1-800-329-8084 At Cairnes-Tapley Insurance Agency, we meet ALL the insurance needs of MARYLAND Contractors.

Let Cairnes Tapley Insurance Agency, The MARYLAND Contractors Insurance
Connection, provide you with a competitive express quote within 24-hours.

FINALLY,
THERE IS A SENSIBLE WAY FOR CONTRACTORS TO GET THEIR WORKER'S COMP INSURANCE QUOTED!

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Worker's Compensation
24-Hour Request-A-Quote Form

Full Name:

Your Email:

Business Name

Phone Number

Fax Number

Mailing Address

Enter the number of claims reported during the past 12 months:

If you have state-assigned Experience Modification,
enter here:

Organization

Corporation

Partnership

Individual

Sub-Chapter 'S'

Other

Select a Code OR Class that applies to you from the drop-down lists below. Select up to six applicable codes and enter the payroll for each class in the yellow box to the right. Thank you.

1. OR

2. OR

3. OR

4. OR

5. OR

6. OR

Do you currently have workers general liability insurance? If yes, please give the name of your company.

Yes No

Have there been any Maryland OSHA citations?

Has there been any lapse in coverage for over 30-days in the past 12 months?

Does owner/manager have less than 3-year experience in this trade?

Any Bankruptcy Filings (Ch.7, 11)?

Will the perspective employees have less than 1-year of average experience in this trade?

Any work performed 15-feet or more above or below the ground?

Any work sublet without certificates of insurance?

Any work performed outside of Maryland?

Are there any employee-leasing, PEO, or labor interchange exposures of any kind?

Is any work performed on roofs or does any work require the use of pressurized combustible gases?

Do you sub-contract over 50% of gross receipts?

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This is not a binding contract of insurance.
The above obtained information is for the purpose of a Quick Quote
and is subject to the accuracy of the information provided.