If Currently with an Outsourced Provider:

✔ Applicable questionnaires, completed and signed: Benefits, EPLI, WC 

✔ 2020 Unemployment Tax Rate and/or Q4 2019 Quarterly Return

✔ Workers Compensation 

• • Copy of Declaration Page, with class codes & rates
  • Loss History Report, for years 2016 thru 2019
  • Premium Due Report- including hours, class codes and payroll per employee

✔ Employment Practices Liability Declaration Page, if available

✔ Most recent pay period’s 

• • Payroll Register/Journal – gross to net breakdown, per employee
  • Service Fee invoice

If currently offering employee benefits:

✔ Most Recent Carrier Invoice(s)

✔ Summary of Benefits – each plan offered

✔ Employee Census – template attached

✔ Copy of carrier Renewal Notice with Rates by tier (if within 60 days of renewal)