein number

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Incorrect number format

Mobile number

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Invalid phone

Website

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Limits of Insurance

Each Employee	$1,000,000
Disease Aggregate	$1,000,000
Disease Each Employee	$1,000,000

When you add a person^†, event, or organization to your policy as an additional insured, they receive protection if they are named in a suit due to a covered business-related loss/claim because of your actions or operations.

† Additional insured status cannot be granted to a friend or co-worker as an extension of your policy. Each individual must purchase their own policy to obtain liability coverage.

† A written contract, such as a venue, studio rental, or employment contract is required to add another party as additional insured.

Payment information

Initial payment:

Switch to annual

Pay

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Credit Card

[selected]

Credit card information

Payment profile

Use different credit card

Card number

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Invalid credit card number

Please enter your credit card and bank information. Your credit card will be used for the down payment and your bank information will be used for the Capital Premium finance agreement monthly draft. If you have questions about alternative payment methods for the capital monthly draft please contact Capital Premium.

Expiration month

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Expiration year

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CVV

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Invalid cvv

Billing zip code

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Invalid ZIP code

Use this card later

This feature will create a customer payment profile for your billing information to allow easy checkout during future policy coverage extensions or updates. Credit card information is not stored within our system. All billing information is processed through authorize.net

EZ-Renew

With this beneficial feature your insurance coverage will be continuous without you worrying about having a lapse in your insurance policy.

You will receive a Conditional Renewal Notice prior to the renewal date of your policy. If you wish to cancel your policy, you must notify us in writing prior to the policy renewal date. You can cancel EZ-Renew at any time from your dashboard. Your policy will be renewed with the same coverage's, additional insureds and endorsements as your current policy. If you wish to change any coverages, you can login to your on-line account and make changes to your policy at any time.

Please note that we do NOT store credit/debit card numbers, nor do we share customer details with any third parties. Recurring billing is managed via Authorize.net.

Order summary

Policy Holder Edit

, ,

Email:

Mobile number:

Mailing Address is the Same as the Physical Address

Mailing Address:

, ,

Payment Information Edit

Payment Method:

Workers Compensation Cleaning and Janitorial (configuration in progress)

Payment Breakdown

Policy start date: - Policy end date: Edit

If changes are needed, please reach out to your agent.

Edit

Limits of Insurance

Each Employee	$1,000,000
Disease Aggregate	$1,000,000
Disease Each Employee	$1,000,000

Policy Holder Business Information

Edit

Business Type
name
DBA
Mobile number
Website
Business Activities
Business Activities Description
Product Description

Owner Information

Edit

Owner's Full Name

Owner's Title

Are There Any Additional Owners?

Add. Owner's Full Name

Add. Owner's Title

Add. Owner's Full Name (2)

Add. Owner's Title (2)

Add. Owner's Full Name (3)

Add. Owner's Title (3)

Total Annual Owner's Payroll

Owner payroll amount will be adjusted subject to state minimum/maximums where applicable.

Do You Want to Include the Owner(s) in This Coverage?

Based on your selection, a state-specific owner inclusion/exclusion form will be completed for you regarding your response. To see this from, check you dashboard after purchasing.

General Eligibility

Edit

Which of These Business Activities Best Describes You?

Total Number of Employees

Total Annual Employee Payroll

Do You Have Any Seasonal Employees?

How Many Years Have You Been in Business?

What Is Your Employee Turnover Rate Each Year?

How Often Does the Business Clean Employee Work Areas?

Does the Business Have a Formal Written Safety Program?

Does the Business Offer Group Employee Health Insurance?

Does the Business Offer a Formal Orientation or Training Program?

Do You Sponsor Any Athletic Teams?

Do Any Employees Perform Work for Other Businesses or Subsidiaries?

Does the Applicant Own, Operate, or Lease Aircraft/Watercraft?

Are There Any Other Entities That You Own or Manage That Still Owe Undisputed Work Comp Premium to Anyone?

Any Tax Liens or Bankruptcy Within the Last Five (5) Years?

Any Work Performed on Barges?

Do You Lease Employees to or From Other Employers?

Is the Applicant Engaged in Any Other Type of Business?

Is There Any Volunteer or Donated Labor?

What Percentage of the Work Is Subcontracted?

Tell us a little more about your business

Edit

Does the business do window, power washing or other exterior work off the ground?

Does the business perform any disaster recovery, mold remediation, fire or water restoration, hazardous or biohazard materials, or construction clean-up?

Does the business perform any landscaping or maintenance on public highways?

Does the business plant trees over 20ft tall?

Does the business engage in installation of pools or ponds?

Does the business do any tree trimming or removal requiring work above ground level?

Insurance Information

Edit

Who Is Your Current Insurance Carrier?

Any Work Subcontracted to Others Without Certificates of Insurance?

How Long Have You Had Workers Comp Coverage?

Any Prior Coverage Declined, Canceled, or Non-Renewed in the Last Three (3) Years?

Prior Insurance

Claims History

Edit

How Many Losses Have You Had in the Past 4 Years?

If You Have Had a Loss in the Past 4 Years, Was Any Single Loss More Than $50,000?

Additional Insureds

Edit

Unlimited Additional Insureds

Additional Insureds

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Employees

Edit

{[{ employee.firstName }]} {[{ employee.lastName }]}

Independent Contractors

Edit

{[{ contractor.firstName }]} {[{ contractor.lastName }]}

Your policy will be issued and your documents available immediately after clicking the "Purchase Policy" button below. Your policy application may be subject to review by our underwriting team to verify that the business operation, product, and/or service meet the eligibility guidelines established for the program. In the event we need further clarification to determine eligibility, we will contact you via email at the email address used to establish your account. If an account is found to be ineligible during the underwriting period, the policy will be subject to immediate cancellation and a full refund will be issued. After the underwriting period, the premium is 100% earned and no refunds will be given.

Your agent will be contacting you soon. There is a pending document to be submitted.

Coupon

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Discount applies to Additional Insureds only!

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An account with this email address already exists. Please login or change email address.

Based on your previous answers, it appears your business situation is unique and deserves a more personal touch. Please complete the application and one of our licensed sales agents will contact you within 48 hours to complete your quote.

Please click here to be directed to an application that is specifically for those whose business is in .

This state is not available for this program.

Annual

Order total

Workers Compensation Cleaning and Janitorial (configuration in progress)

Policy Endorsements

Additional insureds

Unlimited

Cancel unlimited AIs

Coverage for Employees

Coverage for Independent Contractors

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monthly

^{DUE TODAY:} ^{(downpayment)}

Physical Address

Mailing address

Business information

Limits of Insurance

Owner Information

General Eligibility

Tell us a little more about your business

Insurance Information

Claims History

Payment information

Initial payment:

Pay

Credit card information

EZ-Renew

Order summary

Policy Holder Edit

Payment Information Edit

Workers Compensation Cleaning and Janitorial (configuration in progress)

Limits of Insurance

Policy Holder Business Information

Owner Information

General Eligibility

Tell us a little more about your business

Insurance Information

Claims History

Additional Insureds

Employees

Independent Contractors

Order total

Policy Endorsements

Additional insureds

Coverage for Employees

Coverage for Independent Contractors

Sign Here