Workers Compensation Insurance Quote Maryland

Upper Chesapeake Insurance
Agency of Baltimore, MD
offers affordable Commercial
Insurance coverage options
and experienced business
insurance services throughout
Maryland.

In addition to a Maryland
Workers Comp Insurance
quote, we also offer affordable
Group Health Insurance
quotes.

We are a Baltimore, MD full service insurance agency, offering
comprehensive Maryland workers compensation insurance quotes to
businesses located in the following neighborhoods, cities and counties:
Federal Hill, Locust Point, Canton, Fells Point, Bolton Hill, Butchers Hill,
Dundalk, Essex, Baltimore Highlands, Lansdowne, Middle River,
Rosedale, Arundel Village, Brooklyn Park, Kenwood, Eastpoint, North
Point, Chesaco Park, Rossville, Halethorpe, Elkridge, Linthicum, Glen
Burnie, Rippling Ridge, Garland, Ferndale, Woodlawn Heights, South
Gate, Severn, Catonsville, Shipley, Arbutus, West Edmondale, High Point,
Riviera Beach, Green Haven, Orchard Beach, Lipins Corner, Ellicott City,
Lochearn, Brighton, Woodmoor, Rockdale, Lynne Acres, Pikesville,
Randallstown, Owings Mills, Garrison, Towson, Mays Chapel, Overlea,
Parkville, Carney, Perry Hall, Elmwood, Edgemere, North Point Village,
Rodgers Forge, Ruxton, Linhigh, Fullerton, Putty Hill, Baynesville,
Lutherville-Timonium, Annapolis, Columbia, Hampton, Providence,
Montgomery County, Carroll County, Prince Georges County, Howard
County, Anne Arundel County, Harford County, and Baltimore County,
MD. We also offer Maryland workers compensation insurance quotes
throughout the Old Line State.

We provide affordable Workers Compensation

Insurance services throughout Maryland!

Maryland Workers Compensation
Insurance Quote

Business Name:
Premises Address:
City:
MARYLAND     Zip Code:
Contact Name:
Phone #:    Ext #:
Fax:    Years in Business:
Email Address: (Required)

About Your Maryland Business:

Federal Employer's ID #:
Description of Operations or SIC code:

# of full-time employees:     # of part-time employees:
# of locations:     Estimated Annual Payroll: $
Experience Mod (if any, per policy)

Select all that apply to your Maryland business:
Operate or lease aircraft/watercraft     Work Underground
Work above 15 feet                           Require out of state travel
Use Subcontractors                            Delivery Service
Pre-employment physicals                   Offer safety incentive programs
Store, treat, dispose, or transport hazardour waste
Work on vessels, docks, or bridges over water
Other

Recent Insurance Information:

Current Insurance Company:
Policy #: Expiration Date: (mm/dd/yyyy)
Losses past 3 years:
Description of losses or loss runs:

What types of coverages do you currently have:
Commercial Auto
Commercial Liability
Commercial Property
Workers Comp
Group Health
Group Life
Group Disability
Group Long Term Care
Other

Maryland Employee Information:

Employee       Classification Code       Yearly Payroll Estimate
      1                                         $
      2                                         $
      3                                         $
      4                                         $
      5                                         $

Officers / Partners / Owners Information:

Principal             Name                                          Title                    Include
      1
      2
      3

Additional Information or Comments

Click on the "Submit Quote Information" button below to send your
Maryland Workers Compensation Insurance quote request.**

**Information received from this Maryland Workers Compensation Insurance quote
request form sent to Upper Chesapeake Insurance Agency, will be for our use only
and will not be sold, given to or distributed to any other parties. A quote will be
based on the workers compensation insurance policy information provided
and does not guarantee acceptance of the risk by us. The precise
coverage afforded is subject to meeting underwriting guidelines, and the
terms, conditions and exclusions of the policy as issued. By submitting this
request you acknowledge that this is neither an offer to insure nor a
guarantee of insurance. Completion of this form does not entitle your
business to a Maryland Workers Compensation Insurance Policy. We are
licensed in Maryland and will not provide quotes for other states.

Maryland Business Information:

Upper Chesapeake

Insurance Agency, Inc.

900 South Charles Street

Baltimore, Maryland 21230

Baltimore County, MD

(410) 385-0455

Fax: (410) 385-3098

Upper Chesapeake Insurance Agency, Inc.

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