Products: OREGON WORKERS COMPENSATION APPLICATION
We write Oregon workers compensation coverage through a number of companies. We are representatives of SAIF, the primary workers company in Oregon, and we use them as our first option.
If your business has employees, you are required by law to have this coverage, with very few exceptions.
Below are the questions that are usually asked in applying for this coverage. You may print this information and fax it to us at 503-620-7856. Or you may call us for a quote at 503-620-0230. We do not currently accept these applications over the internet. For additional contact information, click here.
PLEASE NOTE: No coverage is bound until you receive verification from us confirming it.
Information we will need:
Date you want coverage to begin
Applicant Name
Contact Person
Mailing Address
City
State
Zip Code
Phone #
Best time to call you
Fax #
Email address
Location address if different from above
City
State
Zip Code
Are there any other location addresses?
If so, what address?
Name of your business (exactly as you want it to appear)
Date business began
Is business a Sole proprietor / Partnership / Corporation / LLC / Other
Federal Employer ID # or SS #
Name and share % of each owner
Brief description of business (What specific types of jobs does your business do?)
If you are a contractor, what is your Oregon registration #?
What percentage of your work is residential? Commercial?
Class or job description of employees
Number of employees
Estimated annual payroll
Is there more than one class of employees?
If yes, provide description, number of employees, payroll
If you have had prior workers compensation coverage:
Name of insurance company
Date coverage began with this company
Annual renewal date
What is the current experience modification, if any
If coverage cancelled or non-renewed, why?
We need details of:
- How much experience you have had in managing employees
- Any claims you have had
- Any work your employees would do outside the state of Oregon
- The main hazards of the business
- What procedures your business uses to enhance employee safety
- What controls are in place to protect employees from injury.
|
