Workers Compensation
ROOFERS, DEBRIS REMOVAL, TREE - TRIMMERS ARE WELCOME, WE CAN OFFER COVERAGE FOR VIRTUALLY EVERY OCCUPATION
Directions to Pensacola Office, Div. of Workers Comp
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Rules and Forms
- Contains Notice of Exemption
Latest Legislative Updates
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Request a quote only - it is not an offer of coverage.
Business Name
*
Contact Person
*
Email Address:
Address:
City/State
*
Zip Code:
Type of Business
Sole Proprietor
C Corporation
S Corporation
Partnership
Other
Chamber of Commerce Member?
No
Pensacola
Gulf Breeze
Description of Business
*
Owners/Officers/Partners Exempt?
Yes
No
Date Business Started
*
Currently Covered?
Yes
No
Current Policy Expiration Date
Ever been cancelled or non-renewed in the last three years?
Yes
No
Current Carrier
Requested Effective Date
*
Any Losses in the last 3 years
Yes
No
If so total amount of losses
Do you have copies of last 3 years loss runs?
Yes
No
Number of Employees
*
Annual Payroll for Classification #1
*
Number of employees Classification #1
Job Description Classification #1
Annual Payroll for Classification #2
Number of employees for Classification #2
Job Description Classification #2
Annual Payroll for Classification #3
Number of employees for Classification #3
Job Descripton Classification #3
Comments:
Security code:
*
*
indicates a required field
Workers Comp Info
Find out the latest information regarding Workers Compensation.
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YOUR "ONE SOURCE SOLUTION" FOR ALL YOUR BUSINESS NEEDS
Kite Insurance Agency LLC
15 Memory Lane
Pensacola, FL 32503
Phone: 850-857-4800 - FAX: 850-478-9878
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