ARM-Capacity Workers Compensation Quote

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Workers Compensation, Business Owners General Liability, Professional Liability, Errors and Ommissions Insurance and more!

Insurance options that fit businesses in every stage of growth - from the emerging company to the publicly traded multinational.

Workers Compensation Insurance
Under Workers' Compensation laws, benefits must be paid for on-the-job injuries, regardless of negligences on anyone's part. This means that even if the employee is injured though his/her own negligence, he/she is entitled to benefits, and cannot sue an employer that maintains required coverage.

Part One of the policy covers the employer’s statutory liabilities under workers compensation laws.

Part Two (Employers Liability Insurance) of the policy covers liability arising out of employees’ work-related injuries that do not fall under the workers compensation statute and pays on behalf of the insured (employer) all sums that the insured shall become legally obligated to pay as damages because of bodily injury by accident or disease sustained by any employee of the insured arising out of and in the course of his employment by the insured

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ARM-Capacity Technology Client Representative Call:

888.ARMofNY (888-276-6369)
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Workers Compensation Insurance

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Complete the following information to obtain an Insurance Quote.

GENERAL BUSINESS INFORMATION

Name of Corp./Business

Business Structure
(Check One) INC CORP LLC
SOLE PROPRIETOR
PARTNERSHIP
OTHER

Federal Tax ID

DBA (if applicable)

Business Address

City

State

Zip Code

Business Web site Address

EXPERIENCE & BASIC RATING INFORMATION

Please Describe the
Nature of Your Business

NCCI Exp. Mod Factor (if available)

# of Owners

# of Employees

# of Years This Business Name

Annual Payroll Owners

Annual Payroll Employeesers

COVERAGE REQUEST

Coverage Requested

Other Coverage Limits

Include Owners in Coverage? YES No

Losses-Claims in the Last 5 Years? YES No

If Losses and/or Claims
List - Date, Amount Paid and
Description of Each Loss

CURRENT COVERAGE INFORMATION

Current Insurance Carrier

Current Expiration Date

Current Premium

CONTACT INFORMATION

First Name:

Last Name:

*Email:

Phone: Fax:

Questions/Comments

When Do You Need Quote?

How Did You Hear About Us?

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Thank you for completing this form

ARM-Capacity's Policy on sharing information:

This application will be treated as confidential;
We will only use information provided to assist in obtaining non-binding indications of business insurance coverage;
We will not distribute information to other parties other than for insurance underwriting purposes.

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FAX: 212.937.3923

or Call:
888.ARMofNY - 888.276.6369