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Workers Compensation &
Employers Liability Proposal
 
Proposal Especially Prepared for - Client -  First Name and Last Name
Date of Proposal - 3/22/2007
 

Employers liability Coverage

Bodily Injury By accident $100,000/Each accident
  Bodily Injury By Disease $100,000/Each Employee
  Bodily Injury By Disease $500,000/Policy Limit
Bodily Injury By accident $500,000/Each accident
  Bodily Injury By Disease $500,000/Each Employee
  Bodily Injury By Disease $500,000/Policy Limit
 
Class / Area of Operations Class Code Estimated Annual Payroll Rate Per $100 Estimated Premium
 
Risk Modification Factor
Coverage Factor
Expense Constant
Approximate annual Rate
 
“Thanks for Your Consideration, Let us know if You have any questions or Would Like to Start Your Coverage.”
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www.IndianaContractorsInsurance.com

The Above Proposal is a brief outline of a  General Liability Policy.  This is a Proposal & not proof of Coverage.  Final Rate and Acceptance is subject to Company Approval. Underwriting process can include but not limited to a credit check, telephone verification & proof of prior coverage & prior loss information (if previously insured) 

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