Online Quote

This online quote form is designed to provide you with an initial estimate of what you might expect to pay, should you wish to obtain Workers’ Compensation coverage through the Kentucky AGC Self Insurers’ Fund. It is not binding, only an actual quote issued by a Kentucky AGC SIF Underwriter is valid for policy issuance. Please note that minimum premium for Fund membership is $1000.00.

Name(Required)

First Last

Email Address(Required)

General Information

Calendar Year in which you wish to receive an estimate

Rates & Premiums

Classification	Payroll	Premium	Actions

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Minimum premium is $1,000.

Premium Estimates

Total Manual Premium

Experience Modifier (EMOD)

If you are unsure of your experience modification factor, leave as 1.0.

Experience Modification

Total Standard Premium

Estimated Discount Factor

Total Standard Premium With Discount Applied*

Standard Surcharge

Subtotal

KY Assessment Tax Rate

Estimated Annual Premium

* Discounts are automatically applied based on premium size. Contact [email protected] with questions.

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